Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:
Anti-Inflammatory Diet and Lifestyle.
There are over 190 articles on diet, inflammation and disease on this blog
(find topics using search [upper left] or index [lower right]), and
more articles by Prof. Ayers on Suite101 .

Monday, September 1, 2008

Anti-inflammatory Diet

Components of an Anti-inflammatory Diet (focus on meats, fish, eggs and leafy vegetables)
Note:  All food is unhealthy without gut bacteria adapted to the food.  See other posts on repair of gut flora.
  • Low starch and other simple sugars -- insulin and high blood glucose are inflammatory; so use complex polysaccharides (not starch); starch only in small portions (1/2 banana or one side of a hamburger bun) and preferably in unprocessed, less available forms, e.g. coarse ground or fat coated -- bread with butter; less than 30 gm in any meal, less is healthier, grains are frequently a problem -- gluten intolerance
  • No high fructose corn syrup -- high free fructose (in contrast to sucrose) is inflammatory and contributes to crosslinking of collagen fibers, which means prematurely aged skin; sucrose is much better than alternative sweeteners
  • High ratio of omega-3 to omega-6 fats -- most vegetable oils (olive oil is the exception) are very high in omega-6 fats and are inflammatory and should be avoided; omega-3 fats from fish oil cannot have their full anti-inflammatory impact in the presence of vegetable oils; omega-3 supplements are needed to overcome existing inflammation -- take with saturated fats
  • No trans fats -- all are inflammatory
  • Probiotics and prebiotics -- the bacteria in your gut are vitally important in reducing inflammation; most of the bacteria that initially colonize breastfed babies and are also present in fermented products seem to be helpful; formula quickly converts baby gut bacteria to inflammatory species and should be avoided completely for as long as possible to permit the baby’s immune system to mature (at least 6 months exclusive breastfeeding.)
  • Saturated fats are healthy and reduce the peroxidation of omega-3 fatty acids at sites of local  inflammation, e.g. fatty liver.  Saturated fats should be the major source of dietary calories.
  • Vegetable antioxidants -- vegetables and fruits, along with coffee and chocolate supply very useful, anti-inflammatory anti-oxidants
  • Sensible daily supplements: 1,000 mg vitamin C; 2,000-5,000 i.u vitamin D3 (to produce serum levels of 60ng/ml); 750 mg glucosamine
  • Associated anti-inflammatory lifestyle components:
exercise (cardiovascular and muscle building),
minimizing body fat,
dental hygiene
vagal nerve stimulation

271 comments:

1 – 200 of 271   Newer›   Newest»
mtflight said...

Great blog!

To raise 25(OH)D3 to the 50-60ng/dl, wouldn't it be a higher D3 intake?

Dr. Art Ayers said...

mtflight,
I just use "vitamin D" for simplicity and assume that people will supplement with D3. Sorry if that is confusing.

Thanks for reading and commenting.
Art

C, Nielson said...

I had previously read about most of your anti-inflamatory measures. However, I had never heard that glucosomine was anti-inflamatory. Can you give any further information on this?

Dr. Art Ayers said...

C, Nielson,
Glucosamine is a common food supplement for arthritis. The literature on clinical studies is cluttered with contradictions. My take is that glucosamine is effective in reducing symptoms in people with high inflammation.

Studies with cartilage producing cells (chondrocytes) indicate that glucosamine reduces activity of the transcription factor (NFkB) involved in inflammation.

Glucosamine is the precursor for many glycosaminoglycans, e.g. heparan sulfate, but there is no evidence that dietary glucosamine raises blood glucosamine levels enough to impact GAG synthesis away from the gut. I think that the inflammatory action of glucosamine in arthritis, for example, results from an impact on the immune system in the gut. Glucosamine may also have an anti-inflammatory impact via changes in the gut flora.

The bottom line is that glucosamine is cheap and has few side effects.

Art

Andre said...

Dr Ayers,

You say some carbs are necessary. Is the gluconeogenesis in the liver not enough to supply all the glucose the body (brain, kidneys etc.) needs?

Dr. Art Ayers said...

Andre,
I think that your point is correct. Your liver should be able to provide a constant, low level of blood glucose and your brain and other organs can use lipids for energy.

The problem comes if some starch is introduced and insulin increases a little, then hunger will quickly follow as the blood sugar drops. The hunger can be ignored or a some carbs will be needed to keep the blood sugar high enough to turn off the hunger alarm.

You are right, that if you take out the carbs, you don't crave them.

It probably also makes a difference with respect to your glycogen stores and pattern of exercise.

Thanks for the comment.

Michail said...

Mr Ayers,

Aren't conventionally corn or soy-fed livestock or poultry inflammatory? I thought only grass-fed animals, along with their derivatives (eggs, milk) have a good ω3/ω6 ratio, hence less inflammatory or anti-inflammatory.
Thank you

William Trumbower said...

Art Sorry for the late post. I consider olive and avocado oils as fruit oils rather than vegetable oils. to Michail I think that grassfed beef is ideal, but even supermarket beef with its higher levels of omega 6 is better than not eating beef at all. The real key to Art's diet is avoiding sugar and grain starch as well as avoiding as much omega 6 oils as possible. The more inflamatory your diet, the more EPA & DHA one needs to balance it out.

Alfredo E. said...

Hi Dr. Ayers, what is your opinion on soy and its derivates? Some Latin American governments swear by it and have general kid population programs to provide them soy everyday.

Alfredo E.
www.omega-3-fish-oil-wonders.com

Anonymous said...

Dr. Ayers,

I must say I think your blog is interesting and worth reading even if I do not always fully understand. My limited knowledge in molecular biology makes it particularly difficult.

I share your view that many of the diseases we have depends on the diet, although I myself can not really explain why.

I come from Sweden and here we have an ongoing intense debate about diets. There is a small but fast-growing group of people who switch to a diet based on natural animal fat and proteins, and a small amount of carbohydrates. A kind of PALEOLITHIC diet with milk products added (cheese, butter and cream).

I have been eating according to this diet since the beginning of the year and feel great from it. One of the reasons that I tried the diet was that I was diagnosed with autoimmune hypothyroidism (Hashimoto's). For my part, I have eaten small quantities of grains and a lot of dairy products.

Before the summer, I got hold of a book called "Enough". The author launches a theory she calls basallergi (basic allergy?). A basallergi is a kind of intolerance against our basic foodstuffs such as milk and cereal. This basallergi we draw on us by introducing formula milk and porridge before the children's intestines and immune system is fully developed.

Since July, I have ruled out the cereal and dairy products completely and I feel that I feel even better, although my readings, eg antibodies have been worse.

I would be very happy if you would like to read the links I attached and provide a short comment to the basallergi-theory and the explanation that the theory provides. Does the author's ideas seem likely? If not, what is in them that's wrong?

Sincerely,
Martin

A google translation of a Swedish page:
http://translate.google.se/translate?hl=sv&sl=sv&tl=en&u=http%3A%2F%2Fwww.2000taletsvetenskap.nu%2Frecensioner%2Fbasallergin.htm

The page in Swedish: http://www.2000taletsvetenskap.nu/recensioner/basa
llergin.htm

P.S I hope you can understand the translated page allthough the translation is quite bad. But then you might prefer the swedish page. I saw that you have been working at a university in Stockholm. D.S

Dr. Art Ayers said...

Martin,
You are right about the challenging transliteration of the article. I could understand it quite well with the help of the accompanying original Swedish version.

I would say that the author of the basic allergy comes to essentially the same conclusions as what I have presented on my blog, but has emphasized that the initiation event is exposure to food antigens with an immature infant gut/immune system. I would merely suggest that the immature infant gut when exposed to inflammatory formula becomes immunologically intolerant.

I wouldn't agree that grain is fundamental. I think that it has always compromised health, but has become a problem in the presence of so many other inflammatory factors, such as escalating Cesarean births and use of artificial formula. Women are getting pregnant and giving birth at much higher levels of chronic inflammation. Babies are born with higher initial inflammation.

The basic allergy model lacks some molecular details, but it comes to many of the same conclusions. My wife is a lactation consultant, so I firmly endorse exclusive breastfeeding for at least 6 months and continued breastfeeding with food for at least two years. Our cultures need to return to nurturing mothers and infants for extended nursing.

Thanks for your comments and the opportunity to practice my Swedish.

Dr. Art Ayers said...

Alfredo,
I don't have a problem with soy, in fact I had edamame with my chicken last night.

Some people are upset about the lectins, protease inhibitors and phytoestrogens in soy. I don't think it is any big deal. I wouldn't feed it to babies, since I think it is actually even more allergenic than cow's milk, but I think it is a good source of protein in moderation.

Seeds in general tend to be high in omega-6 fatty acids. Leafy veggies are higher in omega-3s (short chain). It is hard to make a combination of vegetables that has a healthy mix of protein, saturated fat, low omega-6 fatty acids and low carbs. The high fiber also tends to produce hydrogen gas that feeds pathogens, such as Helicobacter pylori (biofilms?).

Those are my initial thoughts.
Thanks for the comments.

Jackie said...

Wow! I have been surfing in order to gather info about anti-inflammatory foods/diet and so happy to have been sent your blog info from a friend in S. Africa on the same mission. I've seen so many auto-immune diseases when I worked at Stanford Med Ctr. in Palo Alto. I've been wondering why the terrific increase in pelvic organ prolapse in younger women and why I suddenly got it at 61. My main focus is connective tissue disorders (weak fascia primarily rather than systemic disease). Connective tissue disease is a misnomer for me - I mean a weakness of connective tissue. I shall enjoy reading whatever you have to offer. You sound brilliant. I missed an opportunity to go to med sch. because of a son with diabetes at age 36 months, etc. and would have loved to have gone into research, but instead became an RN as that was economically mandated. Thanks for your sharing of knowledge. Jackie

Dr. Art Ayers said...

Jackie,
Welcome.
I started looking into inflammation based on my initial work on cartilage structure and development. Most of the micrographs that I use on my blog are from chrondrocytes. I was interested in how cartilage was secreted and assembled, and was initially working on collagen XI. I was fascinated that the cartilage was synthesized by chondrocytes that dwelled within the cartilage and constantly digested cartilage and produced new cartilage as a result. It was interesting that the chondrocytes were so far blood vessels. In fact, cartilage inhibits angiogenesis via collagen fragments, endostatin.

The halo around each chondrocyte is filled with heparan sulfate that is rapidly recycled (half-life of 6 hours!)

So prolapsed organs may result from failure of cartilage development, i.e. young cartilage produced by chondrocytes that are in contact with blood vessels has no tensile strength. Inflammation enhances angiogenesis and hence is the killer of cartilage. Prolapse, I conclude, is in most cases due to diet-based inflammation. The epidemic of diet-based inflammation produces lots of sagging organs.

Thanks for your supportive comments.

Jackie said...

Dr. Ayers, Many thanks for your quick response. I can see I'm going to have to 'study' a few words to be sure I'm understanding, but I am so excited at the prospect of finding another avenue to explore for possible strengthening of connective tissue. Most just say surgery for prolapse and that is NOT a good choice as the failure rate is very high.

I've read that Turmeric "has been shown to stop the growth of new blood vessels in tumors" --*not sure how good the source is*.

So thanks for taking the time and I will study your post until I completely understand your logic.

Darn, I wish I were in research. My Dad was a pretty famous nuclear physicist and research was his joy.
Jackie

Jackie said...

http://www.diagnose-me.com/cond/C136795.html Interesting article on prolotherapy and the healing processes of ligaments/collegen. Would love your take on it if and when you have time. It is clearly pro-inflammation, which is counter to everything I read. Old article.
Thanks and sorry if this is inappropriate.
Jackie

Dr. Art Ayers said...

Jackie,
I have been contemplating an article on tendon rehabilitation related to problematic Achilles tendinopathy treated with glyceryl trinitrate (GT) patches. This treatment seems to work, but is paradoxical, because GT is normally seen as a precursor of nitric oxide that would produce blood vessel dilation.

This vasodilation is of course associated with inflammation and that would fit in with the prolotherapy, which is reminiscent of attempts to control tumor growth by injecting inflammatory bacteria.

This also includes the impact of aspirin, which affects several steps in inflammation, including NFkB inhibition and COX transformation to anti-inflammatory lipoxin production. Aspirin also inhibits muscle repair involved in strength training.

The root problem seems to be thinking that inflammation is a damaging response that needs to be minimized. Inflammation is a process starting with damage recognition and progressing through repair to a return to normal function. Trying to stop part of the process leads to lasting damage. Unfortunately, the process can also get overzealous and cause additional damage.

The repair process is also complicated by the need to apply mechanical stress to load bearing structures to get proper repair. Thus, cartilage needs to be stretched to develop strength, but new cartilage is weak.

I also don't understand how to shorten overstretched tendons.

So, I am thinking on the subject and would appreciate any input on the broad subject I have outlined.

Thanks for your comments.

Jackie said...

Dr. Ayers, preliminary response as I'm bright but really have to review to understand your thoughts. My first thought was how I use my neuro-muscular stimulator on almost all areas of my body (not near trachea). I can create contractions of various types or I can use the simple tens unit. EMS (electrical muscle stim) is used to contract and reeducate muscles. Used for prevention or retardation of muscle disuse atrophy, relaxation of spasms, maintain and increase range of motion.....
waveforms: symmetrical, biphasic, square and asymmetrical,biphasic square.
I csn program it to stim pelvic muscles from exterior placement of four electrodes- a pair of positive/negative. I can program it to raise and lower my shoulder with no work on my part. I can use it as a TENS to reduce edema or pain relief (gate theory I think - blocking pain messages to brain).
Now because you may know all about this I'll stop here.
But just a thought for passive use to not have to be load bearing to stimulate the laying down of -------cytes. I am so long out of school (decades) that I am straining here.
Jackie --more when I understand what you have written.

Jackie said...

Just tossing this into the mix- on Prolo and relaxin Jackie

How do hormones play a role?
Many times you can 'fix' SIJD just by doing the corrective exercises when it starts to hurt. Women have a problem with a hormone called relaxin which is present in their bodies during the last trimester of childbirth and serves to soften pelvic cartilage. This hormone is also present about a week before your period and makes you more susceptible to injury through minor trauma. You must be more careful at that time. During your period the hormone is negated and the ligaments firm up again.
Until a method is found to reduce the level of Relaxin in the system each month you must be careful to practice good body mechanics at that time. The Relaxin does not cause SIJD, but makes your ligaments less stable and more prone to injury through minor trauma.
In your experience, what percentage of people with SIJ disorders can fix themselves, more or less, by following religiously the correction and strengthening exercises you describe?
Just a guess, but I believe that at least 50-60% of all with SIJD can fix it themselves. Another 20% can improve, but may need an assistant or professional help to assist with correction. I suspect that 15-30% may need prolo to stabilize unstable joints. I am now of the opinion that prolo should be used early on if the SIJ instability persists longer than one month in order to prevent extensive collagen failure in the long posterior sacroiliac ligament. I believe strongly that surgery must be developed to repair ligamentous damage and preserve function in preference to fusion, where you lose all function. It seems to me that loss of the shock absorber function in the SIJ will increase impact loading to the hip joints and may cause hip disease. And will also increase shear and torsion shear on the disks increasing the probability of disk degeneration and herniation.
http://www.kalindra.com/faq.htm

Dr. Art Ayers said...

Jackie,
My initial response to most issues that follow the menstrual cycle, is that they are inflammation driven and estrogens are anti-inflammatory. Hence there are periodic highs in inflammation and cycles of symptoms.

Celiac inflammation for example can lead to back problems. I would even suggest that diet-based chronic inflammation can lead to connective tissue weakness and SIJD. I wouldn't expect that SIJD can be reversed by diet alone, but I also wouldn't expect to be able to permanently reverse SIJD without addressing the underlying inflammation.

I missed your point on electrical stimulation vs. load bearing exercise. Lasting impact on muscles and connective tissue will only occur if the strain on the fibers is sufficient to cause micro-damage. Is doesn't matter in my mind whether the simulation is by neuron or wire.

I don't have any clinical data, because my exposure is only a monolayer deep -- my experimental systems are cartilage cell cultures.

Do you have any ideas about nitric oxide and connective tissue repair?

Thanks for the ongoing discussion.

Jackie said...

My point on electrical stim was perhaps it could replace the need for mechanical stress to stimulate repair - but working at the cellular level is so different than physical therapy to rehab damaged cartilage.

Will try your final question tomorrow.

Wish I'd 'met' you when I was working on sports med at Stanford.

Jackie said...

I don't have any original thought on NO and connective tissue repair, but when Googled 'nitric oxide and connective tissue' found some very good and current studies. Wish I were in the arena of research so could be more conversant.

Dr. Art Ayers said...

Jackie,
Your comments got me thinking again about cartilage synthesis and in the tendon context, fibroblast response to mechanical stress. As you indicated, there are numerous recent articles on the subject of signaling in response to mechanical stress. What I found interesting was that NO and prostaglandins are involved. Clearly manipulating NO levels around tendons and altering COX activity with inhibitors, e.g. aspirin, could have dramatic impact on tendon healing. There is some suggestion that NO stimulates wound healing by fibroblasts. COX inhibitors seem to be counterindicated.

Jackie said...

