An inflammatory life style and diet will kill you four times faster or the equivalent of being 14 years older. A large, new study shows the combined impact of four lifestyle/diet choices (all of which have inflammatory consequences): smoking, sedentary, low fruits and vegetables and low alcohol. The effects were additive and deadly.
It does not surprise most people that eating, exercising and smoking can impact their lives. A recent, long term study measured the impact. Twenty thousand men and women were categorized by lifestyle (smoking, exercise) and diet (fruits and vegetables [serum vitamin C], alcohol) traits and followed for ten years to see which became ill or died. The four factors that increased the rate of death were smoking, a sedentary lifestyle, low fruits and vegetables (low serum vitamin C) and low alcohol consumption. Each independently increased the death rate with combinations of one or two having less impact than three or four. A combination of all four, the couch potato who smokes, eats just chips and drinks soda, yields a death rate, with cardiovascular morbidity prominent, four times higher than the non-smoking, casual drinker who exercises regularly and eats lots of fruits and vegetable (high serum vitamin C). The increased death rate is equal to aging by fourteen years.
Smoking results in the introduction of a toxic brew of inflammatory compounds. Many of the compounds are so toxic that they cannot be handled in typical biological laboratories without special permits. They damage cells of the lungs and produce chronic inflammation. The odd thing about smoking is that smoke also contains nicotine, which has some anti-inflammatory properties. Without the nicotine, I think that no one could tolerate the smoke. Of course without the nicotine there would be no addiction to promote the smoking habit. The fact that smoking kills, is no longer a surprise. It may be less well known that smoking also increases inflammation and thereby increases the cardiovascular (and other) death rate.
Exercise is healthy, but it is also anti-inflammatory. Intense exercise may produce a quick spike of inflammation, but the persistent impact is anti-inflammatory and reduces inflammation-related diseases and death. Increased muscle mass is anti-inflammatory and increased fat is inflammatory. Trading fat for muscle, the typical pattern with advancing age, also produces increasing chronic inflammation and the typical maladies attributed to aging.
Fruits and vegetables are high in vitamin C, but they are also high in a large number of plant compounds that are anti-inflammatory. The compounds can be anti-inflammatory because they are anti-oxidants, because they block inflammatory pathways or because they promote the growth of anti-inflammatory bacteria in the gut. The bottom line is that you can get your nutrients and complex carbohydrates (not starch) from fruits and vegetables, and lower your inflammation as you live longer, or you can each starch from grains, stimulate inflammation and die young (though you appear old.)
The observation of alcohol consumption as anti-inflammatory requires some explanation. Modest alcohol consumption causes some damage to the digestive tract as it passes through and is absorbed into the blood. The surface cells suffer the greatest impact and some are damaged and die. This localized trauma produces a signal to the body that results in a regional suppression of inflammation. There appears to be an adaptation for the body to tolerate and minimize the damage associated with the productive action of eating food. It appears that alcohol is good medicine.
Tuesday, September 16, 2008
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13 comments:
Hi Art,
Hope you're keeping cool in the high desert. I'm curious about your take on alcohol being anti-inflammatory and what your idea of 'moderate' is.
I like wine and many evenings drink around 15oz. I have noticed in the past year or so that if I drink within two hours of bedtime, it seems to interfere with my sleep. After moving to a low carb diet I also notice alcohol seems to how a more powerful affect on me (this is, in part, due to the way it lowers my blood sugar when I have not eaten in awhile).
So, I am been experimenting with not drinking for a few days to see if I can sleep better. One of the consequences has been that I notice that my ankles and wrists are smaller, with less puffiness (which normally comes and goes, but now is just gone). I always assumed this was some type of inflammation or water retention. It seems to be associated with alcohol consumption.
I generally eat a anti-inflammation diet, so I wondering what if you have any thoughts on whether I am chasing a red herring?
Nick,
Wine is a good subject.
Unfortunately, alcohol and inflammation is not much fun. I am glad that I have already had my dinner and my last drink for the night.
Alcohol kills cells and makes the gut leaky. That means that bacteria with their LPS endotoxin get into the portal circulation to the liver. The liver would respond to the LPS with modest inflammation, but alcohol step us the sensitivity of the toll-like receptor 4, TLR4, which transmits the alarm to NFkB, the major inflammation transcription factor. The result is the release of inflammatory cytokines and a significant contribution to your chronic inflammation.
[A good review: PMID: 19398236]
Hey, if you just ran three six minute miles, your body would also respond with inflammation.
So drinking two glass of red wine is like racing your engine and taking credit for a long drive. It would be interesting to follow the course of a couple of shots of alcohol to see if there is an anti-inflammatory rebound, just like after intense athletics.
