Tuesday, 18 April 2017

Beyond weight Loss - Inflammation

I thank Dr Stephen Phinney for the key information in this post.

Dr Stephen Phinney

Background on Inflammation

In the past GP's have been trained to think only of acute inflammation: redness, pain and heat; signs of distress in the body, and the effort the body is making to repair cellular damage. So they were taught to treat the symptoms of inflammation; for instance putting ice on a sprain, and football players taking to cold pools after the match. It turns out that both these practices delay healing, which is the purpose of inflammation. Even with something this basic, our understanding of how to treat traumatic injury, or fever has been wrong for a long time.

The presence of low-grade chronic inflammation in the body wasn't recognised in science before 1992. Dr W.D. Kannel of Harvard, reviewing data from the Framingham Heart Study, noted that high cholesterol only identified about 50% of those who had heart attacks. Looking for another risk factor he noted that an elevated white blood cell count, but still within the normal range, was apparently a good marker of heart disease risk. Why that might be so, was not understood.

The Women's Health Initiative, the study terminated in 1998, produced the data that confirmed Kannel's observation. Type two diabetes, is characterised by system-wide inflammation. The population of the study was divided into quartile's on the basis if type two diabetes risk. Then the inflammation data for each group was evaluated. There were two measurements of inflammation, C-Reactive Protein, and Interleukin-6.

Comparing the mean inflammation of the lowest risk quartile with the highest risk quartile, they found this result. C-Reactive Protein was 15.7 times higher, and Interleukin-6 was 7.5 times higher in the high risk quartile.

In 2005 Karen Margolis reported from the WHI data, that "The white blood cell count, is a stable, well-standardized, widely available and inexpensive measure of systemic inflammation, and is an independent predictor of CVD events and all-cause mortality in postmenopausal women."

In 2007 Margolis reported that "Postmenopausal women with higher WBC counts have a higher risk of incident invasive breast, colorectal, endometrial, and lung cancer, as well as a higher risk of breast, lung, and overall cancer mortality."

Measuring Inflammation in the Body

There are many possible measures of low grade inflammation, at least 20.

The must commonly used are the following six
Total white blood cell count
Absolute granulocyte count
C-reactive protein
Interleukin-6
Fibrinogen
Serum amyloid A

Dr Phinney says; "The only tool in my list of medications for reducing inflammation, is one of the newer statins. The best solution for this problem is to find ways to reduce or avoid the creation of inflammation in the first place."

Fighting Inflammation with Nutrition

The following foods reduce inflammation: Fruits and vegetables, especially the colourful ones with flavanoids. Omega 3 oils, like fish oil. Moderate use of alcohol. If you want an anti-inflammatory supplement use gamma-topopherol

The following foods are inflammatory. Omega-6 fats are essential, but our diet is flooded with them, and in excess they are highly inflammatory. Iron in excess too, and Dr Phinney thinks Iron is over prescribed, when the real problem is carbohydrate intolerance. Trans-fats, are highly inflammatory, but in NZ there is no requirement to label products containing trans-fats, and no ban on their use (The argument is made that they are rarely used in NZ food products). Sugar, but particularly fructose is inflammatory. Alpha-topopherol is sold as an anti-inflammatory, but in the body it blocks gamma-topopherol, the bodies natural inflammatory defence, defeating our objective.

So Phinney recommends eating fish three times a week, using gamma-topopherol (Sometimes sold as Gamma-E), drinking wine in moderation, eating lots of fat or olive oil, and eating a very low carbohydrate diet.

Evidence Supporting LCHF Diets to Reduce Inflammation

Cassandra Forscythe
Cassandra Forsythe, Women's Fitness
Cassandra Forsythe, in research for her PhD, looked at low-fat v low-carbohydrate diets, and the inflammation they produced. Cassandra was working with Dr Jeff Volek in the Department of Kineseology at the University of Connecticut. Both Stephen Phinney and Richard Feinman were part of her advisory team.

Inflammation is clearly recognised as a prominent feature of many chronic common medical problems. Heavy intake of carbohydrate at any meal, induces an increase in reactive oxygen species, and activates pro-inflammatory pathways.

Comparison of Low Fat and Low Carbohydrate Diets on Circulating Fatty Acid Composition and Markers of Inflammation:
Forty overweight men and women were enrolled. Qualifications; aged 18 to 55; BMI >25; total triglyceride's elevated; and low HDL-C. People using glucose lowering, blood pressure lowering, or lipid lowering medications were excluded. Two groups were formed balanced for gender, age and BMI. One group was assigned a low-fat diet. The other group a very-low-carbohydrate ketogenic diet.

The study was for 12 weeks. No advice to reduce calories was offered to either group. All participants were given individual counseling and a personalised diet, by a registered dietitian. This was reinforced each week when each participant came to a weigh-in. Further education and advice was offered as required. Detailed 7 day food diaries were maintained for weeks one, six and twelve.

Reducing the amount of carbohydrate in the diet led to "considerably greater reductions in a number of pro-inflammatory cytokines, chemokines (both signalling protein molecules indicating cell damage) and adhesion molecules.

While weight loss may help reduce inflammation, the greatest reductions of inflammation were achieved by those who best restricted carbohydrate intake regardless of weight loss. The very-low-carbohydrate diet had strong advantage in blood lipid normalisation, blood glucose control and in reducing the demand for insulin.

A striking result of the VLC Ketogenic Diet was an increase in arachidonic acid, which appears to be beneficial. Several pro-inflammatory markers were reduced including; TNF-α, IL-6, IL-8, MCP-1, E-selectin, I-CAM, and PAI-1 that were related to the increase in arachidonic acid.

The abstract to the paper, "Comparison of Low Fat and Low Carbohydrate Diets on Circulating Fatty Acid Composition and Markers of Inflammation," is available (PDF). Today, she works as a nutrition educator and weight loss coach and is the author of two popular books for women: “The New Rules of Lifting for Women”, co-authored with Lou Schuler and Alwyn Cosgrove, and “Women's Health Perfect Body Diet”.

John Stephen Veitch
The Network Ambassador
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