Chronic Inflammation: Understanding the “Cytokine Storm”

The leading causes of death among Americans are slow developing, lifestyle-related chronic diseases. This includes diabetes, heart disease,  stroke, cancer, hypertension or high cholesterol levels. Diet can often be (but not always) the underlying condition reflected as obesity.  Obesity is now considered to be a major risk factor for complications of COVID-19 infections.

A previous post  explains the role of diet in this occurrence. The post was written before the  co-morbidities   (underlying conditions) were associated with inflammation and severe COVID infections. The following well written article was initially published in The Conversation and succinctly explains how the role of inflammation can contribute to severe COVID and death often described as the “cytokine storm”.

CLICK HERE.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Blue Zone: A Book Review

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By Sally J. Feltner, M.S., Ph.D.

Ponce de Leon began his quest for the fountain of youth in 1531 and humans have been seeking magical solutions for keeping us younger and living our later years in relatively good health.

In 2009 with the backing of the University of Minnesota School of Public Health, AARP and the National Geographic, Dan Buettner established the Blue Zone Project and authored The Blue Zones: 9 Lessons for Living Longer from the people who lived the longest, He interviewed those who were either centenarians or those in their later years and began to investigate what factors may have contributed to five regions of longevity hot spots in the world that included:

  • Sardinia in Italy with the highest concentration of centenarian men.
  • Seventh Day Adventists in Loma Linda, California, where some residents live ten more healthy years than the average American.
  • The Nicoya Peninsula in Costa Rica that has the world’s lowest rates of middle-age mortality and the second highest concentration of male centenarians.
  • Ikaria, Greece that has one of the world’s lowest rates of middle age mortality and lowest rates of dementia. Only 20 percent of people over 80 showed any signs of dementia, whereas a similar study of long-lived people near Athens showed an almost 50 percent rate of dementia- a rate similar to that for older Americans.”
  • Okinawa, Japan home to the world’s longest living women.

Remarkably, all the regions had common characteristics that included family and purpose, community and spirituality, stress reduction and physical activity. Mr. Buettner later published The Blue Zones Solution and coauthored with Ed Diener, The Blue Zones of Happiness.

One major practice was that all their diets, though not vegan, were predominantly based on plants. Meat and other animal products are either the exception or used as a condiment. Okinawans, practice a philosophy called hara-hachi bu regarding food; they only eat until they are 80% full

In the Costa Rican Zone, everyone feels like they have a plan de vida or life plan. Even at ages above 60 and 70, inhabitants don’t stop living. They keep themselves busy; they love to work. It provides them a “reason to waking up in the morning” called ikigai. There is no word for “retirement” in Okinawa.

The book introduces some very interesting longevity “superstars.”

  • Marge Jones, at 100 years old from Loma Linda begins every day with a mile walk, a stationary bicycle ride, and some weight lifting. “I’m for anything that has to do with health”, she says
  • Kamada Nakazitam, 102 years old from Okinawa says “To be healthy enough to embrace my great – great grandchild is bliss.”
  • Ellsworh Wareham, age 91 from Loma Linda, assists during heart surgery procedures, something he does about two or three times a week
  • Abuela Panchita, 100 year old Costa Rican woman whose 80 year old son, Tommy bicycles to see her every day, spends every day cooking, splitting logs and using a machine to clear brush from her
  • The notion of moai in Okinawa stands for “a social support network. Says 77 year old Klazuko Mann, “each member knows that her friends count on her as much as she counts on her friends.”
  • From the author: “I once pressed a 101-year-old woman in Ikaria, Greece to tell why she thought people there lived so long. ‘We just forget to die,’ she said with a shrug. None of them went on a diet, joined a gym, or took supplements. They didn’t pursue longevity – it simply ensued”

The final chapters in the first book boil it all down into nine lessons and a cultural distillation of the worlds’ best practices in longevity. Buettner provides credible information available for “adding years to your life and life to your years.”

However, there is a downside that is currently happening. From the Author: “Sardinians today have already taken on the trappings of modern life. For example, junk foods are replacing whole-grain breads and fresh vegetables traditionally consumed here. Young people are fatter, less inclined to follow tradition, and more outwardly focused.”

