Model Monday's: Diana Moldovan
How To Reduce Inflammation As You Age
If you've ever twisted your ankle, cut your finger, or been bitten by an ant, then you've experienced inflammation. Even illnesses like the flu or viral infections cause an inflammatory response from your body. But did you know that inflammation increases with age? The good news is that you can manage inflammation as you get older. A few simple changes in your lifestyle and diet can help you reduce inflammation.
When your body sustains damage of any kind, the area that is hurt may turn red, swell, and feel warm to the touch. Inflammation is your body's way of fighting off infection and healing the damage.
There are two types of inflammation – acute and chronic:
Acute inflammation. This is a type of short-term inflammation that your body produces to address injuries, illnesses, and infections. When you sustain an injury or contract a virus, your white blood cells begin to flood the area to provide protection and healing. Symptoms of acute inflammation include redness, warmth, and swelling. Depending on the severity of your infliction, the inflammatory response will slowly fade away over hours or days.
Chronic inflammation. Your body's response is the same as with acute inflammation, although there isn't always an injury that needs healing. Instead, your body wrongly signals that there is an issue of some kind, leading to inflammation that is persistent. Chronic inflammation is typically less painful than acute inflammation and lasts for a longer amount of time.
Autoimmune disorders that are considered inflammatory include:
Chronic inflammation in seniors isn't always obvious at first. It can impact your body internally while showing no outward symptoms until the condition worsens. Chronic inflammation is made worse by:
Signs of chronic inflammation. Chronic inflammation manifests differently than acute inflammation. If you suspect chronic inflammation, watch for symptoms that include:
Inflammation is common in seniors and is usually considered a symptom of a greater health condition. It is important to identify chronic inflammation early on to prevent long-term damage to your body. If you ever have concerns, talk to your doctor about what's bothering you.
Your doctor will ask questions about what you're experiencing and whether you suspect inflammation. Your doctor may ask for blood work and additional tests to determine the cause of your inflammation.
Medications for an inflammatory disease may include:
Corticosteroids. This is a type of drug that releases an anti-inflammatory hormone that works to offset tissue inflammation. It is usually prescribed for conditions like asthma and rheumatoid arthritis.
Immunosuppressants. This is a type of drug that works to decrease your immune system's response to perceived threats. It is often prescribed to treat eczema and rheumatoid arthritis.
Biologics. This type of drug is made from living organisms that are engineered to target the cells in your body that control your inflammatory response. It is often given to patients who suffer from asthma, psoriasis, and multiple sclerosis.
If your inflammation isn't severe, your doctor may recommend lifestyle changes. While inflammation can't be completely prevented, it can be managed with a healthy lifestyle.
You may be able to reduce inflammation without needing medication. If you want to avoid medication for treating inflammation, try making some lifestyle changes to improve your health such as:
Consider your diet. Try to incorporate anti-inflammatory foods into your diet every day. Think about foods like:
You'll also need to eliminate inflammatory foods that are processed and high in added sugar. Limit these items in your diet:
Change your lifestyle. Get 30 minutes of cardio five days a week and try to incorporate strength training two days per week. You can also:
5 Anti-Inflammatory Diets You Should Try
Long before the invention of cheese curls, chicken nuggets, soda and all the other ultra-processed foods that make up the bulk of the average American diet, people around the globe thrived on their traditional diets. As different as a Chinese stir-fry might seem from a fresh Italian pasta topped with marinara sauce, at its core, a traditional diet meets an anti-inflammatory diet checklist.
Below is a roundup of the more well-researched anti-inflammatory eating patterns from across the world, as well as the DASH diet, which takes its cue from traditional diets.
Traditional Mediterranean DietItaly, Greece, the south of France, Lebanon and other countries along the Mediterranean Sea have unique cuisines, but they share many of the same ingredients. Research suggests the Mediterranean diet helps ward off a bevy of inflammatory-based diseases, including obesity, cardiovascular diseases, stroke, type 2 diabetes, certain cancers, allergies, Parkinson's disease and Alzheimer's disease.
To pluck just one study of hundreds, researchers tracked thousands of Greek adults ages 20 to 86 for four years. For those adhering most closely to a Mediterranean-style diet, deaths from heart disease dropped by one-third, and the group experienced a quarter fewer cancer deaths and deaths from any cause.
Characteristics of a traditional Mediterranean diet include:
Okinawa is a Japanese island famous for having a high rate of its people reach 100 years old in good health. The local diet gets much of the credit.