I think COX inhibitors are bad COX1 for GI bleeds (30,000/yr in the ER from this was a stat years ago) and COX2 for the negative cardio-vascular.

Off Google:
ScienceDirect - Nitric Oxide : Nitric oxide and repair of skeletal muscle injury

Acute and chronic wounds: current management concepts
By Ruth A. Bryant, Denise P. Nix

The above were good reads off Google. There were many theories that might just have something to trigger your thoughts.

I'm really questioning my daily aspirin (81mgs) and also the drastic increase in prolapse, especially in younger gals. Something is wrong in a 'global' (USA) way. I mean there is a huge increase and it is destroying lives as the surgery to correct has an abysmal failure rate (note law suits for mesh erosion) and the main cause is failure to heal connective fascia by suture or to support it by mesh. Whoever solves this problem will be wealthy and famous.

Jackie said...

Correction: Global should mean global. I'm on blogs where gals all over the world are suffering this connective tissue horror.

Dr. Art Ayers said...

Jackie,
I started to question the aspirin a day rationale. It makes sense in terms of some of the anti-inflammatory actions, but not in the broad sweep. I think that it is too powerful, because it chemically modifies COX to make it produce anti-inflammatory lipoxins, and prostaglandins are needed for normal tissue development, notably intestinal epithelia.

What are the co-morbidities of prolapses? Chronic inflammatory diseases? Metabolic syndrome? It would seem that the only cure would be very early intervention. Are there early symptoms, such as knee looseness? What about proteinuria or MS or allergies?

Dr. Art Ayers said...

Jackie,
I think that prolapse is just a symptom of scurvy. Vit.C is used in the hydroxyproline modification of collagen. Oxidative stress can deplete vit.C. I think that women would see their periodic joint loosening decrease if they had adequate vit.C in their diets to compensate for their chronic inflammation.

I think that the global diet shifts that have led to chronic inflammation, have also led to chronic oxidative stress, depletion of vit.C and incipient scurvy. Under these conditions, even supplementation with 1000 mg of vit.C per day would be inadequate.

Jackie said...

'Scuse me, just had to swallow 1000 mg of Vit C. Co-morbidities: childbirth, age, and stopping Hormone Replacement Therapy. I belong to blogs of thousands if you ever wish me to float questions, let me know. Your site is on two of the blogs.

Jorge Cruise and Dr. Oz will make millions from diet and attention to anti-inflammatory protocols, but your work may be far more important as it appears you are searching for the causation factors of connective tissue disorders. When I think of how many folks have Lupus, MS, RA and in my case, mis-diagnosed CLL (I hope) from chronic inflammation. My endoscopy and colonoscopy showed tissue so dark pink that 16 biopsies were done - all negative.
So clearly there is a huge problem with inflammation and healing.

Jackie said...

Dr. Ayers, I just completed reading all of your blogs and I am blown away by how much you have brought together seemingly unrelated disease entities with the inflammatory response (both regular and paradoxical). I've been able to correlate my Reiter's syndrome (following severe Salmonella)with my mis-diagnosed CLL, and my latex allergy (ex-health care workers are 50% likely to have latex allergy) and so on (undiagnosed hypothyroid and 7 spontaneous aborts). Totally mind blowing.

I cannot believe you said one reference sounded 'fishy' OMG a scientist with a sense of humor.
I'll quit taking up space, but if ever you wish me to gather info on anything re: prolapse or ? please let me know. A retired RN should not be left without mental stimulation.

Anonymous said...

Hello Dr Ayers,

Your blog is so enlightening.

Do you have any thoughts on the use of glucosamine while trying to conceive?

Dr. Art Ayers said...

Anon,
The Anti-inflammatory Diet is the fertility diet.

I think that glucosamine works in the gut, by altering gut flora and inflammatory signaling via the receptor for advanced glycation endproducts. That's far away from your question of using glucosamine to increase fertility.

Fertility, gestation and birth are examples of the interplay between the elaboration and disassembly of tissues, e.g. uterine lining, ovulation, placenta, and control of defenses against foreign tissue, e.g. conception vs. birth. Chronic inflammation decreases conception by making women's tissues so heightened in their sensitivity to foreign/fetal tissue that anti-inflammatory female hormones cannot suppress rejection. Not even the high concentration of omega-3 oils in semen can suppress the chronic inflammation, and that would assume that the male isn't equally compromised by chronic dietary inflammation.

The anti-inflammatory diet and lifestyle, augmented by vagal relaxation exercises are a system to eliminate chronic inflammation which means it is an ideal diet to enhance conception. Vit. D and omega-3/6 ratio are far more important than glucosamine.

Thanks for your comments.

Jackie said...

LOXL1 - Hi Dr. Ayers, Are you familiar with studies on this LOXL1 gene done at Harvard? Without it tissues sag, more than from lack of collagen. - study in 2004 for macular degeneration done on mice. Just wondered. Jackie

Anonymous said...

Dr. Ayers:

Could you point me to a summary of "natural" methods for vagal stimulation (one of the "•Associated anti-inflammatory lifestyle components" you suggest)

Thanks,
Jon

Jackie said...

Dr. Ayers - think you mentioned being interested in roles of nitrous oxide in inflammation - Jackie

Another Advantage of Fish Oil


Our bodies convert the DHA (docosahexaenoic acid) in fish oil into a compound called Resolvin D2, which helps down regulate inflammation. This discovery, by investigators in London and at Harvard, may explain why fish oil helps with conditions such as rheumatoid arthritis, heart disease, and many other disorders that are linked to inflammation. The clinicians suggested that Resolvin D2 could lead to new treatments for inflammatory conditions - they found that when they added it to white blood cells that stick to the inner lining of blood vessels (the endothelium) the cells making up this lining produced small amounts of nitric oxide, which discourages the white blood cells from adhering. The result: reduction of inflammation. Another advantage: unlike other anti-inflammatory drugs, Resolvin D2 doesn’t suppress the immune system. The researchers also found that Resolvin D2 is a powerful chemical, and that effects can be measured with very small quantities. The study was published in the journal Nature on October 29, 2009.

e.v.a. said...

Nice blog, dad! I'm citing it in my politics presentation, asserting that a myth of our culture should be that Americans value health and preventive healthcare and therefore anti-inflammatory diets.

David said...

Dr. Ayers,

I must say that I find your blog to be an amazing wealth of information. As a health consultant, I have found this to be a great resource.

I know I am commenting on an old post, but this particular post seems so foundational to the rest of what you're writing about that it seems appropriate. I am curious about something you've written here, and I wonder if you would indulge me with your current thoughts.

1) I have noticed elsewhere on your blog that you extol the virtues of saturated fat, yet here you seem to give the impression that it is benign at best and perhaps even harmful within the context of established inflammation. Could you expound on this? In what sense might saturated fats exacerbate existing inflammation? Do you still believe this is the case?

2) You say here that fruits and vegetables are anti-inflammatory, yet elsewhere in a more recent post I believe I remember you saying that fruit is inflammatory. Is it one or the other, or is it a contextual matter depending on other factors?

The thing that really got me thinking about this was my observations of weight loss with several people, now. I have seen "traditional" low-carb diets work wonders for a lot of people, but I have also seen many other people fail on these diets (while following them to the letter). In a few cases with people who were close to me, the "failures" adopted something called the "Perricone Weight-Loss Diet" and immediately dropped the pounds. Out of curiosity generated from observing these experiences, I read Perricone's book, and it's basically a low glycemic index diet, relatively low carb (greatly discourages wheat), but it has a much higher emphasis on fruits and vegetables (albeit low GI ones). He pushes MUFAs quite a bit and the only saturated fat he praises is coconut oil (he thinks other saturated fats are inflammatory). His premise is basically that we need to be eating foods that "shut off" NF-kB, which then downgrades inflammation and leads to better insulin signaling downstream.

Do you think there's something to this? Is there anything in fruits that actually inhibit NF-kB, and therefore leads to improved insulin signaling? Likewise, in a person with established inflammation, what effect do large servings of saturated fat have on NF-kB?

It makes me wonder if perhaps, for some people, a temporary reduction in saturated fat might be appropriate. Not sure what to think, but searching for the truth between it all.

David

Dr. Art Ayers said...

David,
You have noted my gradual shift away from fruits and toward saturated fats. Fruits and juices seem to get an unjustified free ride. We should be careful to avoid fruits high in fructose and other sugars -- they are part of the problem. Fruits are desirable for their phytochemicals. Saturated fats on the other hand are healthy and have been given unwarranted condemnation.

My impression is that saturated fats can end up being deposited in arterial walls and cause problems. Fat deposits may be enhanced by a high saturated fat diet (aggravated by omega-6 oils) in an inflammatory context. That is just my belief, since I don't know if anyone has done the experiment.

I wonder if those who have trouble losing weight on a high fat diet have other sources of inflammation, such as vegetable oils, vitamin D deficiency or too many initial calories. Perhaps it is important to initially start weight loss to lower production of inflammatory cytokines from the fat cells, before the high fat diet kicks in.

Thanks for the comments.

David said...

Thanks for the quick response. Much appreciated.

The weird thing is that I haven't seen other sources of inflammation in these individuals. Vitamin D is in every case between 70-80 ng/ml (through supplementation), omega-6s were always religiously avoided, and if anything, calories were too low due to the high satiation from ~70% of calories coming from fat. This is why this has been so confusing to me. I know those problems (like high omega-6 consumption, especially) are often present in other low carbers, but it was not an issue here. I suspected hypothyroid, but then why would someone with hypothyroid respond better to the low GI/high fruit and veg/low sat fat diet than to the low carb/paleo diet?

I know that Perricone emphasizes low sugar fruits. Do you know if the beneficial phytochemicals in fruit have any beneficial effect on NF-kB?

David

Dr. Art Ayers said...

David,
I doubt that this paradox is the result of anything subtle, such as phytochemicals. It may be gut flora. I have been looking at the 6-week weight loss plan of the Drs. Eades, featured in their new book. This diet is a transition to the low carb diet.

The first two weeks is basically whey shakes with a simple carb-free meal each day. This two weeks may be an essential adjustment for the gut flora, since they will be starved for sugars, yet provided with ample peptides and saturated fats. This is in contrast to the low carb diet that still permits the carb-dependent gut flora to survive.

For some people, their shift to a low carb diet retains the fat gut flora long enough to maintain fat even with reduced carbs. The fruits and perhaps their phytochemicals may disrupt the old, fat flora and permit a shift to the new thin flora on the low carb diet.

Maybe someone else has a simpler idea.

Thanks for the comments and quandry.

David said...

Ah yes, good thoughts, and thank you for discussing it a bit with me. I know that gut flora is an often underestimated factor. The people I knew on the Perricone diet seemed to eat a TON of yogurt. I wonder if this might have helped with the gut changes you're talking about? Seems like the low-carb crowd (myself included) often don't get much in the way of probiotics.

David said...

Here is an interesting discussion on gut microbes and the relationship to obesity: http://www.nature.com/nature/videoarchive/gutmicrobes/index.html

Are we missing something in the war on obesity by not paying enough attention to our unique microbial colonies?

Dr. Art Ayers said...

David,
That is a great article. It is consistent with what fecal transplant experiments between fat and lean show. The article shows that the gut flora change proportions as weight is lost, but the species present are constant. Other work suggests that the genetic characteristics of the bacteria also change, so that the species definition is not applicable to gut flora and especially not to biofilm bacteria, such as the common E. coli. It would be interesting to see what the actual impact is of pre- and pro-biotics, as well as antibiotics. It is amazing that those studies of phenomena that dominate health and disease are just now starting.

Thanks for your input.

David said...

I absolutely agree.

I think a focus on the gut, and especially on biofilms, might just be the missing link regarding the treatment of persistent, chronic illness. I've read with interest your writings here on biofilms, and it rings true for me, as I've been seeing this develop for quite some time through the teachings of one of my mentors, Dr. Dietrich Klinghardt. He has applied and expanded on the work of Dr. Usman with great success. The emerging protocols and results are very exciting.

I recently came across a quite excellent article on biofilms. Perhaps you would find it interesting as well, if you've not seen it yet: http://www.thefreelibrary.com/Life+on+the+edge:+the+clinical+implications+of+gastrointestinal...-a0211561662

David

Anonymous said...

How is HFCS worse than sucrose when its glucose:fructose ratio is similar to that of sucrose? Sucrose is hydrolyzed readily in the small intestine, so at that point it is more or less equivalent to HFCS.

And I think there might be a little typo in the note on saturated fat. Did you mean to say that sat fat is not unhealthy in the absence of inflammation?

Dr. Art Ayers said...

Anon,
I think that I have succumbed to the media. It seems that HFCS is being more exposed for the hazard that it is. I deny that HFCS is the same as sucrose, in being natural, but both are not treated as healthy by the body. I give sucrose a free ride, because it is less scary than most of the artificial sweeteners. I haven't seen a report that demonstrates that any source of fructose is dangerous and that added carbs are also. I think that is the reality.

Thanks for pointing out the obvious and my typo (I think that it is revealing that I used so many nots and uns when a simple statement that saturated fats are healthy, would have sufficed.)

Anonymous said...

Well I'm glad to hear that you think saturated fats are okay on a low inflammation background. :-)

Eliminating HFCS is great advice. That rules out almost all sweetened processed foods, since very few manufacturers use sucrose anymore.

However, in terms of what's more natural and less processed, I suspect honey and even maple syrup have an edge over sucrose. Their glucose:fructose ratios are both similar to sucrose and HFCS.

Have you seen Lustig's talk yet? If not, you've gotta see it! His discussion of fructose metabolism is eye-opening, to put it mildly.

http://www.youtube.com/watch?v=dBnniua6-oM

steve said...

in looking over your diet recommendations i see nothing that addresses alcohol. Is red wine acceptable or should it not be part of an anti inflammatory lifestyle

Dr. Art Ayers said...

Steve,
Moderate alcohol consumption (approx. 1 drink per day) is considered healthy. It does contribute to calories and perhaps displace more nutritious choices, but it seems to have more benefits than disadvantages.

Red wine seems a good choice to me.

Thanks for the question.

Beth@WeightMaven said...

In the first bullet you write "use complex polysaccharides (not starch)." What's in that category for you?

Dr. Art Ayers said...

Beth,
Any polysaccharides or sugars that are readily converted to glucose or fructose, I consider simple sugars. Nutrition labels are deliberately misleading to avoid recognition of problems with starch.

Complex polysaccharides are typically of plant origin and are cell wall structural materials such as pectin, cellulose, arabinogalactans, and storage materials other than starch, such as inulin. Many of these would also be considered as soluble fiber, but are also converted by gut flora into short chain fatty acids that are nutrients for the gut.

I could also say that simple carbs provide sugars at the top of the GI tract and complex polysaccharides provide nutrients at the lower end of the GI tract.

Thanks for the question.

Steve said...

Thanks Dr. Ayers for your response.
A couple of more questions. You say lower carb is better; is there a level you should not go below? Also, any probiotic recommendations other than dairy, ie specific supplements? Jarrow makes an acidophilis one i am told is good?

Have you written anything about LDL particles: big vs small, impact of sat fat on them? I am thin with trgs of only35 and the higher the sat fat in my diet, the more the LDL particles go up, and still stay 65% plus small. Am guessing with family history of heart disease the liver is not processing fat as it should. Thanks!

whitebeach said...

Dear Dr Ayers,

Great Blog.
I have been dealing rather unsuccessfully with inflammation for years. My diet is very similiar tyo yours. I have recently een diagnosed with a fatty liver. Question how would I alter the diet. I imagine bacon and eggs for breakfast and other animal fats may not be good for a fatty liver.

Any advice would be greatly appreciated.

Regards
John

Dr. Art Ayers said...

John,
For non-alcoholic fatty liver, I would think that saturated fats would be good protection and then it would probably be safe to use fish oil.

The biggest contributor to fatty liver is fructose, which is metabolized in the liver just like alcohol. Eliminate sucrose, honey and high fructose corn syrup and alcohol. If I were you, I would switch to stevia as a sweetener until my liver healed.

You probably also have some gut issues that contribute bacterial LPS to inflame the liver. Probiotics with pectin and inulin should be helpful.

Thanks for your comments.

whitebeach said...

Dear Dr Ayers,

Many thanks for your advice. I have a log history of inflammatory diease starting with tendonitis 25 years ago and then CFS 20 years ago. I may have AS but tested negative to the B74 gene. What saturated fats do you recommend? And what is bacterial LPS? I have suspected parasite infection that may have help cause the fatty liver (flukes?) and have been taking anti parasite herbs (seen some weird results!).
What are your thoughts on liver flushing and cofee enemas?

My tendons and joints have felt weak and easily starined for years. If there is a magic bullet what is it!?

Many thanks
John

whitebeach said...

Sorry forgot to ask about collagen instead of glucosamine: I have been advised to take collagen.

GLUCOSAMINE

We’ve all heard about Glucosamine sulfate – a protein supplement derived from the chitin of shellfish. Chitin is the hard material that makes up the shells. The theory is that in pure form, glucosamine sulfate will rebuild joints because it is a component of the shellfish’s shells as well as a component of your cartilage.

An Italian researcher, Rovati, has been the world authority in the area of glucosamine sulfate for the past 60 years. The main problem was stability – isolated glucosamine sulfate naturally tends to degrade into formless mush after about 30 days. In the 1970s, Dr. Rovati patented a process to stabilize glucosamine sulfate, which process is still used today.

