When we think about inflammation, we envision swelling, redness, and possibly bruising. We commonly imagine a joint or a wound becoming inflamed from an acute injury, such as a sprain or cut. Rarely do we think about our heart being inflamed, yet more and more research points to inflammation as an important underlying cause of heart disease. The difference is that this inflammation comes not from one specific injury, but from the longer term effects on the heart of a continuously stimulated immune system. Patients with chronic inflammatory conditions are known to be at an increased risk of heart disease, but even those without autoimmune disease or other inflammatory disorders can suffer from atherosclerosis after years of chronic stress from the environment, dietary and lifestyle challenges.
Is cholesterol the culprit?
Cardiac disease is generally thought of as mostly a problem of excess fat deposition in arteries and organs. The popular explanation is that as fat builds up in an ever thickening layer, plaques can rupture, and ultimately block the flow of blood through the arteries. While this may be a piece of the puzzle, this theory does not explain why almost half of all heart attacks occur in people with normal cholesterol levels.
To further confuse the issue, contrary to popular belief, dietary cholesterol does not increase blood cholesterol levels. Our bodies control cholesterol production in response to its need. The question then is: why do our bodies start to produce this excess cholesterol and what is cholesterols role in atherosclerosis?
Far from being the enemy we have grown to believe it is, cholesterol is a critical compound for all human beings. It is part of many hormones, is actually necessary for normal fat digestion, helps our brains work, and is required for normal Vitamin D production. The body also increases cholesterol production in response to inflammation, in order to form a protective barrier, much like a Band-Aid. People with normal total cholesterol levels can still have small plaques targeted to areas of inflammation. It is only when this fatty covering ruptures, that trouble occurs. This link between cholesterol production and inflammation may be a key to better understanding its role in cardiovascular disease, and may explain why even those with normal cholesterol can experience a heart attack.
Over 40 years ago, Ross and Glomset developed what is known as the “response to injury” theory of atherosclerosis, postulating that injury to the cells was the first step in the development of the disease. Other researchers implicated infectious agents such as viruses in the development of cardiac disease as well, and there is good evidence to support these theories. These scientists relate the deposition of fat to evidence of inflammation, and suspect both are necessary for the disease to occur.
Once inflammation is present, LDL (the “bad” fat) accumulates around the site of injury and is a key component in plaque formation. The LDL is most dangerous when it is “oxidized”, which means it has been exposed to dangerous free radicals. Free radicals are naturally produced by the body, but are increased when inflammation is present, and can be reduced by consuming anti-inflammatory foods, spices and herbs. Once again, inflammation and heart disease are clearly linked.
Identifying inflammation
A specific blood marker, known as C-reactive protein (CRP), can accurately identify people with increased inflammation, and a number of studies have shown a clear correlation between elevated CRP and heart disease. While this is still not a routine part of a cardiac profile, more and more healthcare practitioners are checking CRP.
Triglycerides (TG) are another important marker to monitor. TG is a standard component of a lipid profile, but is often overlooked when assessing heart risk. This is unfortunate, as more and more data points to TG as an independent risk factor for a heart attack, regardless of whether other cholesterol markers are normal or elevated. TG rise in response to high carbohydrate intake, especially the simple sugars that are so pervasive in a typical American diet. Sweets, alcohol, and refined flours are known to increase chronic inflammation in the body and will also raise TG, providing another link between heart disease and inflammation.
Fighting the Fire
Reducing the lifestyle factors that increase free radical damage is key to protecting your heart. Stress, smoking, excess alcohol and poor diet are major contributors to free radical production and consequent inflammation. Addressing one and ideally all of these areas can have a powerful impact on cardiac health. Simple steps to fight the fire include stopping smoking and limiting alcohol. In terms of alcohol, complete avoidance does not seem warranted. Red wine and beer are both rich in antioxidant nutrients that are heart protective, so one drink a day can be beneficial. Excess intake of 3 or more drinks a day however, is counterproductive and undesirable.
Busy, overscheduled lives lead to inflammation as well. Stress reduction techniques such as meditation, yoga, exercise or simply slowing down to breathe deeply can help. Incorporating these techniques into your life daily can have far reaching benefits and don’t entail a major time commitment.
In terms of diet, brightly colored fruits and vegetables are rich in antioxidants and quench the dangerous free radicals, as do flavorful herbs such as turmeric, ginger and cinnamon. Limit sugar and refined sweets to reduce inflammation. Many low fat foods have extra sugar added instead, so choosing artificially low-fat foods is counterproductive. Stick to naturally lower fat items instead. Cut out processed foods which are empty of key nutrients and snack on nuts and seeds which provide antioxidant nutrients and heart healthy fats. Omega-3 fatty acids such as those found in fatty fish or fish oil are also anti-inflammatory. Even the much maligned egg has a place in the diet; it contains lecithin which helps process fats, as well as antioxidant vitamins.
As it is with many other chronic health issues, inflammation is a key component of the disease. The good news is that the fire can be doused with healthy diet and lifestyle.
Vicki Kobliner MS RD, CD-N is a Registered Dietitian and owner of Holcare Nutrition (www.holcarenutrition.com). Vicki works with infants, children and adults with digestive disorders, food allergies, ADHD, autism and other chronic illness, and provides fertility and prenatal nutrition counseling. Vicki has extensive experience in using dietary modification, appropriate supplementation and functional lab testing to achieve optimal wellness. She can be reached at 203.834.9949 or vicki@holcarenutrition.com.