The first book concludes with a chapter on Your Personal Blue Zone. Other books give us more explicit ways to establish Blue Zones in other areas such as the U.S.

From the back cover of The Blue Zones Solution – “Propagating the Blue Zones would not only prevent a rise in the prevalence of diabetes (and other misfortunes) it would allow us to eliminate more than 80 percent of the burden we have now. That’s revolutionary.”

David Katz, M.D., Director of the Yale-Griffin Prevention Research Center

 

 

Are Our Diets Killing Us?

The Corona Virus

The importance of lifestyle enters into the debate about the coronavirus pandemic and its consequences. Many reports of viral deaths are attributed loosely to underlying conditions exemplified  by the presence of hypertension, heart disease, diabetes/prediabetes, and obesity which is surmised to increase  the mortality risks of the virus. These are the leading causes of death in the U.S. and are collectively referred to as chronic diseases.

“Poor diet, a lifestyle factor among others, is the leading cause of mortality in the United States, causing more than half a million deaths per year. Just 10 dietary factors are estimated to cause nearly 1,000 deaths every day from heart disease, stroke and diabetes alone. These conditions are dizzyingly expensive. Cardiovascular disease costs $351 billion annually in health care spending and lost productivity, while diabetes costs $327 billion annually. The total economic cost of obesity is estimated at $1.72 trillion per year, or 9.3 percent of gross domestic product.” NYT.

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Chronic Disease: Can Your Lifestyle Make a Difference?

 

Lately in the literature, lifestyle medicine has been mentioned as an effective practice that influences our overall health and risk of diseases in general. Many of the  leading causes of death in developed countries have been referred to as chronic diseases and ways to prevent these diseases is to practice a “healthy lifestyle”. But what does that exactly mean? Some research has suggested that our susceptibility to Covid-19 may even be altered by our lifestyles, obesity being named a risk factor.

In 1999, a Harvard-trained cardiologist, James E. Rippe published a textbook entitled Lifestyle Medicine in which he expressed his hope for a “new emphasis in medicine related to the links between daily behaviors and outcomes”. The idea slowly took root. In 2006, Loma Linda University School of Medicine, a Seventh Day Adventist institution in California, debuted the country’s first lifestyle medicine education program. A few years later the School of Medicine Greenville at the University of South Carolina went a step further, integrating lifestyle medicine into every facet of the curriculum and requiring prospective physicians in medical schools to spend 50 hours over two years covering the ways in which diet, nutrition and exercise impact the various organs and systems. Several other medical school programs have followed, that have been dedicated to the principals that healthy food, rich in nutrients, healthy fats, and lean protein, can be a potent weapon in the doctor’s bag.”

“How much a role does nutrition play in health? “It is the thing, says Jennifer Trilik , an associate professor at USC Greenville who directs the schools lifestyle medicine program. “if we’re talking about obesity, cardiovascular disease,  cancer, there’s so much evidence that saturated fat and trans-fat cause chronic inflammation, damaged the DNA and create growths in an adult body that shouldn’t be there. On the other hand, apples and blueberries have so many healthy antioxidants. We were made to eat whole foods and plant based foods, not processed ones out of a bag.

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The Pima Indians: A Study of Lifestyle and Obesity

By Sally J. Feltner, MS, Ph.D

The Pima Indians of Arizona have the highest rates of diabetes and obesity in North America. An estimated 50 percent of Pima adults are obese, and of those, 95% have diabetes type 2.

WHAT HAPPENED?

The story is not new – it more than likely began in the 1500’s when the Spanish explorers made contact with them in the New World. They and most Native tribes of that time were hunter-gatherers. They were lean, active and healthy people.

Pima Indians are believed to be descendants of people who crossed the Bering Strait from Asia to the Americas. Their traditional diet included meals made from the crops they cultivated including corn (maize), kidney beans, sunflower seeds, pumpkins and squash.  Small game such as rabbit, was a staple part of their diet together with meat from their livestock such as sheep and goats. Larger game was also available such as deer, elk and bear. As they were in close proximity to rivers, fish, duck and many different types of shellfish were major elements of their diet, which was also supplemented with herbs, acorns and roots. Sadly, as the years went on, the Arizona group met with some unavoidable circumstances that changed their way of life considerably – especially their traditional diets, economics, and well-being.