There are many companies which do not use Rovati’s method, and sell the cheaper unstabilized form, which may be worthless by the time it gets into your system. Fillers may be used to hide the decomposition of the active ingredient, so percent composition is also an issue in evaluating a brand of glucosamine sulfate. In addition, absorbability into the bloodstream is critical, after the supplement has gone through the digestion process.

Glucosamine sulfate can sometimes deliver what it promises – relieve joint problems. But what usually happens when people stop taking glucosamine? Right – the problem returns. That’s what everybody says. Why is that? Because the action of glucosamine in joints is primarily anti-inflammatory. Glucosamine may stop the inflammation, which is caused by the action of worn out discs, joint capsules, menisci, bursae, etc. But the irritation continues and inflammation is constantly occurring. So when the glucosamine stops coming in, inflammation is once again uncontrolled, and the pain starts back up.

Dr. Art Ayers said...

John,
Glucosamine
I think that all of the glucosamines are equivalent. There is just a patent on the sulfate form, so that is the only one that has received support for clinical studies. I think that all of the special qualities attributed to particular glucosamine/chondroitin/chitin products, is hype.

As far as I can tell, glucosamine never get out of the gut and does not contribute directly to joint/tendon repair. If these supplements have any impact, it is by altering body-wide inflammation by impact on gut flora or the development of the immune system of the gut. There may also be interactions with the transglutaminase and AGE receptor, as I have speculated upon in other articles.

Remember, that most people are eating huge amounts of glucosamine/chondroitin as a natural part of eating meat.

LPS
Bacteria participate in the development of the immune system and one of the triggers is the outer lipopolysaccharide that extends from the peptidylglycan cell wall. This is a rich source of antigens and it is very inflammatory. Bacteria leaking from the gut shed LPS and trigger a system-wide response.

Saturated Fats
Meat and dairy are good sources of saturated fats that are safer than typical omega-6 vegetable oils.

Liver flushing and enemas
I think that most fatty liver comes from either fructose or alcohol. I don't think that liver flushing occurs and enemas should be used only in emergencies. A healthy gut flora should eliminate the need for enemas.

I think that inflammation is hard on cartilage production. Your symptoms are consistent with high levels of chronic inflammation. Typical sources are vitD deficiency, oral/dental infections, diet, obesity, lack of exercise. CFS has also been associated with viral infection.

Thanks for your questions/comments.

whitebeach said...

Dear Dr Ayers,

Thank you for your reply. I hope I am not asking too many questions but I live in an area of little medical knowledge/competence!

Do you think taking collagen would help/strengthen muscles/tendons?

If I have a leaky gut what is the best way to remedy that? I already take probiotics.

What do you think about MSM?

It has been quite difficult to figure out what is the cause of my inflammation. I am not obese, have a good diet, try to exercise, although CFS hampers that. I had all my mercury fillings out 15 years ago but still have a few root canal teeth and gold crowns. I expect sugar and moderate alcohol have caused a fatty liver. Although neither were excessive.

regards
John

Clarence said...

Please elaborate on vagal nerve stimulation.

Chiropractic adjustments to the upper cervical complex can stimulate the vagus nerve. Is this what you are referring to?

whitebeach said...

Dr Ayer's,

Have just spent half an hour trying to figure out which fish oil to buy.There are thousands of different configurations out there. Does it make a difference the ratio DHA to EPA? Should DHA be higher than EPA or vice versa? I know high DHA is recommended for bipolar etc just wondered which was best for anti inflammatory.

Could you also advise on which or what kind of probiotics to take? Once again there are thousands to choose from. I have been taking Kyo-Dophilus9.

Many thanks.
John

David said...

@whitebeach- Speaking for myself, I don't think the EPA/DHA ratio is an issue with most available fish oils. The combined total of the two is what you want to look for. I think a minimum of 3,000 mg combined EPA + DHA is a good starting dose, and this can be tweaked based on an omega-3 index blood spot test (you can get these online and shipped right to your door).

NSI at vitacost.com has a good fish oil (search Mega EFA) that is inexpensive and has 600 mg EPA + DHA per capsule. I also like Life Extension's fish oil, but it's a little more expensive.

Re: Probiotics. For a quick probiotic easily available to anybody, I like Sustenex, which you can get at Walmart, CVS, etc. It's a spore forming bacteria (Bacillus coagulans), so you don't have to worry about refrigerating it, and it easily survives stomach acid. On the other hand, it's only one strain, and sometimes more variety is helpful. If you can spend a little more, I'd recommend anything by Klaire Labs. They have multi-strain, high potency preparations that are truly top notch.

David

Carol said...

Thank you so much for writing this valuable article and for all your other helpful posts.

In the past few days I have been reading many many articles on this issue. It can be really confusing for someone like me and I was hoping you could help. I was wondering if you there are any good books out there that would go into more detail and suggest diet/cooking advice. Would you still suggest "The Anti-Inflammation Zone"?

There is type 1 diabetes and hypothyrodism on one side of my family. My child has type 1 diabetes and ASD. Depression and anxiety is so common in our family that it's just looked at as a normal way of life. Then there is the sciatica, high blood pressure, peptic ulcers, and cancers, amongst other things. I have had extreme anxiety since I was a child. I am constantly catching viruses, my doctor, when I was younger said I had a weak immune system. My sinuses are quite bad and cause me constant aggravation. I used to suffer from migraines. I get pains in my joints but even in other places too. I remember when I got a nasty virus and my knuckle swelled up right before my eyes. I've got acne and mild hirsutism. Sorry, I didn't mean to give you such a long list as I know you can't suggest anything. I was just trying to give a picture of what I'm up against.

Doctors that I have seen don't seem to want to look deeply into anything - they just tell me to exercise. I'm 125 pounds but I don't look healthy - people tell me I should gain weight! I was concerned about my child's diet too. They barely eat anything, apart from cereals, breads, milk, sometimes pasta, and junk food. The doctor and dietician said that it was okay though.

I was just hoping you could point me in the right direction. I have looked at the blog suggestions you have given, from your site, but I was hoping you could tell me of a website or book that give clearer more defined steps? Plus, cooking ideas and meal suggestions? Sometimes, when I look at information from many different sites, I can lose sight of what I'm supposed to be doing. I have done a lot of searching but I'm not sure what is best.

Hope you can help and apologies for the lengthy comment.

Dr. Art Ayers said...

Carol,
You have a family with chronic diet-based inflammation. You should be able to see dramatic results in two weeks with some simple changes in your diet.

Follow these steps:
1) Have your whole family take a small vitamin D3 capsule (2,000 IU), with each meal. If you miss some meals don't worry. Get some sun for a half hour each day -- your inflammation will make you burn more easily, so be careful for the first couple of weeks.

2) Eliminate all cereals, breads, pasta, potatoes -- all sources of grain and starch. Your family history shows lots of example of Helicobacter infections and gluten intolerance, so avoid these problems by kicking the grain/starch/sugar/high fructose corn syrup addiction for a month.

3) Eliminate all vegetable oils (use olive oil, coconut oil and butter) and supplement with two capsules of fish oil with each meal.

4) Saturated fats are your friends. The biomedical literature actually shows that saturated fats are safe and vegetable oil (omega-6) cause inflammation. Most of your calories should come from saturated fats and not carbohydrates. Eat eggs.

5) Eat all meals with meat/fish/eggs and green vegetables. No fruit juices.

6) Eat full fat live yogurt. If it contains pectin and inulin, that is an added bonus.

7) Look up pectin and inulin on Wikipedia and add fruits and vegetables with these gut flora boosters to your diet.

Dietary tastes and habits can be readily changes by just repeatedly eating new foods for three weeks.

The most important meal of the day is breakfast. Do not let your family eat cereal, toast, pancakes, bananas (high starch fruit) or whole grains. These are the source of your family health problems. Eat bacon and eggs, or meat omelettes or huevos rancheros or eggs Benedict. The goal is protein and saturated fat, while avoiding starch and grains.

Lunch is more difficult to find a healthy meal at a school, because they focus on starch and vegetable oils. Otherwise, you can work toward green salads with meat or fish. Simple salad dressings with olive oil and vinegar. Low fat salad dressings just use starch as thickeners. Avoid omega-6 vegetable oils (soy, corn, safflower, etc.), since they are very inflammatory. Enjoy lots of herbs and spices. Add peppers, onions, etc.

Dinner should be just meat and vegetables. Skip the starch and grains, since those are major contributors to your inflammation and gut problems. Enjoy broiled salmon with plenty of butter and lemon, or a grilled steak pierced with slivers of garlic. Microwave some broccoli or cauliflower until tender and then put it in a food processor with plenty of soft herb cheese and enough cream to make either a porridge or soup consistency. Add colorful veggies. Cheese sauces with plenty of butter and spices would be great additions. Just eliminate the starches. Get your calories from saturated fats and eliminate vegetable oils. For a couple of weeks just eat meat/fish/eggs and veggies.

With these changes, you should see dramatic results in the health of your whole family in just a couple of weeks.

I think that Dr. Sears and his anti-inflammation tips are a great start. I think that he still has too much starch in his diet for most people, but it is easy to just reduce the carbs. The Drs. Eades also have several books that share the same anti-inflammatory principles that I have used. I think that some other writers focus too much on the anti-oxidant properties of fruits and vegetables, and ignore the impact of dysfunctional gut flora. (Any members of your family that have frequent diarrhea or constipation, have problems with their gut flora.)

See my article on ASD and gut biofilm (look up ASD in the search window, top left) treatments.
I hope that these suggestions are quickly helpful.

Let me know how it works out.

Tanya said...

http://www.jacn.org/cgi/content/full/26/1/39#SEC3

Krill oil reduced inflammation in 7 days dramatically, and more by 14 day. Sales literature (mercola.com)says it is more effective than regular fish oil...only 300 mg per day was used in this study.

I also heard on the radio today that women who used deep breathing techniques prior to receiving painful stimulus had less pain...reminded me of the vagal stim exercises. More validation for the idea.

Have you ever heard of the HS Omega3 Index Test? Our local clinic offered it. It measures the levels of Omega 3s in the blood. Mine was 'low'...the goal is 8% and I was 5.2...my husband was 3 something! His vitamin d was 12 and mine is down to 40 (haven't supplemented in three months, dropped 10 pts or more). And I am the one that feels yucky?! I think he just accepts feeling crappy better than I do!

The test also showed my iron saturation is high...but I can't really figure out what that means. Made me think of the MS study about iron buildup in the cerebral vessels.

I visited my chiro back home this weekend and he suggested that my liver may be the source of my lingering inflammation. Something to do with my adrenals being overstressed with all the surgeries etc and that in turn affecting liver and cortisol levels.?

Here's to more vitamin D and some kind of oils for me! I am so glad the summer sun will be high soon and I can get some naturally!

Dr. Art Ayers said...

Tanya,
I think that your chiro may be on to something with your liver inflammation. Remember that pre-exiting inflammation in the liver can be aggravated by omega-3 (and omega-6) fatty acids that produce lipid peroxides. The result is that under those conditions, fish or krill oil will be inflammatory. The solution is to include more saturated fats and then the omega-3 are effective as anti-inflammatory agents to heal the liver.

I also think that inflammation makes it harder to achieve anti-inflammatory levels of serum vitD.

Increasing your saturated fats may reduce inflammation, increase the impact of omega-3s and increase the impact of supplemental vitD3 and sunlight in increasing serum vitD.

I also don't know what to think about handling iron. I think that iron is one of the potentially most dangerous dietary components. Women are usually protected from excess iron, but men are more susceptible, especially as they grow older (increasing inflammation?)

You certainly have (had?) a complex series of health problems. They seem to be simplifying and becoming more explicable.

Thank you for the updates and info.

Carol said...

Thank you so much for your reply. I really do appreciate it and I'm sure it will help others who read it too. It's giving me hope. I am looking forward to trying it out.

I've been reading about food and whole state vitamins. I started taking a food state multi-vitamin which included some Vitamin D3 and Lactobacillus Bulgaricus, should I take a certain type of vitamin brand/type? Does it matter whether it's in a food state, or whole food state, or not at all?

I do burn easily! I always wondered why I did more so than my family.

The main problem will be getting my child to eat other things as they are obsessed with tastes, textures, and smells. Not only that, the dietician told me to give them carbohydrates with every meal because of their type 1 diabetes - I still don't understand that.

It'll be tough, at first, but it's one step at a time. I'll start implementing things bit by bit. I will also look at the article on ASD and the books too.

Thank you, again, for taking the time to write me back. I did find it very helpful. I will let you know how we get on.

Tanya said...

Funny you mention my complex issues...my health insurance just assigned me a case manager to help me 'make the most of my benefits'. Ha!

Excerpt from Krill oil article:

"Why Full-Spectrum Vitamin E when Taking Krill Oil?

There is a good risk of "lipid peroxidation" within your body when you are taking high-dose "delicate" fats like Krill Oil without proportionately increasing the fat-soluble antioxidants (tocotrienols, full-spectrum vitamin E provide these fat-soluble antioxidants). Translated, that means that while you absolutely need omega-3 from Krill Oil in your diet, you should also seriously consider full-spectrum vitamin E to both improve the Krill Oil's effectiveness and avoid harm."

Wondering if the E would help tip the scales in my favor? I've avoided E due to the more recent studies showing it is not the great thing it was once thought to be...or is that all bad info too?

The chiro also gave me Vein Lite by Chi Enterprises...a Salvia spp. herb. It sounds a lot like aspirin without the effects. So going to do some slow liver detox stuff for a while and then try it. It also works on PCOS and other things, so am thinking it may be the 'thing' I need to get the inflamm. kicked.
I had been taking tylenol now and then when it got really bad but with the liver issue that doesn't seem like any better idea than the nsaids..but this headache is going to drive me to take something!!!!

Perry said...

Dear Dr. Ayers,

Thank you for this wonderful resource, it is very much appreciated.

I thought I would drop a question here on your big anti inflammation diet post considering you have the widget showing all new posts.

As an eight year Ibuprofen user, I have recently (5 weeks) decided to stop taking it and get to the bottom of my inflammation which is mostly joint and tendon pain, bad low back, and some mild gout and psoriasis.

I am following your diet and eliminating all wheat based foods. I have had good success but ran into an unexpected road block.

Two weeks in, I changed fish oil brands going to a triple strength formula and taking two pills daily. One pill has 950 mg omega3's and 1360 mg total fish oil. The other formulation that I ran out of and changed from was much less.

Within a few days I developed considerable nerve pain in one or two toes, one or two fingers and the back of the hand. It ranged from numbness to tingling to outright pain. My wife experienced the same thing with the new fish oil. We both stopped taking it and symptoms immediately abated.

What are your thoughts? Did we get bad fish oil or just take too much or some other x-factor?

I also got sick with what felt like a viral infection and had what looked like shingles in beginning stage As a child I had chicken pox and once as an adult got shingles badly when I was run down.

How could I go from feeling great to very weak in such a short time all the while eating a good anti inflammatory diet? Could it be bad fish oil?

Now that I am better. I think I want to try that first formulation and dosing that had me feeling so good. I still have some inflammation and joint pain that I suspect will be with me a while.

Incidentally, a small 1/8th teaspoon of turmeric powder takes all my joint pain away for the day but I haven't been using it because I have the idea from you to deal with the underlying causes of the inflammation. Does the fact that Ibuprofen and turmeric work for me tell you anything?

Thank you again.

Dr. Art Ayers said...

Perry,
Long term NSAID use can lead to leaky gut syndrome, bacterial infection at other points of inflammation and the liver. These new chronic inflammations can add to the overall load.

You didn't mention your vitD serum levels or supplements or your saturated fat intake.

Fish oil can be inflammatory to the gut or to the liver if pre-existing inflammation is present. The result is inflammatory lipid peroxides. This can be avoided if saturated fats are abundant in the diet.

Turmeric is not usually effective in such low doses, even though it contains curcumin, a very potent NFkB inhibitor, because it is inactivated in the intestines. Does this suggest that your gut is still compromised from the ibuprofen? It does suggest that intestinal inflammation is still a part of your joint symptoms.

I would suggest that you check your vit.D (supplement/get sunlight until your serum level is 90 ng/ml) to help kill errant bacteria, eat more saturated fats to satisfy your calorie needs, supplement with glutamine to heal your gut, eat full fat live yogurt (preferably with pectin and inulin) to improve gut flora. After a couple of weeks of healing, you can check your sensitivity to fish oils again.

I hope that this helps. Let me know how it works.

westie said...

I really love your blog. Thank you very much for the work.

There is one thing that kind of bothers me at the moment and I think you might be a good person to answer.

I hope you don't find this too stupid but what makes main omega-6 fatty acid, linoleic acid, proinflammatory?

Tanya said...

http://www.irondisorders.org/anemia-of-chronic-disease

Thought this might help with the understanding of iron and inflammation?

Tanya said...

I came across this article
http://raypeat.com/articles/aging/aspirin-brain-cancer.shtml
while researching an antecdote from a friend about a woman with similar symptoms as mine who eventually was diagnosed with an iron and hormone related condition. A hysterectomy eliminated her symptoms. I'm not interested in trying that, but am once again intrigued by the recurring themes of iron, hormone, and thyroid. Hoping to get someone to look into it with me when I return to Mayo perhaps.

