Is Low-Grade Inflammation Making You Sick?

Coming up on this episode of the Doctor's Pharmacy.

A lot of what is causing this low level chronic silent inflammation today is our environment, our dietary habits, our lifestyle.

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And now let's get back to this week's episode of the Doctor's Pharmacy. Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy podcast. Inflammation is at the root of many, and some would say all, chronic conditions. Our modern diets and lifestyles have created an environment of chronic inflammation wreaking havoc on our health and balancing your immune system and cooling off chronic inflammation is essential to overall health and well-being. In today's episode, we feature three conversations from the doctor's pharmacy about what inflammation is, what contributes to it, and how to reduce it. Dr. Hyman speaks with Dr. Shilpa Ravella about the detrimental effects of chronic inflammation that just don't let up, with Dr. Rupa Mariah and Raj Patel about the link between colonialism and the inflammatory state of our world and our bodies. And finally, Dr. Hyman talks about the many lifestyle factors that lead to inflammation. Let's jump in.

Inflammation is actually an ancestral force that evolved to protect us from things like pathogens and poisons and traumas, all of these ancient killers. So it's actually a good thing in our bodies to have inflammation when we need it. But the problem is that because we've evolved these strong, robust immune responses, we also tend to pay a price for it. And this is called the biological price of having a strong immune system. And we can see that with autoimmune diseases, for example, like rheumatoid arthritis or inflammatory bowel disease. But now what we're seeing is that we've also transformed our modern environments from the food we eat to the air we breathe to how we move, how we interact with others in terms of social connections. So our immune systems are constantly triggered at a low level, and this leads to chronic silent inflammation in the bodies. And we know today that this type of inflammation can actually be an independent cause of disease. And it is tied to a variety of modern chronic diseases. The majority of our top killers, it's tied to heart disease, cancer, diabetes, neurodegenerative disorders, some psychiatric issues, obesity. So, what we're seeing today is that the majority of us in the modern world are inflamed.

Yeah.

Most people don't walk around going, oh, I'm inflamed. Like, if you got a rash or you have a sore throat, you know, I'm inflamed, right? If you have arthritis in your knee and it's swollen up, you go, I got a problem. But most people who are overweight or have heart disease or high blood pressure, diabetes or depression, they're not walking around thinking, oh, I'm inflamed. I better, deal with that, right?

Right, absolutely.

So, explain how inflammation plays a role there because we think of inflammation typically as being something that is there to fight infection or our immune system that gets activated to fight cancer and then can get dysregulated with autoimmunity and allergy. But, we don't think of it in.

Terms of sort of this general state.

Of being kind of low-grade inflammation which we're all suffering.

Right, and I think that's a great point is that we don't tend to think of inflammation as being so broad. For example, when we think of inflammation, we think of autoimmune disorders, typical autoimmune disorders, or as you said, when we have a cold or a flu. But now what we're seeing is that low-level inflammation can actually cause some of these disorders, or it is tied to nearly all of these modern chronic disorders. And you're right that if you go into your doctor's office, your typical Western physician's office, you're unlikely to be offered a test for inflammation. So, the question is, how exactly do you know that you're inflamed? And I think there are a lot of things that are coming up these days. For example, in cardiology clinics, doctors might test you for something called C-reactive protein, high sensitivity C-reactive protein. And that's a marker of inflammation in the body. It's made in the liver in response to areas of inflammation. And there are a variety of other markers as well, but some of the problems with these tests is that they may not be that specific. So if you have elevated C-reactive protein, you may have that elevation from the cold you have, and you cannot be sure where it's coming from in your body, how long it's been there for. But, you know, there are new markers being developed. There are inflammatory signatures, for example. There was a Stanford study a couple of years ago on aging and an inflammatory signature comprised of several markers that can help to predict healthy aging. And, you know, there are so many different things that are in I think from tests like CAT scans and MRIs that can pick up inflammation around blood vessels, for example, and predict which plaques are most likely to rupture. So those are some of the things. And one of the proxies for being inflamed that we can all look at when we go to our primary care physician's office is just things like high blood sugar or diabetes. If you have pre-diabetes or diabetes, you are most likely to have some amount of inflammation in the body because high blood sugar, does tend to create inflammation. And if you have that belly fat, for example, then you also know that you most likely have some level of inflammation in the body because we know that the belly fat is a marker for the fat that wraps around your internal abdominal organs.