My sense is that the concentration of alcohol reaching the gut and liver is important, so it is probably better to drink slowly with food. Also NFkB inhibitors might be useful, e.g. turmeric plus black pepper. Spices, herbs and onion/garlic would all be good to minimize the surviving bacteria near the wine/alcohol. Drinking water may also be helpful. I don't like the sound of some of these suggestions in the same mouthful as a nice wine, but you get the idea.
So, I don't know if alcohol is anti-inflammatory or just stress reducing. For some people, alcohol consumption keeps their inflammatory Helicobacter under control and that's anti-inflammatory. Alcohol may also alter the gut flora to favor fermentors, and that also may be anti-inflammatory.
Frankly, I think that one or two drinks a day is good for me and the literature is sufficiently blurred that I think its ok.
Evaporative cooling of irrigation water sprayed on my vine-covered patio makes the breeze about 70F as the sun goes down. That is perfect for a last sip of wine.
Thanks for the comments.
Art, thank you for your comments. The pubmed abstract and your comment make for a bleak prognosis if ALD was happening. As routine serum testing shows normal liver function, I'd like to pursue a different angle for a moment. If ALD was indeed occurring, then the question about any alcohol seems moot. My use is fairly moderate, but everyone is a little different, so I won't rule it out completely, given my medical history (extreme acne for many years, benign menigioma, A-Fib, thin person sleep apnea, high FBS).
I do believe that gluten and grains are an issue for me and stopped grains altogether five months ago. I haven't completely sorted things out, but sugar seems to be unfriendly to me also. Allergies have mostly disappeared since going anti-inflammatory.
Perhaps the effects of years of gluten sensitivity in combination with alcohol creates this 'puffy' effect (wrists, ankles, face - cartilage?) I guess my concern is whether or not a readily observable effect is meaningful enough to remove alcohol, assuming there may be other negative implications I cannot see?
Nick,
I think that with your gluten problem, you are suffering from the long term effects of celiac, i.e. high chronic inflammation, leaky gut, poor vitamin absorbance.
Under those circumstances, it is probably best to back off of alcohol. Maybe you should shift to a glass of dessert wine, i.e. sweeter and hence lower alcohol content.
You should also be aware that NSAIDs also make the gut leak bacteria and can contribute to inflammation of the liver while they suppress inflammation elsewhere. Mini-aspirin may be an issue.
It might be interesting, though ill advised, to see how you respond to antibiotics. The new report (Nature) that rapamycin increases longevity in mice, may be an indication that wiping out chronic mini-infections late in life may block degenerative diseases caused by latent bacterial infections.
Dr. Michael Powell, a rheumatologist has a patent on treating a variety of severe and some terminal illnesses with antibiotics. The problem is that the killed bacteria release endotoxins (LPS from their walls) that cause life-threatening inflammation, so a major part of the therapy is protecting against the side-effects of the antibiotic treatment.
Maybe you should shift to the enjoyment of the natural antibiotics in life: building up to intense exercise, herbs and spices, saunas. You may have a large reservoir of latent bacterial infections, so you should proceed with caution.
By the way, how is your CRP and vitamin D? You sound like your D is still low. All of your blood work must have improved significantly after shifting to a low carb diet. One of the ongoing measures of inflammation may be retention of a sedentary life style. How is your energy? Can you walk comfortably three miles a day at a good pace?
Good luck, and thanks for the comments.
Art
Art,
I am actually quite active and have just assumed that aches and the other issues are all part of the game. I came to realize many years ago that I needed to go to the gym or be outside golfing/hiking/biking at least 3-4 days a week for mental health. But that amount of activity led to a lot of chronic pain. When I discovered that I needed to go LC, I also came to believe that I needed to do high intensity weight training and stop running on the treadmill so much (about three miles every other day with intermittent sprinting). My body continues to need daily movement/activity to feel good, but I don't run anymore (by the way the vicks has been helpful). I always walk the golf course.
Blood work has changed -- vitamin D was 30 ng/ml, though I haven't measured it since I started supplementing 5000IU daily. I don't know what my CRP was before my dietary changes, but after a few months I had it measured - 2.43.
Lipids - before and after two months:
TC - 224 -- 195
TG - 102 -- 81
HDL - 69 -- 74
LDL - 135 -- 105
I found the OGTT test interesting, but have no basis for comparison. My FBS was highish for about 10 years at around 105 (not until last December did I know this was an issue). Post LC diet, I started getting FBS readings in the 80s-90s. It is usually high the day after eating out.
My OGTT (though my own meter disagreed with the test) showed my FBS that day at 69, two hour at 76 and three hours a 54. When I drink alcohol on an empty stomach, my measured BS often heads to the 60s. The test showed that fasting insulin was below ref at all intervals with the fasting number at 2 (ref - 1.9-23).