Dr. Art Ayers said...

Tanya,
Iron is a huge topic and I am only beginning to put together a picture of all of its interactions. For example, iron is also used to produce HCl in the stomach. Iron is also needed for oxidative bursts and of course iron limitation, e.g. lactoferrin, is important in milk and tissue defenses.

Limiting iron uptake seems to be important and men are particularly sensitive to excess iron. Ingesting grains may be beneficial, because they can minimize excess iron consumption from meat, because the phytate in grain chelates iron. Gut flora may regulate iron uptake through the production of phytase to remove the phosphates from phytate. I speculate that antibiotic use in meat production may alter phytase production in agricultural animals, reduce iron intake, but also result in extra phytate remaining in feces and contributing to phosphate pollution.

The aspirin article does not discuss the action of aspirin directly on controlling the stability of NFkB, the transcription factor that controls COX-2 production. I agree that just considering the action of aspirin on COX-2 alone is simplistic. Also, inflammatory eicosanoids are needed for normal gut development. It is thus healthier to avoid spot sources of inflammation, rather than attempting to lower overall inflammatory capacity, e.g. by aspirin.

I hope that my ignorance of hormonal interactions based on estrogens or thyroid hormones won't prevent me from understanding inflammatory diseases. I just assume that problems with steroid hormones or thyroid are symptoms that will fade once inflammation is controlled.

Thanks for the input.

westie said...

I've been reading your educational articles and I came to the conclusion that inflammation you are fighting here is related NFkB and COX-2 activation.

There are couple of things that I find hard to understand:

1) Inflammation and cancer are related but cancer does not need inflammation; inflammatory responce of the body immunesystem kills cancer cells e.g. Th-17.

Immunosuppression of linoleic acid derived PGE-2 helps cancer cells to survive in a hostile environment.

2) Alzheimer is not caused by brain inflammation because brain inflammation seems to cure the disease or atleast stop the progress.

I think AD could be a result of a chronic inflammation/stress which modulates immunesystem and makes brain uncapable to clean away Abeeta.

Dr. Art Ayers said...

Westie,
What is inflammation? That seems to be the heart of your comment and that definition is a stumbling block for the explanation of immune function and cancer.

When I talk about inflammation I mean the cellular activation of the NFkB transcription factor that controls the expression of five or six dozen genes associated with inflammation, e.g. TNFa, interleukin 1, COX-2, iNOS, heparanase (inflammatory cytokines, prostaglandins, NO, heparan sulfate proteoglycan metabolism.) Expression of these genes in a tissue results in the symptoms of inflammation: swelling, redness, pain, heat.

NFkB is also required for the elaboration/removal of tissues that respond to steroid hormones and other forms of proliferation, e.g. cancer. Thus, NFkB activation blocks apoptosis. Thus, inflammation-based phenomena, e.g. cancer, postpartum depression, acne, etc. can all be treated by various applications of aspirin, which alters COX-2, but also acts on NFkB activation directly. NFkB, as the name indicates, is also intimately involved in immune system function and the immune system can influence all of the other phenomena, including cancer.

Alzheimer's may be a result of the innate immune system related to vit.D receptor/transcription factor, since Abeta seems to act like other antimicrobial peptides under the control of the vit.D receptor. Abeta fibers also form when heparan sulfate proteoglycan expression is suppressed by inflammation. I agree, that chronic inflammation may be necessary for AD to progress. Berberine, which blocks amyloid production by binding to heparan sulfates, should be an effective treatment for AD, if it crosses the BBB.

Thanks for your comments.

crapartist said...

Dear Dr. Ayers,

So you oppose brown rice, oatmeal and the like on an anti-inflammation diet?

Great work here (anything on rosacea especially appreciated). Many no doubt thank you, including myself.

Dr. Art Ayers said...

Crapartist,
I think that it is easier to stay anti-inflammatory on a low carb diet. Avoiding grains/gluten is also helpful for most. Small amounts of rice seem to be fine and coarse oats seem to be less of a problem than most grains.

I have several articles on rosacea. Just use the search (upper left) or index (lower right), to find your way to those articles. If you have any particular questions about rosacea, ask and I will see if I have any relevant insights.

Thanks for your comments.

crapartist said...

Many anti-inflammation gurus encourage fruit, some grains. such as Sears, Perricone, Weil.

While other doctors/ "experts" disagree.

Gluten and dairy are almost always off all lists, understandably.

these divides are curious, especially regarding fruit.

.

Dr. Art Ayers said...

Crapartist,
I don't think that it is hard to explain why most people put grain and fruit into diets. There are big agricultural interests behind those commodities.

Cereal and bananas are as important in some cultures as apple pie. At least apples have pectin.

Grains are hard on a lot of people and I think that the problem with grain intolerance is the high background level of diet-based inflammation. Absent the high inflammation, I think that more people would tolerate grains very well. The real culprits leading to the downward cascade are probably omega-6 vegetable oils and fructose.

Fruits are no problem and are probably healthy whole. Fruit juices are another problems, because they are so rich in fructose/sucrose. These juices are a major problem for children. The Dickens culture fed babies gin and modern cultures feed children fructose, which is metabolized the same way as ethanol.

Thanks for your questions.

crapartist said...

I'm fairly certain the doctors i mentioned and others have no interest in agricultural profits when encouraging certain grains and fruits on their anti-inflammation diets.

They are not advocating the Govt's ridiculous pyramid (which has huge financial interest in grain/ag).

but understand your point.

Anonymous said...

I am severly Vit D deficient, with bad IBD, fructose intolerance, wheat allergy and suffer periodic arthritic back flare-ups. Going grain-free is the only remedy for the pain. I had a gene test for the HLA-b27 gene but it was negative, so I went back to eating grains (rice and oats). I have had a very bad repeat of pain after eating rye bread. Is there another gene for starch related back pain, or are grains inflamatory for us all? How can I get back to normal as at the present time my list of foods to eat is very limited. I seem to react to everything.

Dr. Art Ayers said...

Anonymous,
If you improve by getting off grains, I take that as an indication of gluten intolerance. Most of the tests for celiac are hit or miss. Checking for a genetic predisposition is interesting, but shouldn't, in my opinion, be used to dismiss observations of improvement when gluten is removed.

I think that gluten intolerance or some form of celiac is grossly under-diagnosed. The first step for most people with chronic digestive issues should be to get off grains and shift to a low carb diet.

In your case, I would suggest correcting your vit.D deficiency as a high priority, then focus on correcting your gut flora with a goal of having normal bowel movements. Lactulose has been shown to be helpful in developing more normal gut flora. So shift to the anti-inflammatory diet that I recommend. That means low carbs, more saturated fat, no vegetable oils (use olive oil, butter), pectin and inulin. All of these will change your gut flora, which means that you will interpret the gut reaction as intolerance, so go slowly and be persistent. Food intolerances are mostly due to poorly adapted gut flora and not food allergies. Constipation indicates a very damaged gut flora and needs lots of work to restore normal function. A normal gut flora is incompatible with antibiotic use.

Thanks for your comments and let me know how your progress.

Anonymous said...

Hi Doc, thanks for the great information on immune response and the gut. My question is; what about body responses such as bad headaches, rashes, itchy skin and eyes caused by food with either high level amine (chocolate, meat) or salicylates (peppers, chili). If I get my gut bacteria sorted out will I still get these affects. Also I was given some Saccharomyces boulardii to sort out my diarrhea and I had to stop taking it as it caused a bad rash all over but especially around my mouth. The manufacturers said it was an amine response. Since taking your advice I have been able to tolerate Kefir before each meal and am enjoying soft cheeses for the first tiem. When would it be safe to try chili again or should I stay away from it altogether.

Dr. Art Ayers said...

Anonymous,
I haven't read a convincing explanation of salicylate and amine intolerances. I have read that salicylate intolerance responds well to fish oil supplements. That being the case, I would suspect that some aspect of inflammation is involved.

It seems odd that some people are sensitive to aspirin and salicylates, since those compounds inhibit key parts of inflammation.

I would suggest that you continue expanding your diet and improving your gut flora, before testing your ability to tolerate previous triggers.

Have you checked your serum vit.D?

Thanks for your questions.

Anonymous said...

Dear Dr Ayers, I have been corresponding with you regarding my low vitamin D level and IBD. I also suffer from arthritis and find staying away from tomatoes and potatoes helps me with pain management. Is this imagination? I found a web site, http://www.westonaprice.org/Nightshades.html,, that states that nightshade plants conatin another form of vitamin D, Calcitriol. This apparently signals the intestines to absorb calcium from our diet, too much calcitriol, the most active form of vitamin D. Overconsumption of calcitriol from nightshade foods can circumvent the kidney’s control and over time lead to calcium deposits in the soft tissues such as the tendons, ligaments, cartilage, cardiovascular tissues, kidneys and skin. What if calcinosis could explain most, if not all these osteoarthritic changes? Instead of your joints wearing out, what if nightshades and their calcitriol content were causing the joints to slowly calcify?

Dr. Art Ayers said...

Anon,
I don't doubt that some people are sensitive to nightshades, but I doubt that nightshades contribute much to the symptoms you describe in most people.

All of the symptoms that you describe are classic for chronic diet-based inflammation. In most cases those symptoms will be eliminated by the diet that I recommend. On that diet, fish oil can be increased until the symptoms are controlled. This shows to me that the source of most of the symptoms is inflammation.

IBD provides some complications, because it involves a major disruption of the interaction between the gut and gut flora in the lower part of the small intestines that is involved in immunotolerance, suppressing immune attack on self or common bacteria.

So a major goal of IBD is to normalize the gut flora to repair the gut. I don't see any problem with avoiding nightshades, if it makes your gut happy. You should be able to tell when your gut is in better shape, because it will no longer be sensitive to the nightshades.

My current thinking is that nightshades are not a problem for most people, so the people who do have problems are probably sensitive because of their other health issues. That is why I focus on eliminating the diet components that cause inflammation.

Thanks for the comments.

BendB said...

I wonder how to identify causes of inflammation? I have elevated c-reactive protein (never below 5 and as high as 14 over past decade, no trend). Above 3 is said to mean something other than coronary heart disease (my EBT score was zero so no plaque). Lots of tests ruled out typical causes.

I follow the anti-inflammatory diet and lifestyle as recommended by Dr Ayers, but from many other sources (TYP, Animal Pharm, MDA).

I feel much better than ever before but can't say why I have still inflammation and what to do about it.

Any ideas?

David said...

BendB,

What is your vitamin D level? Do you take fish oil? If so, are you taking enough? Get these basics worked out and maybe throw in some niacin, 1,000+ mg if CRP is still elevated.

David

BendB said...

David,

Thanks for replying... I've seen your comments at Animal Pharm too.

Yes, as a TYP'er (supporting my husband's efforts there), I have normalized vitamin D levels (60+) and continue to take 5000-10000IU depending on the season. I take fish oilabout 1.5g , could take more.

I wonder if niacin is helpful for me, since my HDL is consistently mid-80s. But I noticed a short comment about N.O. here and wonder if l-arginine would be helpful for awhile.

Animal Pharm got me researching thyroid and adrenal health... along with *all* the hormones, as Dr BG puts it.

What interests me most with Dr Ayers is the idea of populating a healthy gut. I am adding apples and leeks, along with other pectin and inulin sources. Just today, Mark's Daily Apple blogged about prebiotics. I feel that's the direction for me, but it's still hard to work out a solution to inflammation without a definitive cause. Maybe just SAD until the last few years and it takes time to recover. Or I could just be a poor candidate for c-reactive protein testing. My doctor suggested seeing a rheumatologist in case I had early arthritis, but really, my joints are not suffering since reducing grain/wheat.

I'll keep reading the blogs and trying suggestions that fit my profile. I judge my health by how I feel since the tests haven't revealed any clear issues.

Tanya said...

BendB

I have tried l-arginine and it was like a major high from the detox when I started taking it (along with some other things like MSM at the time...tried several new things at once...bad idea!) It is considered a female viagra, which I experienced, (aspirin has a similar albeit much lower level effect for me). One caution...it messed with my moods (I tried it again later without the other stuff and it still messed with my moods)...and found out it is contraindicated in people with history of depression (which I don't have but quit taking it anyway). I have been considering trying it again...it and MSM made me feel great but the MSM = rash (toxicity?) on my legs so am hesitant. Seems the NO factor/circulation is important.

My crp is below 1 now and highest I know of was 1.6 but I hurt like it should be at 15! Hoping to someday get to the magic vit D level where it starts to help and then try fish oil again too. My diet has been anti inflamm for over a year more or less and not very SAD before that.

Diet doesn't really seem to change my condition much. I too am investigating hormones as my dizziness post stroke comes on strong when my period starts and have suspected thryoid for a long time.

Chronic Lyme--read somethings (for and against) high dose Vit C and salt...interested to hear what Dr A says about that idea...

rainarana said...

@BendB

"my joints are not suffering since reducing grain/wheat."

Interestingly, I felt much better when initially eliminating most grains but started getting joint pain (and other symptoms)from too much fructose. Whole grains, which we're told are better for us, contain fructans, or inulin which is converted to fructose as it's digested. I found out about fructose malabsorption, which fits my symptoms perfectly, and many of the prebiotic recomendations fall into the forbidden food category. A lot of people with FM follow the advice of nutritionists who are even familiar with FM, in eliminating the problem foods, but I agree with Dr. Ayers, that the more you eliminate the more you have problems with. A lot of people that I've seen with FM also have a history of antibiotic use, which says to me that dysbiosis is a factor. I haven't used antibiotics much, but for about a year was taking a lot of narcotic (constipating) and NSAID (can cause intestinal permeability) pain killers due to a badly herniated disc in my neck.

I don't know what my D levels are yet, will find out next week. I finally convinced my doctor to run a battery of tests to rule out anything more serious, including parasites. I've spent a bit of time in E. Europe, driving around the countryside eating local food, etc . . .

Anyhow, after all that, I think gut flora is an important piece of a puzzle that most doctors either don't understand or just ignore. I go to my doctor now with a list of tests that I want and tell her how I plan on treating myself. It'd be funny if it wasn't so sad, but after being told too many time that there is nothing wrong with me I've gotten kinda fed up. I do have a tendency to get a bit gung-ho and have made myself miserable instead of just uncomfortable a couple of times. You have to pace yourself. Unfortunately I've yet to find an outline of exactly how it's done, what to expect, time lines and so forth.

Dr. Art Ayers said...

BendB,
I think that the readers have picked up on most of the obvious approaches to lowering inflammation with Diet and D. But you have already being doing those things and have successfully reduced some joint inflammation by reducing grain.

The persistent elevated CRP is a hint of some source of chronic inflammation as you have identified. That combined with the response to grain would suggest celiac and the remedy would be gluten avoidance plus gut flora restoration, also as you note.

CRP is produced in the liver in response to fat cytokines. It is also interesting that the CRP molecule itself belongs to the pentraxin family of flattened jelly donut structures made of beta sheets with a hydrophobic center that could probably carry steroids. The surface has several heparin-binding domains. It is also related to the trimmed-off ends of collagen molecules, e.g. collagen XI. CRP binds to the phospholipids with choline attached. So, CRP has several connections with lipids and lipid metabolism.

I would suggest that you may have visceral fat that is contributing to CRP production. Fasting would produce enough and anti-inflammatory signal to reduce CRP, if this is the source.

Rainarana also brought up the CRP liver connection by talking about fructose. Fructose acts on the liver in the same way that alcohol does and I would expect that the results would be sensitive to saturated fats. Thus, saturated fats can be helpful in healing the liver in response to omega-3 oils.

Vitamin C and salt are interesting in the context of gut flora, etc. Note that vit.C acts as an anti-oxidant, but it is also involved in connective tissue matrix production. Without sufficient vit.C, you can't produce collagen (hydroxyproline) and the result is scurvy. Joint inflammation may change the requirement for vit.C. Chronic Lyme may benefit from the impact of vit.C as an anti-oxidant in handling ROS as well as in collagen synthesis. Salt is used both in acid production in the stomach as well as in hormonal control of blood pressure.

Lyme is far to complex to discuss as a single disease, since it is a suite of intermingled diseases that differ with each tick bite.

Thanks for all of the comments/questions/answers

mary said...

I have enjoyed reading your blog. I am a (perhaps permanently) retired physician who has been spectacularly unsuccessful in helping patients adhere to anti-inflammatory guidelines similar to yours. Even when they questioned me about my 40# weight loss and heard my story, eyes usually glazed over when they heard they might...benefit...from...cutting...back...on...refined......carbohydrates!!! Not able to even think about it for the most part.

I have been looking at your site now for several days. Have you put up any info linking fibromyalgia and the inflammatory lifestyle? Do you have any specific suggestions for those with these type of bodily complaints? I've prescribed my fair share of cymbalta etc with only mild success. The other suggestions I've given have been as well received as the ones about carbs!

Finally, I would be interested in more on vagal nerve stimulation. I don't see a search function for your blog and the articles/labels you list don't have many specifics. Your post on the anti-inflammatory lifestyle mentions this topic, though, so I am curious what stimulation would entail. I'm guessing deep breathing exercises?