Yeah, I mean, by the way, that fat is a source of a lot of inflammation because it's not just the belly fat is not just holding up your pants. It's actually a very active immune hormonal organ. that's spewing out all kinds of inflammatory signals if you get this excess belly fat. And I think most people don't realize that. If you have a big belly, you've got a smoldering fire inside of you. And that is really important to understand. And the reason we get the big belly is 'cause of what we're eating. So, let's talk about.

Some of the.

Things you were talking about. Like how do we know, right? So we can do a CRP, but it's not very specific. It doesn't tell us why. It, you know, there are other markers. We mentioned Stanford research. I think that was David Fuhrman's work on the Thousand Immunomes Project, where he looked at cytokines or inflammatory markers in a thousand people from little kids to old people. And he found they were like things that we probably never heard about in medical school, these cytokines that we don't test for in a normal lab result, but that actually are probably more predictive and more correlated with various age-related diseases than other markers that we actually do measure, right? So we're kind of learning about how to test for this. And you mentioned high resolution scans, imaging tests. Now, for example, with Alzheimer's, we know that Alzheimer's is an inflammation in the brain. We can see through various MRI and high technology scans, we can see inflammation in the brain. We can see, for example, a new AI-driven heart scans we can see inflamed plaque where rather than just looking at O and angiogram or, you know, even calcium score, which gives you a rough idea of the calcified plaque, it doesn't tell you how inflamed your plaque is. So we're getting more and more sophisticated. But, you know, are there, are there tests that we should all be doing to check for inflammation?

And are there tests that help us.

Figure out the why?

Like, what is the why behind why we're so inflamed? I think that's a, it's a certainly a tough question. For sure. And I think it's also very specialty dependent. You know, for example, in my own practice, I tend to see inflammation all throughout the intestinal tract. And so depending on what sorts of symptoms a patient's come in with, I may do endoscopic testing, I may do an upper endoscopy and a colonoscopy, and I may catch microscopic inflammation in the intestines as well through that way. And there are also stool tests that we do in our practice to measure inflammation like lactoferrin, which is one of the stool tests. And these are very situation dependent. And again, if you go to your physician in general, you're unlikely to be told, hey, let's just check you for inflammation and then let's try to treat it. And we're not quite there yet, but I think we're getting there. And I think one of the interesting things, too, with testing is that, you know, perhaps we should be measuring inflammatory responses to challenges. rather than just like a baseline snapshot of inflammation. I think that's something that could be very interesting as well because we want to know that the immune system is doing its job when it should be and not overreacting as well. So I think there are a lot of great things that will come up in the future regarding testing and hopefully we'll see more and more specific markers and we'll see more trials in this space. But I think when we go to our physician's office, in the modern age, we have some proxies that can tell us if we're inflamed and we have specialty specific diagnostic tools that we can use as well. Interesting.

You mentioned sort of a challenging the immune system. Can you talk more about that? Because we know, for example, if you want to check for diabetes, you do a glucose tolerance test where you give people a bunch of sugar and see what happens to their blood sugar. Or if you want to check someone's heart, you don't just check an EKG, you put them on a stress test or do a stress echo to stress their system. Tell us what you're talking about. I think this is a really interesting concept of how do we test our immune system's function? Are we overreacting or underreacting?

Yeah, I think it can be as simple as injecting a molecule like lipopolysaccharide and trying to figure out what the immune system's response is. Is the immune system one, responding appropriately? And two, is it overreacting? Are we having too much inflammation to a stressor? And I think that could tell us more than perhaps just a snapshot of the blood markers that we have currently. And this is something that I think maybe that we will see in the future. Yeah.

Now, we've all heard about the cytokine storm from COVID and cytokines are basically the messenger molecules of your immune system. And a lot of the, you know, work by David Furman, things we're measuring like CRP, TNF-alpha, IL-6, cytokines, they're just.