"The overall dietary pattern is dominated by anti-inflammatory vegetables, particularly Okinawan sweet potatoes," says Bradley J. Willcox, M.D., a professor of geriatric medicine and director of research at the Department of Geriatric Medicine for the John A. Burns School of Medicine at the University of Hawaii.
"They also have the highest soy consumption in Japan, and likely, the world," he says, adding the diet also boasts low amounts of pro-inflammatory foods, such as added sugar, saturated fat and red meat.
A traditional Okinawan diet is:
While this may sound like any other healthy diet, there are unique elements, such as:
The cuisines of Denmark, Sweden and Finland differ, but traditionally, they share core healthy foods, including:
These foods provide anti-inflammatory benefits due to a wealth of nutrients. Rye deserves a special shoutout—it's a grain that's been shown to help reduce blood sugar, the inflammatory marker C-reactive protein, and PSA (a marker for prostate cancer in men).
People who adhere more closely to this way of eating have lower blood levels of C-reactive protein and other markers of inflammation, according to a University of Eastern Finland review of the research.
Especially protective are fruit (apples, pears, berries), grains (rye, oat and barley) and diets that limit non-lean and processed meat and keep alcohol in moderation. The review also found that even a short-term stint on a healthy Nordic diet can improve certain inflammatory markers and trim off pounds. The randomized studies—done in various Nordic countries, and lasting six to 24 weeks—assigned a healthy Nordic diet to one group while the other stayed on the modern (and less healthy) diet of the country.
A healthy Nordic diet may also have big payoffs when it comes to type 2 diabetes protection, a disease closely linked with chronic inflammation. In a study tracking 57,053 middle-aged Danes for 15 years, those whose diet most closely mirrored a healthy Nordic pattern cut risk for type 2 diabetes by 25% (for women) and 38% (for men), compared to people whose diets strayed most from the healthy paradigm.
Traditional Mexican DietAnother popular, anti-inflammatory eating pattern hails from Mexico. Mainstays of a traditional Mexican diet include:
Indeed, research has linked a traditional Mexican diet to lower inflammation. A National Cancer Institute-funded study of 493 post-menopausal women of Mexican descent living in the U.S. Found that those following a more traditional Mexican diet averaged a 23% lower CRP score—the blood marker of inflammation.
Legumes, which play a starring role in Mexican cuisine, are linked to protection from an impressive lineup of inflammatory-related conditions: High blood pressure, obesity, high blood cholesterol, type 2 diabetes and cardiovascular disease. How does a bean-based diet manage all that? According to a review in Advances in Nutrition much of the credit goes to its very high fiber level, which has bodywide effects:
Legumes are so nutritious that the Dietary Guidelines for Americans recommends we consume them weekly.
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Join Now Dietary Approaches to Stop Hypertension (DASH)The DASH diet was created in the 1990s in the United States as a way to lower high blood pressure (hypertension). It does that—and more. A 2018 review of several studies found that DASH significantly lowers CRP compared to a typical American diet.
DASH follows the anti-inflammation playbook. It's rich in fruits and vegetables, most grains are whole, its protein sources are mainly fish, poultry and legumes and it limits pro-inflammatory foods such as red meat, sweets and sugary beverages.
Another perk of the DASH Diet is that it can lower your LDL. Excessive saturated fat raises LDL—the "bad" blood cholesterol—but DASH limits foods high in this fat, which are also known to trigger inflammation. These foods include fatty meat, high-fat dairy (butter, cream, cheese, whole milk), and coconut, palm and palm kernel oils. Instead, the menu features fat-free or low-fat dairy and vegetable oils, such as canola, corn, olive and safflower oil.
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Inflammation May Be The Culprit Behind Our Deadliest Diseases
In the early days of my medical residency, I met a man whom we'll call Jason. He arrived to our emergency room on a holiday, nonchalant yet amiable, and complained of mild chest pain. Jason was tall and trim, with a strong South Boston accent and fingertips still faintly stained from his last home-improvement project. He was only 45 years old, but he looked much younger. He didn't smoke, barely drank alcohol, and his cholesterol levels had always been normal. No one in his family had a history of heart disease. He asked us if we could work quickly—he wanted to be home for dinner with his daughters.
We welcomed a likely false alarm. Maybe Jason was having a bout of acid reflux, or even a panic attack. His heart, surely, was as robust as the rest of him. He was young and without any risk factors for heart disease. And he had been in excellent health all of his life. Our minds wandered to other patients and tasks.
But as the day wore on, Jason's symptoms persisted. When the results of his blood tests finally blinked on our pagers, we were shocked to find that he was suffering from a massive heart attack. Jason was rushed to the cardiac catheterization lab, where a cardiologist began threading a thin tube through an artery in the leg in an attempt to open up blockages in the arteries feeding the heart.