  • In 1859, the Arizona Pimas’ land along the Gila River was taken away by the U.S. government which left them to live on what land was left known as the Gila Reservation.
  • In 1866, new settlers began to populate the Pima region and diverted the water from the Gila River for their own use.
  • By 1869, the river had dried up and the Arizona Pimas were left with no water and less land to grow their food and crops resulting in an on – and – off – 40-year-old famine. As a result, the government exacerbated the problem again by providing subsidized foods to the tribe consisting of white flour, sugar, lard and canned goods, a far cry from their traditional diets of corn, beans and squash.

The timing of these significant changes in lifestyle and livelihood of the Arizona Pima population coincides with their development of diabetes type 2.  At the turn of the nineteenth century, studies recorded only one case on the Gila River Reservation. In 1937, a study documented twenty-one persons with diabetes. By the 1950’s, however, the prevalence had increased ten-fold and a study initiated in 1965 documented in the Arizona Pima Indians the highest prevalence of diabetes ever recorded.

THE PIMA INDIANS IN MEXICO

The Pima Indians who had settled in Mexico resided in the small town of Maycoba. For decades they had been isolated until 1991 when a paved access to the town was constructed.  Before that they grew a majority of their own food and still adhered primarily to their traditional diet that was similar to the Arizona tribe. Since they are genetically similar to the Arizona Pima, they present an opportunity to study and compare the two-lifestyle patterns of both tribes (diet and exercise) on their health statistics.

What Has Been Learned from Various Studies of these two Populations?

An Abstract from one study in 1994 that compared the two groups gives us the following details:

OBJECTIVE The Pima Indians of Arizona have the highest reported prevalence of obesity and diabetes type 2 In parallel with abrupt changes in lifestyle and the incidence in Arizona Pimas have increased to epidemic proportions during the past decades. To assess the possible impact of the environment on the prevalence of obesity and diabetes type 2, data were collected on members of a population of Pima ancestry living in a remote mountainous location in northwestern Mexico, with a lifestyle contrasting markedly with that in Arizona.

RESULTS  The Mexican Pimas were significantly lighter and shorter with a lower Body Mass Index. They also had a significantly lower plasma total cholesterol level than the Arizona Pimas. Even more startling was that diabetes type 2 was less prevalent with only 2 women (11%) and 1 man (6%) in the Mexican group compared with a prevalence of 37% and 54% in male and female Arizona Pima Indians respectively.

CONCLUSIONS This preliminary investigation shows that obesity, and perhaps type 2 diabetes is less prevalent among people of Pima heritage living a “traditional” lifestyle than among Pimas living in an “affluent” environment. These findings suggest that, despite a similar potential genetic predisposition to these conditions, a traditional lifestyle, characterized by a diet including less animal fat and more complex carbohydrates and by greater energy expenditure in physical labor, may protect against the development of cardiovascular disease risk factors, obesity, and diabetes type 2.

DISCUSSION:

These results indicate that a more traditional lifestyle of the Mexican Pimas protects the group against obesity, diabetes and kidney disease, even though they may have a genetic predisposition for such health problems.

What explains the results of experiences of the Arizona Pima?  One popular theory is one thing that drives obesity is a switch to a diet of highly refined carbohydrates that are so common in the Standard American Diet (SAD). When the Pima replaced traditional, unrefined carbohydrates with refined (sugar and flour), they became obese. It may not be the amount of food we eat but what kinds or quality we consume.

The lessons learned here support the theory that lifestyle factors appear to significantly influence the prevalence of obesity and diabetes type 2 in a population predisposed genetically to these conditions. Their story gives us all the opportunity to reassess our own current diets and lifestyle factors that may lead to healthier food environments and ultimately prevent our current situation of the diabesity dilemma.

SOURCES

Stephen Guyenet, Lessons From the Pima Indians. Whole Heath Source: Nutrition and Health Science.