My regular doc wanted me to go on statins and a lowfat diet. Obviously, I did not comply (she did not see the OGTT, just the FBS).
I saw an ND and she wanted me to go on byetta or januvia, nature throid and supplements for the adrenals. While I believe my endocrine system has been compromised, I am skeptical about 'adrenal fatigue'. I imagine that some of the issues will resolve if I stay off of gluten long term. I hate to be cynical, but it seems that NDs create an annuity through selling supplements.
If you are wondering about the dietary changes, I ate significant amounts of carbs via pasta, sandwiches, crackers and cereals. Probably around 300-350 gms a day. Kept fairly lowfat and lowish protien. I ate very high amounts of fruit, which I no longer do. Occasionally I will have some melon or some berries. Carbs come mostly from raw milk, greek yogurt, nuts and some veggies - about 50-75gms a day (not counting wine!).
Nick,
That is amazing progress. It is a shame that you were obeying all of the conventional rules and they were mostly wrong. All of the exercise probably provided a lot of protection from the inflammation of the high carb diet. The inflammation led to celiac, which led to allergies, etc.
I don't know how to reverse the autoimmune focused system, i.e. how to regain tolerance. The answer is presented in helminth therapy, but I don't know how to interpret it in more reasonable terms.
Maybe the answer is gut flora. You haven't mentioned your attempts to construct a healthy self from the inside out. What about pre- and pro-biotics?
The other possibility is oxidative stress. How many grams of vitamin C, spaced throughout the day, does it take to either make you feel great or give you the runs? Have you tried taurine to improve your glutathione? Lots of greens? What about glucosamine?
I hope those are helpful thoughts.
Art, I have not tried any of the remedies that you ask about in your comment. I just finished reading about taurine, and wikipedia makes it sound like a wonder drug. Whey protein looks like another way to increase gluthathione. I don't use energy drinks, but assume taurine can be found as a supplement.
As for vitamin C, I have not tried taking copious amounts of it for any reason. I have been prejudiced somewhat by reading that production of vitamin C comes from overseas and it is not always processed in a safe manner. It would be interesting to try taking it to find out the answer to your question.
I recently decreased my intake of greens, as I became a little tired of eating them everyday. I began taking a basic multi-vitamin to make sure I am not deficient. Is there a recommended way to supplement vitamin C? I have some packages of Emergen-C which is 1000 mg of C. It is to be mixed with water and has 6gms of carbs. Given what I read about prebiotics and sugar, it seems a bit is necessary as a prebiotic. I can't say I have found enough information on prebiotics to understand how I might try them.
I have not tried probiotics and still need to research to see how to approach them.
I experimented in the past week with eating a little ice cream sweetened with sugar. I found that my blood sugar an hour later was in the 70's both times, which surprised me. It seems to make my GI uncomfortable for about 24 hours though.
I have glucosimine around but I am not familiar with the concept of using it for the gut vs. the joints. I have never taken enough to notice a difference in back pain.
Thanks for all the ideas, it is fun to learn, some of your posts are difficult for the untrained types like me, so are not readily understood beyond the conceptual.
Nick,
Sorry if you got the impression that all of the articles that I write are entry level. I have a rather diverse audience and I mix in plant biochemistry, molecular biology, computational protein modeling, glycobiology, etc. I have to admit that what I am trying to do is put together a lot of the research literature and my own experience and make sense of diet and disease.
I think that there is enough information to understand most of our major diseases and prevent them with simple diet and lifestyle adjustments. Unfortunately the medical industry is uninterested in health. So, to prevent most diseases, we have to work against the medical community.
Many of the simple solutions are going to come from the gut. Glucosamine, for example, is taken to remove symptoms of joint inflammation, but less than 1% of the glucosamine eaten ever gets out of the gut. So the action of glucosamine is in the gut. That is where glucosamine can change the gut flora to enhance the bacteria (probiotics) that in term communicate biochemically with the 70% of your immune system cells that have a home base in the gut. Glucosamine, I think, is a prebiotic.
I don't think that it matters for a quick, two week experiment, where you get your vitamin C. You can worry about the details of contaminants after you figure out if you have a problem with oxidative stress. Contaminants in the diet, are only important over the long haul.
I think, for example, that if the total intestinal bacteria of a healthy person were used to exchange the gut flora of another arthritic person, then the arthritis would be transferred. That experiment works with obesity!
The multivitamin will not be adequate to compensate for poor absorbance, if you have some gut problems carrying over from gluten intolerance. The typical way of starting up a gut with probiotics is to use fermenting bacteria from live yogurt. It is like starting sour dough. By the way, your appendix provides the starting culture after diarrhea. There are lots of commercial products, but I don't know if they are better than a couple of weeks of a good natural live yogurt. Milk products are typically full of prebiotics, but would be better just for starting.
