Most people associate inflammation with tennis elbow or some other injury. But many health experts are saying that chronic inflammation is actually the cause of many of today's common illnesses, from arthritis to heart disease. Anna Soref, The Natural Foods Merchandiser's health and beauty editor, recently spoke with Jack Challem, The Nutrition Reporter, about his new book, The Inflammation Syndrome: The Complete Nutritional Program to Prevent and Reverse Heart Disease, Arthritis, Diabetes, Allergies, and Asthma (John Wiley & Sons Inc., 2003) to find out more about chronic inflammation.

NFM: What exactly is inflammation syndrome?

JC: Inflammation is intertwined in most, perhaps all, disease processes. Furthermore, many inflammatory diseases are related to each other, even though the medical establishment doesn't see the correlation. If you have arthritis, you see a rheumatologist; if you have gastritis, you consult with a gastroenterologist. Different inflammatory diseases are often manifestations of the same underlying problems, which are related to the body's inability to turn off its inflammatory response. When you connect the dots, you have the inflammation syndrome.

NFM: Don't we need inflammation?

JC: We need inflammation to protect us from infections and to initiate the healing process. After doing these things, inflammation should go away. But many people experience chronic inflammation. More than 70 million Americans have arthritis, 39 million have allergies and 17 million have asthma. Chronic inflammation results in the immune system breaking down normal, healthy tissue.

NFM: Would you explain what "-itis" means?

JC: The suffix "-itis" means inflammatory disease. Dermatitis means inflammation of the skin, bronchitis means inflammation of the bronchial tubes. Some inflammatory diseases, such as asthma, do not have the "-itis" ending, but they are still inflammatory.

NFM: What's behind all this inflammation?

JC: I believe it's related to major changes in the diet, particularly the composition of fats and low levels of antioxidants. We all know that the modern diet is highly processed and manufactured. Over the years, the amount of pro-inflammatory fats in the diet has increased substantially, while anti-inflammatory fats have decreased. Instead of a 1:1 ratio between these fats, the ratio is now 30:1 of pro-inflammatory fats over anti-inflammatory fats in the American diet. The result is that the body can't turn off its inflammatory response, which sets the stage for chronic inflammation.

The pro-inflammatory fats are the omega-6 family, found in corn, safflower, and other common cooking oils. The anti-inflammatory fats are the omega-3 family, found in fish, flaxseed and leafy green vegetables. Trans fats complicate the situation by inhibiting enzymes involved in the body's processing of omega-3 fats.

NFM: And what about antioxidants?

JC: Antioxidants are anti-inflammatory. They quench free radicals, which are involved in inflammatory reactions. Studies have shown that the majority of Americans do not consume many fruits and vegetables, the major dietary sources of antioxidants.

NFM: What has drawn so much attention to inflammation recently?

JC: It has been two things. One, testing for C-reactive protein has become much more common. CRP promotes inflammation, but it is now easy to test for. Two, medicine has quietly redefined coronary heart disease as an inflammatory disorder of blood vessels. People with high CRP levels are 4.5 times more likely to have a heart attack.

NFM: How does inflammation cause heart disease?

JC: There are a couple of mechanisms. One is that there is some injury to the arteries, such as from homocysteine, which is the result of inadequate B vitamins. Another is that oxidized low-density lipoprotein in the heart's arteries triggers an inflammatory response. Nonoxidized LDL doesn't have this effect. Of course, oxidized LDL is a sign of inadequate antioxidant intake.

NFM: How does a person get tested for CRP?

JC: The high-sensitivity CRP test is a blood test that you can get through your physician. It's inexpensive, about $30 for someone without insurance. A normal high-sensitivity CRP level should be less than 0.11 milligrams per deciliter [mg/dL] of blood.

NFM: Does elevated CRP show up in any other diseases?

JC: Inflammation is involved in many diseases. People with Alzheimer's or cancer tend to have high CRP levels. People who are overweight also have high CRP levels, because fat cells, in addition to the liver, make CRP. People with diabetes also have elevated CRP levels.

NFM: And how does that tie into the inflammation syndrome?

JC: If you have one inflammatory disease, you are likely on the fast track to developing others. The inflammation does not remain localized, such as around the heart or knee joints. Inflammation-promoting cells circulate throughout the body. Being overweight is a risk factor for diabetes, and both [excess weight] and diabetes are risk factors for heart disease. One of the major common denominators is inflammation—hence, the inflammation syndrome.

NFM: What anti-inflammatory foods do you recommend?

JC: I encourage people to eat more fish, particularly wild or Alaskan salmon. It is rich in anti-inflammatory omega-3 fats. I also recommend that people eat more vegetables because of their anti-inflammatory antioxidants. The best cooking oils are olive oil, macadamia nut oil and cold-pressed grapeseed oil. They are all anti-inflammatory. I think it is important to eliminate refined carbohydrates, and reduce carbohydrates overall.

NFM: What are some of the key anti-inflammatory supplements?

JC: At the top of the list are omega-3 fish oils, gamma-linolenic acid (GLA, an omega-6 fat that behaves more like an omega-3) and vitamin E. Several studies have shown that natural vitamin E supplements lower CRP levels by 30 percent to 50 percent, and that they also benefit people with rheumatoid arthritis.

NFM: To quell inflammation, would a person with arthritis take the same supplements as someone with heart disease?

JC: Many of the supplements would be the same—omega-3s, GLA and vitamin E. Studies show these supplements benefit many different inflammatory diseases. But other supplements would be more individualized. For example, two clinical studies have now shown that glucosamine builds cartilage, so this supplement is especially helpful in osteoarthritis, but probably not heart disease.

NFM: Do you think retailers will start seeing supplement blends designed specifically for reducing inflammation?

JC: These products are already appearing in health and natural foods stores. Some contain the anti-inflammatory fats we've discussed. Others contain herbs, which are rich in anti-inflammatory antioxidants. There is a growing number of products to choose from, but retailers have to remember to coach their customers on ways to eat better as well.

Jack Challem will present "Reversing the Inflammation Syndrome" at Natural Products Expo East, Sept. 4, 9 a.m.-10:15 a.m.

Natural Foods Merchandiser volume XXIV/number 9/p. 86, 88