Leslie O Schulz, PhD, Lisa S. Chaudhari, PhD. High-Risk Populations: The Pimas of Arizona and Mexico. Curr Obes Rep. 2015 March 1; 4(1): 92-98

Ravussin, et al. Effects of a Traditional Lifestyle on Obesity in Pima Indians, Diabetes Care 1994 September 17(9): 1067-1074

All About Diabetes Type 2 in the U.S.

We may be approaching another healthcare crisis other than the pandemic.  In both crises, the numbers keep rising and no one really seems  to earnestly do much about it. Both can be frustrating and prevention can be a key factor.  Prevention always is the best medical advice but it’s difficult to find help due to a lack of interest or funding.  In my opinion, many cases of diabetes type 2 can be prevented if enough attention is paid to understanding certain aspects of the disease. Studies of previous prevention programs have shown to make a difference. One particular study compared lifestyle  modifications with the anti-diabetes drug, metformin and found that lifestyle modifications were just as effective as taking the drug. This finding is an important result in that it suggests that lifestyle can influence our health and help to prevent some of the chronic diseases that have become leading causes of death in the U.S.

Even weight loss of 5-10% of body weight  is the first line of defense against diabetes type 2 as well as learning about which foods you eat can help control blood glucose levels thus resulting in insulin secretion and/or insulin resistance.

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You can find the complete study HERE.

Diet and Inflammation

Diet, Chronic Disease and Inflammation

By Sally J. Feltner, MS, PhD

A lot of recent attention has been paid to the role of lifestyle in many chronic diseases (lately referred to as underlying causes of mortality in the Covid-19 viral pandemic).  Deaths due to this virus have been strongly associated with age, obesity, high blood pressure and diabetes to name a few. Many people with the viral infection have reported to have had at least one or two of these chronic conditions. Obesity alone has been known to be associated with low-grade inflammation.

Diet is one of those lifestyle factors in which somehow, we have gone astray. As we often hear, the Standard American Diet (SAD) is becoming more and more to be a causative factor of our ill health.  As a result, body weight is on the rise and we are becoming more sedentary. Obesity is linked to the metabolic syndrome and type-2 diabetes  and has come to be called the diabesity pandemic.

Recently, we have changed our ideas about diet and heart disease.  Many doctors still think the high fat, high cholesterol diet of the last decade was to blame.  However, this is a simplified view that dismisses the research that now supports the possibility that heart disease is mediated by other biological events other than cholesterol, including oxidative stress (free radicals), insulin sensitivity, endothelial dysfunction and blood clotting mechanisms and most importantly low-grade inflammation. Also, heart disease is now thought to have other risk factors such as high LDL cholesterol, high triglycerides and low HDL cholesterol that may be or not be related to dietary factors.

(FYI – endothelium is the tissue which forms a single layer of cells lining various organs and cavities of the body, especially the blood vessels, heart, and lymphatic vessels.)

We should be aware that inflammation is a double-edged sword. Inflammation in the body is necessary to protect us from infections and cancer and when appropriate from diseases. In its acute state as when you cut your finger, its reactions are self-limiting and resolve rapidly; the process is meant to heal and repair tissue damage.  However, when inflammation is inappropriate, it can get out of hand and contribute to disease, especially chronic diseases. That is when inflammation can become your enemy.  In this type, the inflammatory response needs be controlled or managed or at least short lived. Should it continue on, persisting cytokines of the immune system can produce excessive damage, leading to a number of diseases, including fibromyalgia, lupus, MS, and more. Cytokines can persist and overwhelm the immune response by releasing signals in the nervous system and and may contribute to a “cytokine storm” killing healthy cells as well as the offending agents (bacteria or virus).

(FYI – cytokines are small proteins produced by immune defensive cells that affect other cells and the immune response to an infectious agent. They act as cell messengers.

Can Diet as a Lifestyle Make a Difference in our Susceptibility to Disease and Affect Our Overall Health??

Recently, much has been written about specific foods and dietary approaches you can do to that either promote or reduce low grade inflammation. Keep in mind that this is only speculation, and some is just pure marketing by the food industry to promote a certain brand. At this point, we are beginning to research this more conclusively and in order to do that, studies have to measure whether a certain substance in the diet either raises or depresses what is known as inflammatory biomarkers in the body. The most used is one called high sensitivity C-Reactive protein (hsCRP). Others include inflammatory markers interleukin-1 or interleukin-6 as well as others. To do this involves a simple blood sample. I have had one to measure my inflammatory status a few years ago. If you see a study that claims to have noninflammatory properties, look for the way the study was performed – i.e., did it measure the effects on these inflammatory markers.