Whey (e.g. lactoferrin) should be useful to eliminate pesky bad bacteria that might get set up in the gut. It might be helpful during a transition to a healthier gut.
Don't forget the herbs and spices to favor the good gut flora. Have you tried a sauna? [If the heat actually kills lots of cryptic bacterial infections, you may actually feel a little inflamed, fatigued afterward. I am not talking about blood pressure changes. More like achy cold symptoms. That should lessen with each repetition.]
Good luck. You shouldn't have to put up with any aches or pains, but it may take a while to get rid of all of the chronic silent mini-infections resulting from years of a leaky gut.
Art,
Thanks again for leading me to such interesting information and ideas. The study on obesity and gut flora in mice is fascinating.
Do you think glucosimine contains some kind of bacteria that is helpful to the gut flora? Here is an interesting antidote. I mentioned to you that I had a benign brain tumor removed (back in those days it took 10 hours and a bit of the removal of brain tissue to remove the thing, hence quite an assault on the body). This was back in 1986. I had many symptoms that didn't lead any flint starters (docs) to the tumor. This included migranes, inner ear caused balance problems, occasional numbness of the right hand and forearm, some speech slurring, etc.
Interestingly, I was also experiencing significant issues with my GI. It seemed that various foods caused and an 'all exits open, no waiting' problem, within minutes of a meal. I had to be very careful to be near a bathroom after a meal. It seemed to be most associated with MSG, maybe garlic, and dishes with cream sauce. I assumed I had somehow developed a lactose intolerance.
Sometime after the surgery, I began taking glucosimine and took it for about 15 years. At some point (7-10 years?) after the surgery the extreme stomach issues resolved (of course, I avoided MSG and cream sauce). I always assumed that the brain tumor created some kind of imbalance that affected my GI and the worst of the problem went away after I no longer had the tumor. Now I wonder if the glucosimine may have been a factor.
On a separate topic, you mention yogurt as a prebiotic due to the live cultures. I eat greek yogurt daily and a cottage cheese with live cultures. Would these two suffice, or are you suggesting that I have to make my own yogurt from some kind of starter?
Nick,
You certainly have a complex medical history. I have a hard time putting it all together, but I would guess that it all started by following the prevailing medical wisdom and eating a highly inflammatory diet. Chronic inflammation led to celiac (gluten intolerance) that produced the diarrhea and leaky gut. These problems led to a slew of food allergies and vitamin deficiencies and probably oxidative stress.
Shifting away from carbs also meant less wheat, which reduced some of your symptoms. You probably need to go on a gluten-free diet.
The yogurt and other fermented products that you eat sound fine. The glucosamine isn't a big deal. It works for some people. I think that it has little to do with the fact that the body uses glucosamine to make cartilage. For meat eaters, the addition of a couple more grams of glucosamine should be meaningless.
Are you taking fish oil supplements?
The reason intense exercise may be bringing some relief, is that it also raises your body temp. That is why I was suggesting saunas or hot tubs. The high temp may purge some of the bacteria that could be distributed throughout your body due to past leaky gut.
Art,
I decided to go grain and legume free last March. I may try to re-introduce rice or lentils at some point and see what happens. I don't eat any packaged products, but naturally get exposed to some things when I eat out.
I do take CLO each day, and will likely switch to a high vitamin fermented one soon. I get hot and cold about taking Omega 3 caps, as I eat very little Omega 6 now and think maybe I get enough with the CLO. I also take D3 caps and butter oil extract.
I imagine that part of what I need is just time to let things work themselves out with all the dietary changes. I think your advice to begin to limit alcohol is sound and I am doing that and watching to see if I notice less inflammation.
And I will make sure I don't exchange any gut flora with any obese individuals!
Nick,
I think that your approach is sound. I think that it would be wise for you to be careful to avoid wheat even when you eat out. Celiac doesn't go away, it just smolders and flares.
The fish oil, would be a cheap experiment. Just buy some cheap stuff and try 8-12 per day for two weeks. Remember to take it with meals that have plenty of fat.
The reason I keep bringing up tissue micro infections, is that I am also attempting to explain the increase in inflammation with age. That increase may result from decrease in steroid hormones that are anti-inflammatory, but I think that most of the increase comes from accumulation of tissue micro infections due to leaky gut. Intense exercise and saunas may decrease that source of aging.
Art,
Thank you for taking the time. I'll try the fish oil and vit C in mega doses and report back to you after to see what happens. It is a little harder to get to a sauna. Interestinly, in the past I used to work out in a gym with a jacuzzi and was addicted to the hot soak afterward the workout.
All the best to you.
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