Thank you!

Jimmy said...

Dr. Ayers,
I was hoping you could clear this up for me. I saw a new study for this month of June 2010 titled "Protein causes a glycemic response." Being that insulin and high blood sugar are causes of inflammation, and protein raises insulin, how does protein fit into setting up an anti inflammatory diet? For example, lets say I'm someone with a goal of eating 225 grams a day.. is protein amount per meal significant in causing inflammation, say if I were to eat 30 grams vs. 75g a meal? I was curious as someone might prefer to eat xxx amount of times a day vs. xxx but still be as anti inflammatory as possible. Just curious if this is relevant in the scheme of things.

Anonymous said...

Dr Ayers,
I have high blood pressure and I'm taking Losartan potassium tablets to lower it.
High BP is a symptom of chronic inflamation, correct? And on you list it says not to eat saturated fats. So what do I do to be able to eventually include it in my diet?

Dr. Art Ayers said...

Anonymous,
I made my sentences a little too complicated.

Saturated fats are healthy, in fact healthier than vegetable oils. Saturated fats are also important to protect against potential problems of taking omega-3 oils to lower existing local inflammation, e.g. in the liver.

Start adding saturated fats slowly to permit your bile production to increase. Take vit.D3 supplements with at least 4 grams of fat in the same meal to stimulate bile-mediated uptake.

High carbs are more of a problem for serum lipids, especially triglycerides, than saturated fats.

Thanks for asking for clarification.

Dr. Art Ayers said...

Mary,
I also find psychology challenging in helping people to help themselves via diet. My readers seem to be much more highly motivated to change, but still, even obvious changes, such as moving away from bread or cereal, are major issues. They seem to be as American as apple pie.

I do provide a search function in the blue bar, top left. Unfortunately the comments are not searched and my readers and I put a lot into the comments.

I don't provide specifics, since that seems to be like prescribing. I try to explain how the body works, getting a broad view from discussing many different diseases and people have to fill in some of the blanks for their condition. Amazingly the same simple answers support the cure of many different diseases.

Fibromyalgia, CFS, chemical sensitivity all have a major interaction between the nervous system and immune system. They are all collections of diseases with multiple entry points and similar symptoms. So, for a biochemist/molecular biologist there are a couple too many black boxes. I haven't tried to conceptualize fibromyalgia, but now I will give it some thought.

The vagal stimulation exercises include many of those used in yoga, as well as facial responses to ice water and others used to provide vagal interventions for tachycardia (Valsalvo):
http://www.emoclear.com/thedivereflex.htm
http://www.emoclear.com/thelongevitymaneuver.htm

Thanks for your input.

Tanya said...

Re: Searching this site... If you add this site:coolinginflammation.blogspot.com after the terms in Google, it will search the comments as well as the posts. Hope that helps!

Dr. Art Ayers said...

Jimmy,
Dietary protein does cause both a serum glucose rise and an insulin response. I notice the consequent drop in blood sugar, with a protein shake or a bacon and egg breakfast. I doubt that it happens when carbs are present at the same time. It makes the most sense to me to eliminate extra starch and grain. It isn't missed unless it is eaten. It may also be the case that more saturated fat in the diet decreases the glycemic response to protein.

Thanks for the comments/questions.

judi said...

Dr Ayers,

This goes back to the prolapse discussion.

Isn't MSM supposed to heal/support tendons?

I don't see a mention.

Also chondroitin is often combined w glucosamine and I am wondering if there is any necessity.

What do you think?

Thanks.

Dr. Art Ayers said...

Judi,
I don't think that MSM has been very successful in clinical trials and I wouldn't expect it to do much for connective tissues.

I think that reducing chronic inflammation and associated oxidation stress would be most important in tendon health. Vit.C is intimately involved in collagen production and oxidation stress depletes vit.C and weakens connective tissue. Inflammation also lowers production of the polysaccharides present in connective tissue.

So, I would suggest vit.C, acetylcysteine and vit.D3, as being most important. Glucosamine and chondroitin may impact system-wide inflammation by acting on the gut, but when eaten, they don't make their way to connective tissue.

Thanks for your questions.

Valtsu said...

Hi Dr. Ayers (again :o). What do you think about those articles about fruits and vegetables written by Peter Dobromylskyj in his Hyperlipid-blog? He also seems to read a lot of studies as you too but he claims that he doesn't really think even vegs are that healthy.

And there's similar article in Don's blog "Primal Wisdom", title is "Phytochemical Fallacies?".

Health is quite a difficult topic :S

Dr. Art Ayers said...

Valtsu,
Peter and Don are real health heros. They debunk lots of health myths and provide sound eating advice. I think that they are correct in questioning the health claims of fruits and vegetables. Also, I agree that the anti-oxidant aspect of phytochemicals is over-rated and mostly incorrect.

I disagree on two other areas in which I see potential benefits of veggies: fiber polysaccharides as food for gut flora impacting the gut-associated immune system, and phytochemicals that modulate disverse signaling pathways throughout the body. Phytochemicals also influence the gut flora, e.g. herbs and spices culturally used to control food-borne pathogens.

Impact of food on health is only studied to sell the health benefits of particular foods. Whole foods are not supported by research and phytochemicals in foods are seldom used to support health goals. Phytochemicals must be extracted from plants, before they can be commercially exploited. There is also minimal research on common food components, such as pectin or inulin, and M.D.s seldom bother to make dietary recommendations (even if they had accurate nutrition info), because of the frustration in trying to change diets that are causing diseases. [Note that some people require the extreme of bariatric surgery that has no impact, in order to enforce a weight reduction diet change (in some ways similar to the Drs. Eades 6 Week Cure.)]

Thanks for the comments.

Me said...

Hi,

I was wondering how you stimulate the vagus nerve - on your own.

Thanks,
~K

Dr. Art Ayers said...

~K,
There is a link to vagal stimulation exercises at the bottom of the article on the subject found in the index for this site at the lower right. You can also use the search function for this sight in the blue bar at the top left.

There are numerous ways to stimulate the Vagus nerve in general including:
the Valsalva maneuver
joga relaxation exercises (shavasana)
immersing the face in cold water

Thanks for the question.

Gardensongs said...

Dr Ayers,

Just started reading your blogs, also reading Hyperlid and Paleonu. New to all this.

Some history:

I'm 61, about 60 lbs overweigh, lost 10 pounds past month. Weight gain was slow over 15 years, always at 120 (except for 3 pregnancies) till then.

12/2004-acute anemia-ferritin level 6. IV infusions 3 over 12 months – now 182, checked yearly.

1/2005-hypothyroid, probably had 6 years previous. 112 mcg Levothyroxin.

6/2009-acute de Quervain's tendinitis left wrist, mild right. PT/acupuncture/massage/chiropractic/splinting-no cortisone-almost pain free now.

3/2010-celiac, gluten free since

5/2010-"see stars" re-injury left wrist, new PT (taught diagnostics at Duke U), sent to Rheumatologist, MRI showed DeQuervain's and "early degenerative changes at the triscaphe joint & slightly increased signal and probable degenerative changes at the DRUJ"

6/21-RA factor 61
Anti CCP negative
sed rate by modified Westergren 9
C-Reactive protein 0.21
Rheumatologist dx-RA. Prescribed drugs, I refused-she will follow me as I search for alternatives.

5/2010:
D, 25 oh total 36-up from 31-supplementing 8000 D3

Edema in feet, ankles, knees, hands wrists, forearms & throughout rest of body. 5 acupuncture sessions & 1 lymph drainage massage last 3 weeks.

Paleonu diet past month.

Started a 3.5-day water only fast. Broke the fast when I started getting dizzy-with bacon and spoonful of honey in tea. Two days of bacon and honey. Lost 5 pounds and measureable inches throughout body. Less pain in joints, more mobility.

Steak last 24 hours-stiffness & swelling are returning,

Any help would be really appreciated, so much to learn, so many variables.

1. Any general ideas about this whole adventure, what the test results mean or don't, what else I should be doing/not doing.

2. Peter at Hyperlipid http://high-fat-nutrition.blogspot.com/search/label/Rheumatoid%20arthritis%20and%20fasting
makes a argument for starving the gut bacteria, P. mirablis, for RA until symptoms subside. What's your opinion?

3. Are supplementing with probiotics a good idea? Homemade heavy cream yogurt? (12/2009 my stool analysis for lactobacillus, biufidobacterium and bacillus were all negative and MD encouraged probiotics)

4. any additional tests recommended?

6. Additional supplements?

Thanks for any help you can give me. Looking at this as an exciting adventure instead of a terrible life sentence.

Susan

Dr. Art Ayers said...

Gardensongs,
I would guesss from your description that you have Hashimoto's thyroiditis, which is an autoimmune disease of the thyroid that has progressed from the celiac. That is rather a typical progression based on a combination of diet-based inflammation and simplification of gut flora that leads to disfunction of the immune system. The result is constipation and autoimmune disease.

You have already taken the first step of getting your serum vit.D back to normal. The next step is to eliminate vegetable oils, reduce starch, increase saturated fats and supplement with fish oil capsules. Eat a variety of meat/fish/eggs/dairy, no grain, and lots of low starch veggies. You may still be deficient in some vitamins and minerals, but that will improve with the healing of your gut and gut flora.

I recommend probiotics followed by soluble fiber: fruit/veggies with pectin and inulin, e.g. apples and leeks. The goal is normal stools with no constipation.

You will find as you read through my other articles (ca. 170) that your problems are rather common and others have fixed them with simple diet changes. The gut reconstruction will take months of persistence. Some of the food will cause what seems to be bowel discomfort associated with food intolerance. That is an indication that you are lacking some essential gut flora and will need time for your gut flora to adapt. You should be able to adapt to everything except grains.

The diet I recommend should be easy to maintain. You may also have intestinal yeast. Try the Drs. Eades' diet, 6 Week Cure, to shift to the high fat/protein, low carb diet that I recommend. They include a couple of weeks concentrating on milk whey shakes that may help the transition. I have a couple of articles on my experience with that diet. It is simple to follow and it works both for weight loss and transition to a low carb diet.

Let me know how it goes.

kim said...

would any of your recommendations change for lupus? is the saturated fat still acceptable and if so how much per day would you recommend? is zma alright? as a child i had stephenson johnson syndrome which i think is an immune disorder as well so maybe there is some underlying issues, so right now avoiding starch and gluten.

also in regards to soy is it ok if fermented like tempeh and edamame but not good if in soymilk or tofu?
what is your recommendation to put in coffee then?
thanks

Dr. Art Ayers said...

Kim,
I don't know about any special food prohibitions for lupus.

I see lupus as an autoimmune disease based on inflammation and dysfunction of the tolerance component of the immune system that, which is based in the gut associated immune tissue. This means that the development of lupus requires chronic inflammation, e.g. high carb/veg. oil diet, and a disruption of gut flora, e.g. antibiotic treatment. The inflammation will provide the tissue destruction that releases cell proteins that produce an immune response when the tolerance system is corrupted. The self antigens involved is determined by their content of domains with basic amino acids.

Curing lupus would require a longterm shift to an anti-inflammatory diet and restructuring the gut flora to repair the immune system of the gut. I outline the recommended diet and the goal of restructuring the gut flora is normal stools (no constipation) with tolerance of a wide variety of vegetables.

I don't think that ZMA, soy and coffee will make any difference.

Thanks for for your questions/comments.

Anonymous said...

Dr. Ayers,

I wanted to follow up on your thoughts about my inquiry of trying to conceive and glucosamine on 10/13/09. I took your reply to heart, and focused on the anti-inflammatory diet and also started supplementing with vitamin d and omega-3 salmon oil - no glucosamine though. I am convinced these changes led to my subsequent conception. I am currently 30 weeks pregnant and looking forward to our baby's birth in September. Thanks for your insight. I love reading about your research and the findings. By the way, I'll be 43 in October, and was having a lot of problems with joint pain and I'm sure overall inflammation in my body when I initially came upon your blog. I'm doing so much better now in every way after taking your advice. Thanks again!

Dr. Art Ayers said...

Anonymous,
Wow, someone got pregnant just by reading my words of wisdom! Those are potent words.

I am so happy that simply shifting to a healthy diet has been the help that you needed.

Keep me updated.

Anonymous said...

Thank you so much for your blog and your research. I was wondering how to re-build my gut flora. I have been suffering from constipation for a few weeks now.

Dr. Art Ayers said...

Anonymous,
Constipation should not start suddenly, unless it follows antibiotic use or is due to simple dehydration.

If you have constipation due to oversimplification of gut flora, then regeneration of gut flora occurs by replenishing the bacteria in the upper, minimal oxygen part of the GI tract with probiotics and then using soluble fiber (pectin/apples, inulin/leeks) to feed the lower gut flora. Some source of new bacteria, e.g. fresh veggies that are not over cleaned or sterilized, is needed as well as diverse sources of plant polysaccharides found in green veggies. There are hundreds of different species of bacteria in the healthy gut, so it takes time and great diversity in diet to cultivate all of the needed bacteria.

The goal is normal stools and no food intolerances.

Thanks for the question.

Anonymous said...

Dr Ayers
I found your site through Whole health source blog. I have samter's disease for last 7 years,which i acquired while living in USA. I had horrible sinus problem with polyps. I gave up gluten after reading Stephan's blog. I felt lot better. I never realized how important Vitamin D is. After reading your blog i started taking 5000 IU Vit D and there is tremendous improvement. After 6 years of no sense of smell I have started to smell things again, a faint smell but better than none. I have to thank you for your convincing posts on vit D and inflammation. I have tried 100s of supplements before but never thought vit D will be helpful for sinus. Im still bit confused how does vit D minimizes inflammation. I have one small question about olive oil. According to wikipedia omega6: omega 3 ratio of olive olive oil is between 3 to 13. How do i know which oil has ratio 3 and which one has ratio 13. If its 13 then its a bad ratio.
Sincerely
Rashed

Dr. Art Ayers said...

Rashed,
I don't think that the 3/6 ratio in olive oil is as important that the polyunsaturated fatty acids are less than 10% and most of the olive oil is monounsaturated or saturated fatty acids. The low PUFAs make it a ok oil for cooking, although the PUFAs are still too fragile for high heat and can produce inflammatory products.

The point is to reduce intake of the major sources of omega-6 fatty acids, the vegetable oils. The common vegetable oils and high dietary starch are the major health threats in modern diets. Saturated fats are not a problem and the biomedical literature, when properly analyzed, supports their safety over vegetable oils.

So I don't worry about the quality of my olive oil. Of course it would be useful to pick a "peppery" olive oil to optimize the antioxidants, but that is no big deal compared to avoidance of vegetable/seed oils.

I hope that you are aware that humming is the best treatment for sinus problems/infections. It is much more effective than antibiotics.

Thanks for the question.

Anonymous said...

Dr Ayers
Thank you for your advice. I tried humming and yogic breathing before. It helps only when nasal blockage is not too severe. I have nasal polyps, so cant always hum . But when im able to hum it really helps. As part of Samter's triad i have nasal polyp , asthma and aspirin allergy. I was off Asthma medication when i stopped taking vegetable oils, i thought soybean oil was harmless.I am following your anti inflammatory diet with daily small servings of rice. I gave up gluten but i cant convince myself to give up rice, it doesn't have a bad reputation. How bad is rice? My asthma feels way better just after few weeks of fish oil and vitamin D. My nasal congestion has improved . Do you think this diet will cure my polyps? I don't want to have any more surgery and want these polyps gone for good. I had had them for last 7 years,its really annoying. I feel hopeless about this polyps. I will appreciate your comments.
Thanks
Rashed
ps:Wikipedia has two numbers for omega 6 contents of olive oil. Under olive oil page it says omega 6 contents is between 3.5% to 21 %.
Under Linoleic acid page it shows omega 6 content as 10%.

Dr. Art Ayers said...

Rashed,
I think that small amounts of rice are ok as long as most of your calories are coming from saturated fats.

I also think that your point about the variable content of omega-6 fatty acids in olive oil is correct. I think it depends on whether the pits are crushed with the rest of the olive to increase oil yields. The seeds seem to be the major source of omega-6 fatty acids, e.g. soy, corn, etc. It doesn't seem like the olive oil industry wants to make their omega-6 content readily available. I don't know where to find the composition of individual brands of oil.

Aspirin sensitivity is a physiological response and not usually immunological. I don't understand how it ties in with asthma and nasal polyps. Low omega-6 and fish oil supplements are recommended for the whole syndrome, so I expect that an anti-inflammatory diet will treat all three symptoms simultaneously. There is also probably a sinus rinse that would be helpful, but I don't know what it is.

Keep me updated.

Anonymous said...

What is the point of eating greens and anti-inflammatory chocolate and coffee and simultaneously recommend dairy? Dairy products block the antioxidants in these foods whether eaten simultaneously or within a few hours. This may be helpful to counteract oxalates but will also block any purported anti-inflammatory effects which are a result of the plant antioxidants. Also, where do nuts and seeds -- specifically pumpkin seeds fit in to your diet ideas?

Anonymous said...

Wondering if you've seen this?

Obesity and diabetes: immune cells in fat tissue explain the link.

http://www.wehi.edu.au/uploads/harrison_wentworth_diabetes_paper.pdf

Keep up the great work! And thank you,
An avid reader from France

Dr. Art Ayers said...