More from TIMEAs I learned in the ensuing years of training, Jason's story is not unusual. For too many people, the first clue that they have cardiovascular disease is a heart attack or a stroke—or even death. But we wondered, in Jason's case, why it had happened—what was the cause?
Traditionally, doctors address common risk factors for developing cardiovascular disease, including high blood cholesterol levels, diabetes, smoking, and family history. But one of the biggest revelations of 21st century medicine is the unveiling of another important cause of heart disease, one that may lurk in the body unseen and unfelt, yet increases the risk of dropping dead from a heart attack or stroke: inflammation.
Inflammation is a primeval force that evolved with benevolent intent, striving to protect the body against pathogens, poisons and traumas—all of which ancient humans routinely succumbed to. It can be grasped by the naked eye. Slam your knee onto the edge of a table with enough force, for example, and redness, heat, pain and swelling—the four cardinal signs of inflammation—inevitably ensue, as blood flow quickens and vessels dilate, allowing fluid and protein to leak out into tissues. Inflammation works to handle and to eventually heal the wound.
But inflammation is not always helpful, or even harmless. In autoimmune diseases like rheumatoid arthritis, lupus, and inflammatory bowel disease, it rages against the body's own tissues, disrupting essential functions and ultimately leading to disability. Today, we know that inflammation plays an important role not only in autoimmunity but in many other chronic conditions as well, including heart disease, cancer, obesity, diabetes and aging. In fact, low-level, invisible inflammation, simmering quietly in the blood of ostensibly healthy people, may be a common thread running through nearly all diseases.
Read More: You Asked: What Is Inflammation, And Why Should I Care About It?
Research reveals that persistent low-level inflammation, which is twice as common as elevated blood cholesterol levels, plays a part in every stage of heart disease including increasing the risk of plaque rupture which leads to heart attacks. In fact, half of all heart attacks occur in people with normal cholesterol levels. In 2017, the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS) showed that treating low-level inflammation in people who experienced prior heart attacks—correcting for differences in other factors like blood cholesterol, diabetes and high blood pressure—lowered patients' risk of heart attacks, stroke and even death from cardiac events. In 2020, another large clinical trial found that colchicine, a medication deployed for centuries by ancient Greeks and Egyptians to treat the glaring, roaring inflammation of gouty arthritis, could also treat the hidden iteration in heart disease, decreasing the risk of cardiac events. Perhaps Jason, seemingly healthy, had been silently inflamed.
Many years after my encounter with Jason, a patient came to my gastroenterology clinic complaining of rectal bleeding. For a couple of years, Rebecca had been noticing small spots of bright blood dotting the toilet paper when she had a bowel movement. This would only happen on occasion, and she insisted her hemorrhoids were responsible for the spotting. She was only 34 years old and had no family history of colon cancer. Busy with three kids to care for and chronically short on time, she had put off visiting a gastroenterologist. But when I performed her colonoscopy, I found more than hemorrhoids: a jagged, motley collection of tissue gripped at the walls of her colon, so hard and unforgiving that I couldn't advance my scope through its narrow opening. Imaging scans showed that she had cancer which had already spread to the liver. It was the first time I had diagnosed colon cancer in someone so young, but it wouldn't be the last. Cancer is invading more collective years of human life than ever before.
While inflammation weaves through the arteries feeding the heart, it may fester in tumors as well. The immune system fights tumors as it does germs, attempting to keep cancerous cells in check. But it also betrays the body by helping them to grow and spread. Inflammation fuels cancer in many cases, and cancer—like a cut to the skin—fuels inflammation. Cancer is fed not only by obviously inflamed tissues but by insidious, low-level inflammation as well, which doctors typically do not test for. Whether it shows up before or after the birth of a cancer, inflammation can affect all its life stages, from early genetic influences that transform normal cells into malignant ones to the continued growth and spread of cancerous tissue throughout the body. Cancer, in fact, behaves like a "wound that does not heal," as scientist Harold Dvorak writes. Of course, cancer may arise in non-inflamed tissues as well, and not all types of tissue inflammation carry an equivalent increase in the risk of cancer.
That inflammation is a common element in humankind's top killers—heart disease and cancer—is unlikely to be serendipitous. The intricate link between inflammation and modern chronic diseases is rooted in our evolutionary history. In order to survive infections, famine, and other dangers in brutish ancestral times, we developed hyperactive immune systems and insulin-resistant bodies adept at storing fat. But our modern environment has been markedly transformed, from the food we eat to the air we breathe, how we move and more. Our immune system is exceptionally sensitive to the triggers of this new world, portending a higher risk of chronic, hidden inflammation.