The goal of this blog post is to guide us to the right anti-inflammatory foods to reduce your risk of illness. Consistently, pick the wrong ones, and you could accelerate the inflammatory disease process.

Foods that allegedly promote inflammation – try to limit these foods as much as possible:

  • Refined carbohydrates such as white bread and pastries; choose whole grains instead. They need not be gluten-free unless you have some issues with wheat and need to limit its intake.
  • French fries and other fried foods
  • Soda and other sugar-sweetened beverages
  • Red meat (burgers, steaks) and processed meat (hog dogs, sausage)
  • Margarine, shortening, lard (high levels of trans fatty acids)

Foods that allegedly reduce inflammation –   include in the diet as much as possible

  • Tomatoes rich in lycopene and carotenoids – healthy phytochemicals usually with antioxidant propertiesHigher
  • Olive oil – rich in monounsaturated fat and phytochemicals
  • Green leafy vegetables such as spinach, kale, collard and other greens – a randomized German study showed that 8 servings of fruits and vegetables for 4 weeks in men had lower levels of hsCRP.
  • Nuts like almonds and walnuts – high in monounsaturated fats
  • Fatty fish like salmon, mackerel, tuna, sardines – Diets rich in omega-3 fatty acids reduced inflammation.
  • Fruits such as strawberries, blueberries, cherries, and oranges
  • Higher fiber consumption was associated with less inflammation in seven studies, using hsCRP as a marker.

Bottom Line:

If you’re looking for an eating plan that closely follows the tenets of anti-inflammatory eating, consider the Mediterranean Diet which is high in fruits, vegetables, nuts, whole grains, fish and healthy oils (primarily olive oil).

In addition to lowering inflammation, a more, natural, less processed food diet can have noticeable effects on your physical and emotional health.

The Mediterranean Diet In A Nutshell

A Mediterranean diet is a good example of a diet that reduces low-grade inflammation and at the same time appears to reduce the risk of heart disease. It is a diet pattern that has been studied extensively and without a doubt scores high in the healthy column. It comes highly recommended and contains most of the foods labeled Anti-inflammatory.

High in fresh fruits and vegetables, olive oil, legumes, unrefined grains
Moderate in low-fat dairy
Low in meat
Moderate to high in fish
Moderate alcohol intake

Blue Zones Cities USA

Dan Buettner’s groundbreaking ambitious Blue Zone project is beginning to transform American cities into Blue Zone cities  and has so far helped thousands of people lose weight, reverse disease, and increase life satisfaction by changing in part the way they eat, live, and connect.

The original Blue Zones areas helped shape these transformations. Practically speaking, Americans cannot be expected to eat the same foods as the Blue Zone inhabitants did. That would be impossible in the U.S. food environment. However, lots of lessons can be learned from their way of life that led them to longevity and health in their older years than anyone could have imagined. Get a brief glimpse of how one city (Ft. Worth, TX) transformed themselves into better health outcomes. Small changes can make a difference over time.

 

CLICK ON THE VIDEO.

Blue Zones in America?

Dan Buettner, author of The Blue Zones and The Blue Zones Solution has revealed that the world’s longest living people have lived lifestyles over the past 100 years that help them and others lead healthier and more fulfilling lives.

One of these lifestyles includes their diets.  Buettner’s teams have helped thousands of people lose weight and reverse disease by changing the way they live, eat, and connect with each other. Ultimately, these changes can transform your health and help you live longer.

The basis of this diet at a glance:

  • Rich in “healthy” fats including olive oil and omega-3 fatty acids.
  • Vegetables abound; meat is minor.
  • Loads of beneficial herbs.
  • Moderate drinking.
  • Practice of a slower pace of life with a strong social connection.

FYI: There is a new book by Dan Buettner called The Blue Zones Kitchen: 100 recipes to live to 100. The information is priceless and the photographs are stunning (provided by David McLain and National Geographic).

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