Anonymous,
I have read that milk chocolate is loses the benefits of the chocolate antioxidants, but I don't understand the biochemistry. I also think that most of the hype about plant antioxidants is false. I don't think that they act as antioxidants at all, but rather are involved in interfering with binding of some unknown receptors.

The question is whether or not dairy is unhealthy. I think that it is very nutritious, but also modifies the gut flora. Milk is adapted to establish calf gut flora. That is not the same as human adult or baby gut flora. Adults with healthy gut flora probably just digest or inactivate the milk and use it as nutrients. Those with compromised gut flora may have their gut flora further disrupted by milk components.

Thanks for the question.

BigWhiskey said...

so, then, what do you think of Heavy Cream as a source of saturated fat for anyone, whether healthy or comprised gut flora?

Thank you for your selfless devotion to such an outstanding blog on Health!!

jaime said...

Hi Dr. Ayers,

You mention that saturated fats are ok in the absence of imflammation, but what happen when there IS some sort of inflammatory disease? in that case, What kind of diet is the most recommended?

Great blog BTW!
Thanks

Dr. Art Ayers said...

BigWhiskey,
I think that heavy cream is safe and healthy. It is a good source of saturated fats. I use cream with my coffee every morning and if I get distracted, I will not be hungry for four to six hours. If I have half and half, which has a dose of lactose, I will be hungry in a couple of hours.

Thanks for the question.

Dr. Art Ayers said...

Jaime,
I wrote this article almost exactly two years ago. My views on saturated fats have changed substantially. The biomedical data show that saturated fats are safer to eat than vegetable oils (O6s). This goes along with the studies that show that low serum lipids are more associated with disease than high serum cholesterol, and that statins and lowering serum lipid had no beneficial impact on heart disease.

I learned a lot in two years and all of it reinforced the idea that getting most calories from saturated fats rather than grain carbs is the foundation for health.

Thanks for the question.

BigWhiskey said...

Great Health to us all, then!!
Bravo and Long Live the Freedom in the Internet!!

Steve said...

Hi Dr Ayers,

Regarding gut flora adaptation to dairy: In an otherwise anti-inflammatory paleo type diet that previously included plenty of dairy, would suddenly completely eliminating all dairy then produce an inflammatory response due to starving some of the gut flora and resulting shift in composition? This would most likely be relatively short termed?

How much weight do you give the concerns of Cordain with dairy such as IGF-1, Betacellulin stimulation of EGF receptors, Insulin and estrogen factors etc.?

Much is (again?) not completely proven and inflammation and mal-adapted gut flora could explain much of the epidemiology they cite. This also goes the other way with certain healthy cultures consuming plenty of dairy, as well as studies such as one showing kids on whole milk have a lower BMI, as just one example.

I still think its a grey area that is highly individual, and though it wasnt designed FOR us, it can still be usefull as a source of probiotics, SFA, CLA, protein & nutrients.

Cheers,

Steve

BigWhiskey said...

May I call your attention to the topic of "Sudden Cardiac Death (SCD)" on this blog and the elevation of NEPA in low carb regimes?

http://carbsanity.blogspot.com/

Dr. Art Ayers said...

Bigwhiskey,
I don't know what to think about carb restriction, non-esterified fatty acids and sudden heart stoppage. The biggest problem with the research on the subject from my perspective is that there is no control for chronic inflammation. I would think that with low chronic inflammation, the free fatty acids would be of no consequence. Low carbs would reduce peroxide-based insulin resistance and normalize electron flow through mitochondria. Low inflammation would also normalize lipid transport (via heparan sulfate proteoglycans).

I think that the major risk would occur with low carbs and obesity, without controlling chronic inflammation through vit.D/elimination of vegetable oils/normalizing gut flora and increasing consumption of short chain saturated fats.

Thanks for the question.

BigWhiskey said...

Thanks again for your attention. As an "Old Cherokee Legend" has it, there are two wolves warring with each other in all of us, Good Wolf and Bad Wolf; the wolf we feed wins.

Jackie said...

Dr. Ayers, have not posted for awhile but read blog faithfully. I have a quandary and think you will have some important thoughts. One doctor suggested perhaps I have GERD or acid reflex although signs and symptoms minimal and after extreme stress the past two months or more and stomach discomfort, I had an ultrasound of the abdomen.

I have non-alcoholic fatty liver. I am 71, have lost a lot of weight quickly (a cause) and have tried to follow your suggestions on anti-inflam diet. My quandary is I think because I am 71, not obese at all, active, not diabetic, that I am producing TOO LITTLE ACID and not metabolizing fats and yet the doc suggested antacids for the slight heartburn/belching etc and a tiny amount of yeast on tongue (probably from mouth night guard).

I ordered some Betain (being used experimentally for fatty liver), will take Milk Thistle and B-12.

Please, please any suggestions deeply appreciated. I think you know more than any doctors I've seen. I was a nurse and sort of know how most doctors think, and I need a scientist! Many thanks,
Jackie

Jackie said...

PS: I follow most of your diet suggestions: D3, C, Omega 3, Protein Whey Isolate, Super greens and veggies etc.

Monica said...

Dr. Ayer,
We are attempting to heal my sons juvenile rheumatoid arthritis naturally by using your recommended diet and some supplements. He currently takes his vitamins in gummy forms, but that also means that he is getting sugars with them. Do you think that will have any effects on his healing? The sweeteners that I see are glucose syrup, sucrose, rice syrup, organic sugar, glycerin and HFCS. These are for fermented cod liver oil, vitamin D, probiotic, and the last ingredients were for his children's ibuprofen, which he still refuses to walk without having it in his system. Your input would be greatly appreciated as we don't want to do anything that would hinder his healing. He does not eat any grains/sugars, eats plenty of raw veggies and 1/2 a banana or apple a day.
Thanks
Monica

Angel said...

Hello, i want to write a short comment about annika lagerhorns swedish book Enough that you looked at a while back.

I have seen the pattern in myself that i react to the same things as she reacts to, but with cracking joints. Apparently her sister, like me, never got the gut inflammation but she got cracking joints that disappeared when on the diet.

Annika's diet is a low histamine diet if you look at it.. it seems that people with IBD break down histamine slowly. I have read this in many places. Maybe they are low methylators? I react the most to yeast, vinager, MSG, mushrooms and antifungals (releasing dead intestinal yeast) and they are also the highest histamine foods.

I find it very interesting that she can eat a low histamine diet and stay away from symptoms.. and that at the same time people can stay away from eating starch and be symptom free. Why do they stop reacting to starch when they are not eating histamine??? This is very interesting to me. I remember a post where you wrote about how the klebsiella enzyme used to break down starch causes.. was it colitis or chrons?

I read this post of yours today http://coolinginflammation.blogspot.com/2009/11/biofilms-as-human-gut-mycorrhizals.html

In the end here you wrote "Disruption of this system by chronic inflammation can deplete Tregs and lead to unrestrained immune attack that is observed as inflammatory bowel disease. Thus, Crohn’s disease and ulcerative colitis may be triggered by damaged biofilms."

I do not fully understand this, but do you think that is it possible that histamine damages gut biofilms and in this way causes the inflammation?

It would be very interesting to hear your take on this histamine thing.

Brooksie6 said...

Could you please advise on the use of coconut oil in the anti-inflammatory diet? I wish to follow the meal plan written by Mary Enig & Sally Fallon in "Eat Fat, Lose Fat". However, I have some concern over the fat content she is suggesting. For me it would be 4 1/2 tablespoons of coconut oil per day. I didn't question this until I saw your post here that we should limit saturated fat intact if chronic inflammation is already present. Well, I have Young Onset Parkinson's Disease, so I already have some inflammation going on. I don't want to end up making things worse for myself. Thanks! This blog is very informative, btw.

Laura

max_peretti said...

anti inflammatory diet for Osteoarthritis in both hips
good morning my name is max
i have 36 yeras old and i praticed kickboxing but Recently (two years ago)
I discovered to suffer Osteoarthritis in both hips

this is my list of diet used every day for about 6 months
whit protocol warrior diet (eating only once daily in the evening)
I only train 2 times a week in the gym

morning:
water with supplement of glucosamine chondroitin msm omega 3
and magnesium carbonate in a citrate formulation

evening
water with supplement of glucosamine chondroitin msm and omega 3
3 eggs (sometimes with the addition of pasteurized egg white)
many seasoned steamed broccoli raw olive oil
red beans
300g greek yogurt zero fat low carb high protein
many nuts and almonds
Raw chocolate sugar-free
and magnesium carbonate in a citrate formulation
(occasionally 2 oranges and a little pineapple)

is wrong as my anti inflammatory diet?

Thanks for your precious input!
Max from Italy

Dr. Art Ayers said...

Max,
Your diet is low in carbs, but you need to get your calories from saturated fats, e.g. meat, eggs, butter. So you are probably short on saturated fats and associated vit.D. The nuts are good source of omega-6 fatty acids, that can also cause inflammation. I doubt that you are taking enough omega-3 supplements to compensate. You could increase your fish oil temporarily to see if that relieves symptoms. But, I would shift away from the nuts and use full fat yogurt.

Your kickboxing should not cause wear and tear of bones, unless you are also suffering from chronic inflammation. I would expect your serum vit.D to be low.

Since arthritis is primarily an autoimmune disease, I would also expect your gut flora to be part of the problem. So, make sure that your yogurt has live probiotics and eat a wider variety of local vegetables (sources of bacteria as well as soluble fiber, pectin/inulin) to enhance the complexity of your gut flora. Common symptoms of dysfunctional gut flora are food intolerances and constipation.

You might also try menthol or castor oil applied over the general area of your joints to provide temporary relief from discomfort and inflammation.

I hope this helps. Let me know.

Dr. Art Ayers said...

Brooksie6,
Saturated fats in general, are the safest fats. I put in the speculative comment about the possibility that saturated fats may contribute to artery disease, simply because the medical community has obsessed over the potential impact of saturated fats and cardiovascular disease. I think that the evidence is very weak, but I thought that the only problem could occur with existing inflammation. In other words, I entertained the possibility that high saturated fats may contribute to the advancement of artery disease after inflammation has already caused damage.

I would encourage the anti-inflammatory diet as a basic support for Parkinson's disease. Vitamin D may be very important, since it is involved in controlling inflammation and some of the small, basic defensive peptides, that may be a problem in interactions between negatively charged polymers and amyloids (or other binding proteins), e.g. Alzheimer's, Parkinson's and perhaps celiac.

I hope that this is helpful. Let me know how it works.

Giorgio470 said...

Dr. Art,
Great blog! I have been following a fairly low carb diet for over a year.. based on the Dr's Eades work. I have BPH which is getting very bad (Ive been on Flomax for about 5 yrs and its not working very well anymore)recent PSA is 6. I am at the point wher I am seriously considering surgery..YIKES!
I have recently come across the idea of inflammation Re: heart disease and folloing my nose, so to speak, came to your blog..
One thing that makes me think inflamation is linked to my prostate prob, is that if i take ibuprofen with my flomax, it greatly improves things... however I dont want to wreck my guts taking NSAIDS for too long. so I am looking for any info on reducing inflammation..
Dr Eades says in 'Protien Power' that for some, eating egg yolks and red meat could create more inflammation because of the arachiondonic acid, leading to the production of the 'bad' eicosanoids... all of this is new to me... I plan on cutting out red meat and eggs , and increasing omega 3 - fish oil and see if that helps... do you have any rcommendations other than your basic anti inflammitory diet.
thanks again for the awesome blog!
George

Giorgio470 said...

Hi again,
Ive been reading more entries and found what you have said alreadiy about prostate problems... hopefully Ill find some new info that will help! thanks
George

Buccaneer said...

Appreciate the content on your blog. A few questions -

1. Fruits have anti oxidants some fruits are anti inflammatory as well. For example, banana and dates are inflammatory, but canteloupes, papayas and pineapples for example are anti inflammatory (my source of informaion is nutritiondata.self.com).

2. Isn't meat, eggs, and recommended fats inflammatory? You mention they are not problematic in case of chronic inflammation. But same can be said about carbs...they may not be problematic in a healthy non inflammed body...

3. Just 1/2 banana in a whole day? Isn't that too much of a fruit phobia? Of all the health foods, fruits and veggies are promoted by everyone as health foods.

4. How do we seperate non starch polysacc? I only eat whole oats, sweet potato and whole brown rice among grain products. How do I seperate the non starch from the starch constituents?

Thanks in advance

Dr. Art Ayers said...

Buccaneer,
The anti-oxidant content of most fruits does not compensate for the inflammatory content of fructose. Whole fruit isn't as bad and may be of benefit if it is low in starch and contains soluble fiber, e.g. apple. Unripe bananas are not as bad, because they have branched starch, which isn't as readily digested and passes into the colon.

Saturated fats have been given a false evaluation. The good studies show that saturated fat is healthier than polyunsaturated fats or starch.

I gave the example of 1/2 a banana to illustrate about the amount of starch that can be used in one meal without causing too steep a rise and fall in blood sugar for many individuals. High carb diets also stimulate overeating, because the associated spike in insulin causes a plunging blood sugar that produces hunger.

Grains are high in starch. Oats have some soluble fiber, but there is no point in eating all of the starch to get the fiber, it just brings on rapid hunger. Some people seem to do ok on calorie-restricted diets rich in starch, as long as vegetable oils are avoided, but most have health problems. The typical American diet is an example of a starch-based diet rich in vegetable oils that leads to health problems. It is a lot easier to maintain health on a fat-based, meat diet with abundant veggies for soluble fiber.

Look at my other articles for a full discussion of the benefits of saturated fats and the risks of omega-6 oils and starch.

Anonymous said...

any thoughts on psoriasis please

Dr. Art Ayers said...

Anonymous,
I think some psoriasis sufferers benefit from shifting to the recommended anti-inflammatory diet and improving the health of their gut flora.

See my article on psoriasis by using the search function upper left or the index in the lower right.

I would also try some topical applications of compounds that bind to hot and cold sensors, e.g. capsaicin, menthol/Vicks, castor oil. Apply to normal skin surrounding lesions.

Do hot or cold treatments of surrounding skin have an impact? Low dose Naltrexone may also be appropriate to investigate.

Let me know what works.

Anonymous said...

Dr Ayers
I greatly benefited from following your suggestions. My allergy and sinus polyps problems have been much better. Recently i added 400 IU Vit E and it helps a lot. I wanted to know how much Lactulose should i take to improve my gut flora without having loose motions.
I also eat a lot of onion and garlic in our curry. But i have read that heat degrades inulin.
Will there be any inulin left once they are cooked for 30 minutes.
Thanks for all your help
Rashed Hasan

Dr. Art Ayers said...

Rashed,
Lactulose is another simple disaccharide sugar that humans don't produce enzymes to digest. As a result, it acts like a soluble fiber, i.e. digestion requires accumulation of colon bacteria that produce the needed enzymes. The poorly adapted gut flora produce symptoms of lactulose intolerance, which increases the transit of stools and acts like a laxative. With time the gut flora become more diverse and acquire the capactiy to grow normally in the presence of lactulose.

To get the dose right, I would suggest using less than the minimum amount that loosens stools.

Insulin should not be degraded by heat. It may become more soluble, but it will still act as a colon bacteria nutrient in the same way. The chemical bonds holding the sugars of polysaccharides together are not broken by boiling temperatures. Food is softened by heating, because the weak hydrogen bonds between the polysaccharide strands are loosened by heat.

Thanks for the questions.

Anonymous said...

Art,thanks for your suggestions will give them a try and report back in a few weeks,interesting thing ,when you asked about hot and cold applications, i remmeber years a go i tried an experiment on a plaque on my arm,for a bout 2 - 3 days whenever i thought about it ,maybe every hour i ran the cold tapwater over the lesion for a minute or 2,after about 2-3 days i was left with a circle of plaque but inside the circle the skin was completely clear,does that give you any clue cus it baffled me. thanks again
chris

Dr. Art Ayers said...

Chris,
I interpret that to mean that the cold sensors can mediate an anti-inflammatory process, just as they can work for cold or hot applications to an injury.

This also means that application of Vicks Vaporub frequently to the skin around a plaque should eliminate the plaque. It should work best on extremities. I don't know if application of menthol, capsaicin or castor oil directly to plaques is a good or bad idea.

What happens in hot springs and saunas, when skin temperature is elevated. It should provide general relief.

The anti-inflammatory diet and healthy gut flora should get at the causes of the psoriasis.

Thanks for your observations.

notonourwatch said...

Hey, absolutely brilliant blog! thank you! so my situation, am 32, have severe Ankylosing spondylitis since i was 19, just had both hips replaced, spine seems not to be fused, and luckily my neck isnt either.....anyways to make a very long story short, i am 4 days on a No starch diet as per Professor Alan Ebringer,,,,,,however have been eating a lot of fruit, particualrly apple, pears and grapes, and then raisins!!!!

so a few questions if i may be so bold:

how does fruit sugar cause inflammation?

what fruits and in what quantity and sequence can be eaten so as not to cause inflammation?

Dr. Art Ayers said...