Moreover, inflammation is intimately tied to essential, life-sustaining processes occurring throughout the body. Metabolic processes, for example, include those that convert food into energy and remove waste. The metabolic syndrome is a group of risk factors associated with heart disease, diabetes and some cancers: fat around the stomach, high blood pressure, high blood sugar, and unhealthy cholesterol levels. Traditionally, metabolic processes and immune reactions were viewed as distinct entities with disparate functions. But we now know that they are intimately interdependent.
Managing energy and defending the body against infections are both crucial for survival, and coevolved. Fat cells—which are known to play a part in metabolism—and immune cells derive from the same ancestral cell, and share many roles. An excess of fatty tissue, particularly the "visceral fat" that wraps around abdominal organs, acts like immune organ, producing a slew of inflammatory molecules. In fact, in markedly obese individuals, more than half of the cells making up their fat tissue are actually immune cells. Low-level inflammation may help to explain the ties between obesity and a variety of chronic diseases, including heart disease and cancer.
Chronic diseases are complex entities, and a singular, unifying theory of disease may forever be elusive. But mounting evidence suggests that inflammation is an important common thread running through many distinct diseases. Conditions that tend to cluster together include not only heart disease, stroke, cancer, diabetes and obesity but also neurodegenerative conditions like Alzheimer's. If you are diagnosed with any one of these diseases, you are more likely to develop one or more of the others. And it is no accident that these illnesses tend to emerge during the aging process, which itself is tied to inflammation. In fact, "inflammaging"—the hidden inflammation of old age—is one of several essential factors that drive aging in humans.
The idea that inflammation may be a shared biological mechanism between many of our modern chronic diseases fosters a new understanding of human health. It compels us to consider diagnosing, preventing and treating these diseases in concert rather than only in piecemeal fashion. Doing this means delving into the root causes of hidden inflammation, which are largely lifestyle factors, including our diet. The food we eat can promote, prevent—or, in some cases, even treat–inflammation and chronic diseases. For example, the age-old advice to consume more fiber from whole plant foods takes on new meaning when considered in the context of the immune system and inflammation. One of the most important methods by which fiber exerts its healthful benefits is by manipulating the immune system. A fiber deficiency, present in 95 percent of Americans, is tied to a variety of chronic diseases, including heart disease, cancer, diabetes, obesity and an overall higher risk of death from these and other diseases.
A sedentary lifestyle is also inflammatory. The consequences of moving too little can manifest not only in obvious ways—excess subcutaneous fat, for example, or chronic disease—but in hidden ones as well. Dozens of human clinical trials across age groups point to the power of regular exercise to calm chronic, low-level inflammation. Exercise counters inflammation in many ways. For instance, it shrinks inflammatory visceral fat, which is invisible to the naked eye. Remarkably, even in the absence of weight loss, it lowers the numbers of immune cells that infiltrate fat tissue and churn out inflammatory cytokines.
The ways in which we eat and move are intimately linked to another potential root cause of hidden inflammation: our relationship with the microbes that live inside and around us. The intestinal microbiome, which encompasses trillions of germs—including bacteria, viruses and fungi—functions like an organ. It has a central role in immune function and inflammation. Fostering critical conversations between our microbes and immune cells means changing not only our diet, which can affect inflammation directly or through the microbiome, but other lifestyle factors as well. When we embrace the natural world, for example, we encounter ancestral microbes that swim in water and soil and air. These microbes evolved alongside humans, and some of them became indispensable to immune health and inflammation.
Today, around 15 years since my experience with Jason, we know that inflammation is an independent cause of heart disease, and that lifestyle factors play an important part in combating it. We are also attempting to become more adept at catching this silent killer. Blood levels of a molecule known as C-reactive protein (CRP) are elevated in inflamed bodies. In heart disease, a special test called high-sensitivity CRP can be used to detect low-level inflammation that may be present years or even decades before a heart attack or stroke manifests. But existing isolated blood markers tend to be nonspecific: they do not tell us why the inflammation is there or how long it has been around for.
New research is focusing on the potential of clusters of markers—inflammatory "signatures"—to better define the state of being silently inflamed. Imaging tests like magnetic resonance imaging or computed tomography scans may add invaluable information, picking up inflammation that surrounds blood vessels or pointing to inflammatory findings in atherosclerotic plaques that predict rupture. In the 21st century, as hidden inflammation weaves through our deadliest diseases, unveiling this force—seeing what has long been unseen—is poised to make its mark on medicine.
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