Notonorwatch,
It is my impression that ankylosing spondylitis is related to Klebsiella pneumoniae in the colon. It is also an inflammatory disease. So, I think the best approach for treating AS would be dietary and the obvious choice for a diet is the one that I describe on my site. Since celiac is also linked to back problems, that is another reason for controlling diet to control AS.

The problem with fruit is sugars, fructose, sucrose and starch. Fruit juices are the worst, because they avoid one of the benefits of fruit, pectin (and other soluble fibers). I think that the benefits of phytochemicals in fruit are exaggerated. Vegetables are much more important.

If you are trying to avoid Kp, then you need to avoid starch. The easiest way to avoid starch is to shift to a healthier diet based on saturated fats for energy.

I think that you could have avoided all of your problems if the doctors had shifted you to an anti-inflammatory diet on day one. Most medical problems, including aging result from mismanaged inflammation based on unhealthy diets (and antibiotics.) Recent research emphasizes that many drugs work by mimicking the action of gut flora. Unfortunately, gut flora are seldom used to treat disease. It would be much more effective, safer and cheaper than drugs
and surgery.

I would say that the source of your problems is diet and dysfunctional gut flora. You probably would also respond to a fecal transplant, if diet alone doesn't provide a cure. I would expect that artificial joints would be a new source of chronic inflammation, so diet will be even more important.

Let me know what happens.

Asim said...

Dr. Ayers,

You should start a donation link for all the help you provide to us with your 40 years of experience and knowledge, with the purpose of at least assisting in maintaining your site.

notonourwatch said...

hey doc, thanks for that. Yeah i know, well pre-internet when i was 19 and began having serious problems, i fasted for a day as an experiment, ALL my symptoms left me, that propelled me on years of experimenting with diet, never came across the no starch one, but anyway, yes your right, had i started with an effective dietry protocol my problems would have been avoided.

i find myself hungry on the no starch diet and am thin and afraid of losing weight,

,,,also find my lbido effected and have in the past tracked an improvement in this when carbs were ingested!?!

you say that our years and years of eating a certain way determines what type of gut flora we have, how long does it take to change that gut flora,,

many thanks, yes you should put up a donate button!

Dr. Art Ayers said...

Notonourwatch,
I outline the basics of a low carb diet. The point is to gradually change your fat digesting capacity by increasing the amount of saturated fat (meat, eggs, full fat dairy) in your diet. It takes a while to adjust, because you have to take up fats to produce the bile that you need to take up more fat. You also have to heal your liver and you also may accumulate some gut bacteria that can digest excess fat.

I would guess that you lack 2/3 of the hundred + species of different bacteria that you need to be healthy. The missing bacteria are the ones that let you digest the foods that you haven't been eating and also avoid autoimmune and inflammatory diseases. You could get a lot of benefit from diverse probiotics. A simple solution would be full fat, live yogurt without added sugar.

Food intolerances are the result of the missing bacteria, they are not genetic and they are a sign of a sick gut flora and a damaged immune system. All food intolerances (most "food allergies" are actually food intolerances, even when diagnosed by a doctor) can be cured simply by continuing to eat small amounts of the problems food. Just persist until the gut flora adapts. It is quicker if the people you contact are healthy and have a healthy gut flora. You can tell if they have a healthy gut flora: no autoimmune, allergy or inflammatory diseases, no food intolerances, no constipation.

New gut bacteria are also picked up on the veggies that you eat, so don't over wash or kill the bacteria by cooking.

The libido problems and hunger are just temporary problems. It sounds like in most cases you just stopped the carbs and didn't replace the calories with fats. You just starved yourself. The major point that you may be missing is that the medical nutrition advice to avoid fats is simply wrong and not supported by the medical literature. A low fat diet is unhealthy and contributes to many diseases. Lowering blood cholesterol has also been shown to be unhealthy and contributes to heart disease. Just avoid vegetable oils. Corn oil, soy oil, canola oil, etc. are all inflammatory. Stick to butter, olive oil and coconut oil.

Changing diet is hard, because your gut flora adapts to what you eat and it takes persistence to change. Simple intolerances, such as lactose intolerance, can be eliminated in 2-3 weeks, by eating live yogurt. More complex intolerances take longer.

Tell me of your progress.

Anonymous said...

Hi Art,
I wanted to ask you about dairy foods and wether you feel it can cause prostrate growth or cancer via IGF-1 and IGF-2 and the fact it has a lot of growth stimulants naturally occurring and maybe some from what the animals are fed.
I read a book by Jane Plant about prostrate cancer and she had a chapter on dairy and put forward what seemed like a good argument for not using dairy in the diet,but me not being well educated in these matters would welcome your take on this.

thankyou once again.
chris

Anonymous said...

found this about lactulose as well Art,didnt know if youd seen it,am taking it since you recommended it,looking good

http://www.duphalac.com/professionals/prebioticeffectpro/0,,10320-2-0,00.htm
thanks
Chris

notonourwatch said...

Doc, your brilliant, so glad i found this! so yes, i am 7 days on the no starch diet as per Doctor Alan Ebringer,,, i am actually in Russia now, doing rehab post surgery and so i ordered fried liver with apple at a Ukranian resturant, was fried in butter and thats the first dairy I have had in the days, i was/am afraid to take any as apparently it also can feed the Kleb,,,
---any thoughts on that?

anyway, I'll know pretty soon, i have since the second or third day enjoyed a lower inflamation rate in my body and feel good,,, got some questions for you , if you can answer some would be amazing,,

ate some smoked lard at the resturant too, whats your deal with lard???

commercial pro-biotics from health food store, any good???

fecal implant, how is it done? where?....googling it now, doubt its in Russia, sounds like an amazing idea to me, funnily enough..

i bought a vitamin d3 supplement,but it came in a bottle, its drops??? thought that was weird, but it is Russia! should be just as effective right?

thats it for now, thought i had more but later maybe, I'm recovering....its great to finally feel better!!

notonourwatch said...

now i remember, i also wanted to ask you about what you thought the positive or negative effect of drinking human breast milk would be, taboo aside, i have heard of people drinking it as a treatment for some things, could it be useful??? many thanks

Dr. Art Ayers said...

Anonymous
Prostate and milk
I don't think that the growth factors in milk are a big deal. They may contribute to problems, but the major risk factors are an inflammatory diet and dysfunctional gut flora. Most people observe that symptoms from swollen prostates are reduced by improvements in diet.

Thanks for the questions.

Dr. Art Ayers said...

Anonymous,
lactulose
Thanks for the link. It follows basically what I have been saying. Lactulose is a prebiotic. If the gut flora are not adapted to it, it acts as a laxative, i.e. indicating temporary intolerance.

Dr. Art Ayers said...

Notonourwatch,
Lard is sort of like a mixture of olive oil and butter. It is quite healthy and superior to vegetable oils.

Vit.D3 in liquid form is fine.

Commercial probiotics are a good quick fix to start repairing gut flora. Diverse, fresh veggies are the best source of probiotics and prebiotics.

I think that wide use of cheap, non-medical forms of fecal transplants, e.g. health spas, could replace most of the medical establishment. Now that would be healthcare reform!

Breast milk is essential for newborns, but much less effective for adults, since adult gut flora digest most of the beneficial components. That is why for example, babies receiving any formula need 100X the iron. The adult gut flora established by formula take up 99% of the iron. Breast milk also adapts to the baby, that also means that the milk produced initially, colostrum, is very different from milk six months later.

Thanks for the questions and let me know how heal.

Anonymous said...

It's amazing that you take the time to reply to people's comments on here.

What about if you are struggling with Candida? Would fruit, chocolate, and coffee still be helpful? Any more details you could provide on the types would be much appreciated.

Aside from taking probiotics, prebiotics, and antifungals, is there anything else one can do to get the gut to be able to handle minimal amounts of sugar (I'm talking like the sugar in carrots, sweet potatoes, low sugar fruits).

Thank you so much.

Adam said...

Hi Dr.Ayers,
What is your opinion on the use of Betaine Hydrochloride supplement for constipation?
My constipation started after I changed my diet and cut out all the sugar,gluten and other harmful foods.
Most of my diet right now consist of meat, low carb vegtables and fat(coconut oil, butter and extra virgin olive oil)
I'm also supplementing with cod liver oil, vitamin C and vitamin D3.
can adding probiotics and glucasmine help with my digestive problems?
Thank you for your time.

Nick said...

Hey Dr. Art Ayers,

Im 20 years old (male), and have mild rosacea on my nose/cheeks, and have some eczema problems. Also have a receding Hairline, and have read some articles linking these 3 problems. Not sure if it is true though.

Anyways, I am wondering if my diet is sufficient. My doctor said my vitamin d levels were low, so i started supplementing with 5000iu every morning.

Started a probiotic every morning, take 4 fish oil capsules daily, 2000mg of lysine, Multi-vitamin, claritan in the morning, zyrtec at night, and started taking organic milk thistle everyday.

I used to have a very unhealhty diet expercially before bed. Foods high in fat and sugar (JUNK FOOD), although I am in good shape. exercise daily.

I have started eating nothing but, greens and a steak, chicken breast or fish for lunch and dinner. Usually skip breakfast, but am going to start with eggs soon.

Does this look like a healthy diet for someone with rosecea, ezcema, and hairloss? Anything you suggest?

Also what is your take on marijuana, I do not drink alcohol at all, but will occasionally use marijuana on special occasions.

Thanks so much, I have found your articles to be of much help and very interesting. I love learning new things!

Thanks again.

-Nick

Bill said...

Nick,

Let me try and answer some of your questions.

I would suggest making sure you getting enough healthy animal fats like grass fed beef, butter, ghee, coconut oil. I would also suggest you take some k2 with your D, you'll definitely see some skin texture improvements there.

Get some healthy spices in there for lowering inflammation like tumeric.

The fish oil is good but make sure it is a quality source and it might even be better just to eat more fatty fish such as salmon a few times a week.

Hairloss, ezxcema and rosacea are all inflammatory, so having all those symptoms suggests inflammation is present.

I would suggest looking into Ohhira's probiotics, as I have folliculitis and noticed the most benefit from that.

I have also pretty much cleared about 95% of my folliculitis by drinking alot of raw milk and leaving my skin alone i.e no soap, no scrubbing, and barely ever getting my face wet in the shower.

Also... look into L. Rueteri. I read a review on iHerb awhile back from two people who cleared a good portion of their rosacea using L. Rueteri as it is antagonistic to H. Pylori.

Hopefully that helps!

Nick said...

Thanks Bill,

Glad you got back to me.

I will start taking k2 with my vitamin D ASAP. I was wondering if it is okay to take Ohhiras probiotic with a L Rueteri pearl as well? Very interesting to see the affects.

Also any pre-biotics you would recommend?

I'm glad to hear you cleared up 95% of your folliculitis that’s great!

I have been washing my face with Raw honey every night, and moisturize with extra virgin coconut oil. No hot showers. So far it helps a bit, but need to get the other factors of this disease under control.

Since you said you had folliculitis, I was wondering...whenever I get my scalp wet, I break out in some type of hives. Just red dots all over my scalp, real small in size. They fade away within a minute or two though. Just wanted to maybe hear your thoughts. I have visited a few dermatologists, but most of them are just quick to prescribe a topical that will potentially make it worse in the long run.

Thanks for all the help! :)

mtflight said...

Hi Nick,

It sounds as if you have very sensitive skin, like myself. I recently tried extra virgin coconut oil as a moisturizer after getting out of the shower, and a few hours later noticed that my prepuce was itching. I noticed it must have had a reaction, because it turned red and swelled quite noticeably all in a matter of a few hours. This baffled me, because I had thought it sounded like a good idea. That said, coconut oil has quite bit of lauric acid (which makes it antimicrobial), and it is this acid that may be the cause of my irritation on contact. I've also noticed burning of the eyes when applied too close to them.

By means of this disturbing tale, I suggest you try not using the coconut oil on your face for a few days to rule out the possibility it contributes to the rosy condition.

Something you may want to try is to go gluten and casein free for a few months to see how your skin responds. Another thing you may try is low dose naltrexone, in case that the source of the eczema and rosacea are auto-immune.

You didn't mention butter in your diet. I think it could possibly have a positive impact. Don't take your fish oil on an empty stomach, and add small vitamin E with it if you're going to take so much of it at once to prevent premature peroxidation.

Keep us updated,

Alex

Adam said...

Hi Nick,
I also suffer from the same symptoms, Rosacea, Seborreah Dermatitis, cold hands, and hair loss all over the body.
I completely changed my diet a few monthes ago(low carb, high fat and moderate protein according to the optimal diet by Dr. Jan Kwasniewski)
Maybe it's to early to tell but I haven't seen any improvment so far.
I think diet alone can't really cure my condition, but I have no idea which supplements could help and all the topicals I used in the past were useless, I'm going to try adding vitamin K2 and I'll ask my dermatologist about topical Heparin, I'll update if I see any changes.

Adam.

mtflight said...

Hey Adam,

have you had any thyroid levels tested? The cold hands, dermatitis, and hair-loss sound very suspect.

I would look not only at the ubiquitous TSH (which should be below 2.5) but at free T3 and free T4 to see that they're in the upper range of normal.

I too have had some seborrheic dermatitis and sometimes dandruff, but I had low free T4. In the meantime you will find relief from anti-dandruff shampoo with Selenium Sulfide (Selsun Blue), p. zinc (most other anti-dandruff, Suave for men smells great), t-gel with tar and salicylic acid pads/shampoo if you have any flakes on your face/body.

I hope this helps!

Dr. Art Ayers said...

Hi, mtflight,
Diet and skin:
Just to tie a lot of these threads together, consider the following.
Grain gluten disrupts the integrity of the intestine and produces abnormal presentation of antigens leading to autoimmune diseases, if the gut flora is also abnormal.

The result is thyroiditis and abnormal thyroid hormone production. Abnormal thyroid levels are thought (Powell) to contribute to a hibernation-like state in some tissues and (facilitated by local sites of inflammation) lead to cryptic bacterial infections, e.g. Cpn, in tissues. Bacterial infections can release products that trigger toll-like receptors that produce signaling leading to symptoms.

Antibiotic use leads to disruption of gut flora and alters the immune system by disrupting GALT function. The intestines also develop abnormalities that alter absorption of minerals, vitamins, etc. Skin development is dependent on zinc and iodine.

The bottom line, is that the anti-inflammatory diet that I outline, should fix the gut and gut flora, and reverse the causes of all of the types of skin aliments that are being discussed. A fully functional gut and gut flora is needed for normal uptake of nutrients and deficiencies show in abnormal skin development, which is what shows in skin ailments. Skin ailments are made more challenging, because the gut involvement means that taking supplements is no guarantee that the nutrient will be used. Many skin treatments involve further disruption of gut flora by antibiotics and many people with skin problems have constipation, revealing severely compromised gut flora.

Jay said...

Dr Ayers,
This research from University of Groningen, Netherlands indicates that the biofilms that cause dental plaque and caries attach themselves to teeth using polysaccharides formed from sucrose ONLY, and for people who have dental problems HFCS (which is sucrose-free) may be better although any sucrose free diet would be beneficial including grapes and raisins.
http://www.pnas.org/content/107/50/21406
Jay Bryant

Dr. Art Ayers said...

Jay,
Thanks for the link. I am writing an article on the subject.

Anonymous said...

Dr Ayer
After reading your posts ,I have started taking 3.5 grams of Lactulose as prebiotic and i am getting good results with my sinus.
I have these two following article that creates confusions for me.They also claim Lactulose and FOS are not proper prebiotic since they increases the numbers of enterobacteria. I will appreciate your comments on these articles. I was also wondering if it is a good idea to consume 100 grams of cooked garlic to get 15 grams of inulin daily. We dont have chicory inulin here.
Thanks
Rashed Hasan
www.ncbi.nlm.nih.gov/pmc/articles/PMC1773861/
www.ncbi.nlm.nih.gov/pubmed/15016747?ordinalpos=1&itool=PPMCLayout.PPMCAppController.PPMCArticlePage.PPMCPubmedRA&linkpos=1

Dr. Art Ayers said...

Rashed,
I think that the perspective of the articles is a little naive. It assumes that two weeks will provide adjustment to soluble fiber, but in lab animals, this will probably just shift existing populations of bacteria. In contrast, I would consider the beneficial adjustment to be the recruitment of new species and increased gut flora complexity. Recruitment requires exposure to new bacteria, and that means crude food including the new bacteria. Processed foods, including purified soluble fibers, will lack the needed bacteria.

Thanks for the questions/comments.

Anonymous said...

Dr Ayers
Thank you for your reply. I am using Lactulose regularly. One thing i observed that whenever i take Lactulose ( 1 tsp 3 times a day) my severely clogged sinus opens up a lot within a minute!!!
It seems very strange to me.
(My sinus polyp is so bad that coristeroid sprays don't work at all) I am wondering can this Lactulose reach my colon in 1 minute and alter my gut flora and opens up my sinus?
I had similar results with ayurvedic cleansing formula named " Triphala", its a type of laxative too. But the effect is not as dramatic as Lactulose.
I do not have constipation, but i have 3-4 bowel movements everyday, usually soft stool and its never satisfying.Should i consider it as constipation? My bowel movements has also improved with lactulose. I have to thank you for suggesting this. I hope this information helps others with sinus problems.
Its been a long journey, i had major improvements with Vit D and fish oil too.
Rashed Hasan

Asim said...

Hey Dr. Ayers,

Would like to hear your thoughts on this new discovery as it relates to the 'paleo' diet:

http://io9.com/5719202/neanderthals-ate-their-fruits-and-vegetables

The article mentions some seasonal eating, through cooking of grains, along with indulgence in some fruits, such as dates.

Valtsu said...

Hiya Dr Ayers. I would like to ask about your reasons to recommend vitamin C. There are quite a lot of varying views about the effects of Vit-C and I don't really know whom to trust. Who should take C and why? Does the form matter (ascorbic acid seems to be the most common)?

Dr. Art Ayers said...

Rashed,
I think that by taking lactulose, you are adjusting the various populations of bacteria in your gut, but you are still not bringing in enough new bacteria to reestablish a healthy gut flora. That takes time, diverse veggies and a source of new bacteria, veggies that aren't too clean.

The rapid response to lactulose is puzzling. Impact on gut flora should result from contact with the lactulose in the small intestines. That is at least an hour after ingestion. The rapid response that you are observing is something else. Could it be a reaction to bacteria in the stomach, e.g. H. pylori? It is so fast that I would expect it to be a histamine reaction. You could try to see if histamine is involved by taking an antihistamine before the lactulose, to see if it blocks the reaction.

Let me know if you have any more observations.

Dr. Art Ayers said...

Hi Asim,
I don't put too much weight into including or excluding veggies in the diet based on whether much earlier ancestors or relatives ate it. It is interesting, but I prefer to have a biochemical/molecular basis for my dietary recommendations.

I don't think that humans have very strict diet needs. I think that many modern diets are so extreme that they are at the edge of the ability to human bodies to tolerate them without disease. The recommended low fat diets are an unhealthy example.

Thanks for the input.

Anonymous said...

Dr Ayer
I consumed soybean oil for most part of my life. I have Hashimoto now and i read that soy isoflavones are associated with it. I never ate soy products other than soybean oil.
Now I eat mostly saturated fat but can not avoid soybean oil when i eat out. USDA sites shows that soybean oil doesnt contain isoflavones but wikipedia and several websites cites soybean oil as goitrogenic. I would like your opinion on this.
Thank you
Rashed Hasan

Dr. Art Ayers said...

Hi Rashed,
Hashimoto's thyroiditis usually develops from celiac, so I think that your use of soy oil just contributed to the problem by boosting inflammation, because of its high omega-6 fatty acid composition.

I think that it would be wise to follow the anti-inflammatory diet that I outline on this blog and take special note to avoid grains and gluten. I don't think that soy, aside from the oil, is a big deal. You may also have lots of vitamin/mineral deficiencies because of the celiac.

If you are still worried about the Hashimoto's, I would suggest looking into low dose Naltrexone as an option. I hope that you have actually checked you serum vit.D to confirm that you actually have a level consistent with your supplementation.

Thanks for the questions.

max_peretti said...

Excuse me doctor, but I still have some questions about a diet that helps a maximum joint mobility
The coffee is ok or produce muscle tension and inflammation in the joints?
cheese are good sources of saturated fat or trans fats also contain any damaged too?
beans (preserved in a can) are ok or contain too much starch and thus cause inflammation?
thanks again for the precious help
Max from italy (osteoarthritis in the hips)

Anonymous said...

You said that coffee and chocolate supply anti-inflammatory antioxidants.

You must be aware that stimulants (coffee, tea, chocolate, cigarettes) and stress cause the body to produce adrenalin and cortisol. This in turn results in a release of blood sugar, followed by an insulin spike. Do the anti-inflammatory antioxidants in tea and coffee outweigh the inflammatory insulin? i.e. is the net effect of drinking tea and coffee inflammatory or anti-inflammatory?

andy

Dr. Art Ayers said...

Andy,
I don't worry about the minor contributions of coffee and chocolate to inflammation. I also don't think that most of the dietary sources of antioxidants make much difference. In most cases when the phytochemical antioxidants are isolated from vegetables and fed directly, they have no impact. I think that the active part of the vegetables is the soluble fiber that feeds the gut flora. If the gut flora is healthy, so is the immune system and then the impacts of coffee, chocolate and other minor indulgences simply don't make a difference.

I worry about keeping my gut flora happy and don't spend time thinking about the toxic properties of traditional beverages. Sugar, starch, high fructose corn syrup, vegetable oils, tobacco and alcohol are responsible for most diseases in the modern world. Why do people spend time worrying about coffee and grilled steak, which don't make a measurable contribution to disease?

Thanks for the question.

Anonymous said...

Hi Dr. Ayers

i've looked around your blog but did not find information on buckwheat flour, chickpeas flour and water chestnut flour.

i understand they are safe for celiacs to consume but how far are they consistent with the anti inflammatory diet? e.g. consumption amount per day if they are fine?

Thanks

-TT

maryann0 said...

I enjoy your blog. I am a 46 year old female and a 20+year psoriatic arthritis suffer, have psoriasis and am in menopause. I have been free of biologic agents (Enbrel) for 2 years but am beginning to feel the psoriatic arthritis starting to reactivate.

What are some nutritional and other supports I can put in place to keep myself in remission?

Maryann

Dr. Art Ayers said...

MaryAnn,
Autoimmune and autoinflammatory diseases can only be cured with an anti-inflammatory diet and establishment of gut flora needed to stimulate immunological tolerance. Recent research shows that dozens of different species of bacteria are needed in the small and large intestines for full development of the immune system cells in the lining of the intestines.

In your case, your diet, antibiotic use, etc. have conspired to prevent development of the lymphocytes in your colon, Tregs, that are needed to avoid allergies and autoimmune diseases.

You have treated the inflammatory attack of your immune system on your skin and bones using antibodies against a major signal molecule of inflammation, TNF. That stopped the attack by further crippling your immune system, but didn't fix the underlying problem. It just made you a chronic patient.

What you need is a healthy diet and new gut bacteria. Both are discussed here and under arthritis elsewhere on this blog.

Thanks for the questions.

Bill said...

Dr. Ayers,
I have adhered to an anti-inflammatory diet and lifestyle for 3 years now. Apart from inexcusably neglecting resistance exercise to build muscle, I have been very strict.
You have persuaded me of the importance of a healthy gut flora and following your guidelines, I believe I am really on the right track and having success.
One effect that I have that I believe is of no real consequence is flatulence, probably occurring half of the time after eating. I have noted it mostly when I include probiotic yoghurt and/or fermented cheese. I only eat twice a day at the most, and intermittently fast about once a week for 24 to 30 hours. My daily intake is around 3,000 calories.
I occasionally have short term low level pain that is caused by trapped wind. A brisk walk or other low intensity physical activity always clears the pain by stimulating the passing of the wind build up.
What are your thoughts on this flatulence?
I believe that it's natural, and our ancestors would have had similar reactions with their guts. It may not be socially acceptable today, but I'm not concerned about that, as long as it's a normal, healthy bodily function with no adverse consequences to my health. I very rarely have any stomach upsets and no bowel problems, and I am in the best of health with no inflammation problems that I am aware of.
I've searched for answers to this without success.
Your views on flatulence would be greatly appreciated.

Dr. Art Ayers said...

Hi Bill,
Thanks for the update. I think that flatulence is just the natural production of methane and perhaps some carbon dioxide by bacteria in the gut.

The methane is a product, just like the short chain fatty acids that are used as nutrients by colon cells, and it could be eliminated by further alteration of your gut flora and diet. I don't know of any health consequence.

I think of methane and hydrogen as means for bacteria to eliminate high energy electrons from hydrogen and carbon to compensate for the use of carbs and fats as energy sources. That is similar to fermentation in the absence of an electron transport chain to make ATP.

So, you can experiment with other foods or ignore it.

Thanks for the comments/questions.

Megaera said...

Dr. Ayers:
You've written on several aspects of pharmacodynamics and diet, specifically the diet you advocate. I've tried variants of it in the past with varying degrees of benefit, am currently trying your version with strong D3 supplementation (test for level pending), pre- and probiotics, C, glutamine, etc. I have the following hx: in the distant past I had an ovarian cyst deemed dangerous to operate, treated with massive antibiotics. It resolved with no apparent sequelae. 4 years later I developed adult-onset seizure disorder, etiology unknown, treated with Depakote, which controlled the seizures but has side-effects, including long-term bone integrity issues. Some time later congenital dysplasia required hip replacements; these went well. Two years later I had an emergency appendectomy. About a year later my thyroid function went to hell, though it took another two years to convince doctors it was happening; I now take Armour Thyroid as a consequence of Hashimoto's. A year or two later my then-dormant seizure disorder reactivated, and I resumed anticonvulsants (now Keppra and Topamax). I am also now diagnosed with osteopoenia, possibly due to the Depakote, since that is a known side effect. I declined the pharmaceutical bone-builders offered, didn't like the look of them; some of your other articles make me glad of that decision. Most recently I have had significant tendonitis issues in my dominant hand and significant osteoarthritis developing in both hands. I have for a long time minimized wheat/grain/sugar intake because of weight problems; since November, save for green vegetables and a few fruits (blueberries and cherries, unsweetened) I've cut out carbs. This resolved long-standing constipation, which I linked to the thyroid problem but now is more clearly a generalized inflammation problem. The only vegetable oil I use in any quantity is olive oil, but I did take some flax oil for a while -- I don't any more.

Realizing that this isn't exactly your primary area of inquiry, still, do you have any information on the effect of anticonvulsant meds on systemic inflammation, and -- if they are a problem -- what (if anything) might be done to circumvent an inflammatory effect, as I cannot d c them? Also, does the Hashimoto's require further measures, and if so, what might they be? I am about 35 lb overweight and seem intractably fixed there, regardless of diet, exercise level or both combined. Any suggestions gratefully accepted; your blog is wonderful.

Anonymous said...

Hi, thoughts on this : http://paleohacks.com/questions/23309/low-weight-and-need-to-gain-weight-not-sure-how-to-approach-this-and-would-like/23517#23517

I would appreciate thoughts!

Dr. Art Ayers said...

Anonymous - weight gain,
You have symptoms of poor weight gain, food intolerances, aches and constipation. It seems obvious that one of your big problems is lacking all of the bacteria needed to utilize complex plant (and animal GAGs) polysaccharides. At the same time, you don't seem to be able to absorb fats very well, which suggests poor bile production.

In the absence of the needed bacteria, all you get is compact stools and minimal nutrition. The absence of the bacteria also contributes to vitamin deficiencies and more problems for weight gain.

Most of the advice on the site referenced is sound. You need to eat adequate amounts of protein and gradually increase your saturated fats. That is consistent with the paleo advice. I think that starch for you will also help with weight gain as long as you don't have problems with grains. I would avoid whole grains anyway. They provide no benefits. Potatoes and yams sound good. Avoid vegetable oils and stick to butter, olive oil, coconut oil.

I think that you need to look into your vit.D status (test/supplement/test). Sunlight will only benefit you with vit.D production, if you do not suffer from chronic inflammation, which I think is very likely.

Your basic problem remains a lack of gut bacteria, that can only come in on your food. You are probably lacking half of the 100+ species of different bacteria that are needed. You can only get those bacteria from fresh veggies that have not been overly cleaned -- the bacteria are on the surface. Cleanliness and hygiene are unhealthy for people who need to reestablish their gut flora. It would be best to sample veggies in the garden by just brushing them off.

Hand sanitizing may minimize the spread of viruses, but it increases the risk of autoimmune diseases (because dirty hands can provide the bacteria needed for development of the colon bacteria, Clostridium spp., needed for immunological tolerance.)

Let me know if this is helpful.

Anonymous said...

Dr. Ayers what role does salt play in inflammation and degenerative diseases? i'm getting conflicting information from various sources.

Thanks
-Raul

Anonymous said...

Excellent information here. I'm in New Zealand, and suffer from Hepatitis C. I've had chronic inflammation of the liver for many years, along with chronic fatigue, poor digestion. In recent years i've noticed I'm intolerant of gluten, and have felt better avoiding it.
This diet sounds like a good one, except I am a vegetarian. Is there any special recommendations for vegetarians? I simply do not want to eat meat..but I do eat dairy. ~Jason

hopeful geranium said...

Dr Ayers, glucosamine inhibits production of gamma-interferon; this (INF_gamma) inhibits EPO, amongst other things, freeing up iron to become a factor in inflamation.

WP @ Conscious Life said...

Hi Dr Ayers,
Any idea whether rosacea is caused by inflammation? Would avoiding inflammatory foods and adopting an anti-inflammatory diet help? Thank you!

Megaera said...

Dr. Ayers: I hope you're still responding to questions, as I have this to ask and have been unable to get an answer elsewhere. What is the effect of supplemental iodine on intestinal flora? Used topically it is an antiseptic; taken internally I am assuming it has some antibiotic effect -- if so, how broad-scope is that effect, and what would the effect of supplemental oral iodine be on the gut flora I'm so effortfully laboring to restore?

Anonymous said...

I have Alopecia universalis that developing in the 18 months post partum; it has now been two years since I have been completly bald and I am looking for possible dietary changes.

I do not have a diet high in trans/saturated fats, I only use olive oil, I eat lean red meat and chicken 3-4 times per week, fish 1-2 times, lots of fresh fruit and veg, I take fish oil, silymarin (Cabot's LivaTone), pre/pro-biotics and am trying a 'glutathione patch (not containing glutatione, but 'placed on the liver accupresure point and supposed to stimulate g' production).I have recently done a liver cleanse (Helda Clarke recipe) with hundreds of precipitated bile solids passing through).

Based on your experience and research, would you suggest anything else? The novelty of being bald has worn off and I am committed to growing my hair back.

I believe my Alopecia was related to stress hormone production post-partum and my inability to filter them from my blood, a genetic predisposition, along with 12 months of almost exclusive breast feeding in trying emotional circumstances.

I do hope that you find the time to reply, or at least refer me to pages elswhere for further reading.

S.A.

Bill said...

S.A.
You should eliminate all grains and legumes from your diet. Also ensure your vitamin D levels are +75 ng/ml.
I had alopecia areata for 7 years. Initially triggered by stress.
I have been clear now for more than 2 years.
It took well over a year following the above guidelines before hair loss/growth really improved.
I've had stress in the past few months but the alopecia has not returned.
I believe that the grains and low level vitamin D weakened my immune system and allowed the autoimmune attack, manifesting itself with the hair loss.
You will just have to be very strict and patient.
Best of luck, but it's down to you.

Katy H. said...

How many grams of carbs per day do you consider to be "low carb"? And if meat and dairy are inflammatory, where should our saturated fat be coming from? I use ample olive oil in my brown rice/veggie saute and use flax oil in my fruit/nut shakes, but doubt that's giving me a large amount of sat fat. Do you have a goal of how many grams of saturated fat you want to ingest per day? Following the Optimal Diet for the past year has only left me more inflamed, so I've recently switched to the Ultra Simple Diet which is very similar to what you suggest on your blog.

Katy H. said...

@Bill - What's wrong with legumes??

notonourwatch said...

Hey Bro / Doc!

Its me I wrote to you much much earlier when I got to Russia after my hip surgery.

So, I am about to return to Ireland to continue my rehab! Before my journey I have to open up an aladdins lamp of questions and smokey vapor vague ideas that maybe you can help demystify,,,???

....so, I didn't have enough fibre when I was trying the no starch diet, and there was blood in my stool regularly, I was also only passing a stool every few days.

So I had an examination and one finger up my ass later, the doc diagnosed an anal fissure. I switched to a high fibre, high carb diet and within a few weeks the bleeding and pains had stopped..

.....

I really don't understand the inflammatory process AT ALL...

Over the past 5 months since my double hip replacement surgery I have had about 4 or 5 bouts of severe disabling pain and stiffness.

The second time it happened I went onto the No Starch diet (Prof Erbinger's) within three days the symptoms decreased dramatically.

---HOWEVER-----
when i switched to a high fibre / high carb diet for the reasons above the pain didn't return!!

---Why?

Fasting does seem to still work and when no carb seems to work too but going back on carbs doesnt seem to hurt------

But thats not the end of it, seems that after intense exercise I am out of action for a week or more.
I tested my CRP on one of the days post exercise that I felt really sore and it was up at around 45, where as before it was 33....

Question 1) How can I negate the inflammatory effects of intense exercise????

-------

Ok switching to the other side of my mind....re the fecal implant,

obviously a healthy donor is needed, but what about a super-fit athlete?? Someone like George St Pierre: http://en.wikipedia.org/wiki/Georges_St-Pierre

Would his gut bacteria, be superior to an ordinary healthy donor???

-------

ok here is something that since you will look at it chemically rather than socially may not seem so strange..

Both LSD and MDMA cause a MASSIVE drop in symptoms. Marijuana does too but its anti-inflammatory effects are well known, any reason for the other two???

Ok I think thats enough for now! Hope you have time to answer!
Mucho Thankios
B
www.walkingfilm.com

-

notonourwatch said...

got the answer to the last question:

"Activation of the 5-HT2A receptor with DOI produces superpotent anti-inflammatory effects in cardiovascular related tissues, as well as potent anti-inflammatory effects in non-cardiovascular tissues. Other 5-HT2A agonists like LSD also have potent anti-inflammatory effects against TNF-alpha-induced inflammation."

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