The, the, symptoms of inflammation.

They're not the cause. They're the body's response to something that's irritating it.

Right.

So my, my question is, you know, is, is, you know, why always, why is the immune system pissed off in the first place?

Right.

It's easy to measure. Look at, you know, you can look at scans, you can look at a colonoscopy, you can look at CRP, you can look at all these other biomarkers, but it's not going to tell you the why. And so, you know, my joke always is that a functional medicine doctor is really an inflamologist. Like, I'm an inflamologist. I think I'm, I, like, made it my life's to understand inflammation, to understand what causes it, how to actually remove the causes, and how to get the body's own immune system to calm down and to reduce the inflammation naturally. So can you talk a little bit about, from your perspective, what do you see as the main drivers of this epidemic of inflammation and inflammaging, which we talk a lot about?

I think, first of all, that this idea that all of these disorders share a deep biological link from heart disease and cancer to some cases of depression and neurodegenerative disorders, that lengthening inflammation, it forces us to look at all of these things and really try to figure out what these root causes are. And it forces us also to look at patients and to treat patients not only from specialty perspectives, but also holistically in some ways as well. And a lot of what is causing this low-level chronic silent inflammation today is our environment, our dietary habits, our lifestyle. And we know that chronic inflammatory disorders and when I talk about chronic inflammatory disorders, I'm talking not just about rheumatoid arthritis and inflammatory bowel disease, but all of these different modern diseases because these are inflammatory disorders. And so we know that our lifestyle factors play a very, very important part.

So talk more about specifically, what is it about our diet that's driving the inflammation? And then I want to get into potentially exploring other causes that may not be immediately obvious to people that are driving inflammation.

Sure.

Because your book is really Silent Fire talks about diet as a big driver of inflammation. So exactly what are we talking about here?

There are so many different factors and I think one of the biggest ones is the Western diet and this type of diet is loaded with an excess amount of sugar, salt, inappropriate fats, processed foods, processed meats, refined carbohydrates. And the problem with this Western diet is that our immune system actually tends to respond to it as it would a germ. You know, your immune system tries and tries to kind of fix things in your body, and it realizing that keeps getting these hits, you know, maybe three times a day or six times a day, however many times a day you'll have a meal. And when we are eating this Western type of diet, we're also starving our gut microbes of their most beneficial nutrient, which is fiber. And fiber can manipulate all arms of the immune system, from the innate immune system to the adaptive immune system. And it's an incredibly powerful, powerful nutrient that we need to be eating more of. But 95% of Americans today do not meet the recommended daily allowances of fiber. 28 grams for females and 38, I think, for males. So we are really starving that microbiome. Then the microbes change their behaviors, causing inflammation. They'll inch closer to the mucosa. They will create more inflammatory molecules like lipopolysaccharide. Those molecules will go out into the bloodstream, causing body-wide inflammation. So it's changing, you know, who the microbes are, the species in your gut, and also what their behaviors are. So the Western diet, one of the biggest losses is also the fact that we are depriving our bodies and our guts and our gut microbes of their most essential nutrient. So diet is certainly a very big component of creating this low-grade inflammation. And I would also say that the.

Other main- Not just a lack of fiber though, right? It's probably other things in our diet.

Right. Plenty of other things. And, you know, the other thing too, I would say, is that we tend to think of foods as dampening or creating inflammation, but there's also a reversal going on. This whole process by which inflammation tends to die down in the body is not a passive process. It's an active process and immune cells like macrophages and neutrophils will secrete new mediators. And we need to feed that process. And so we need to eat healthy fats like omega-3s. And I think that's something that we don't do enough of. nearly enough of. So that potential to resolve inflammation in our bodies, we need to really be able to create those molecules. And that also comes from diet because the precursors of these lipid signaling molecules are actually Omega-3s, which we find in a variety of foods. Yeah, I mean, these are called the icosanoids, right?

This is what we learn in medical school. These Pathways of regulating cytokines, inflammation, and they're highly regulated by the fats in our body, particularly the Omega-3 fats. I want to loop back to what you earlier talked about, because I think it's really important. I don't want to skip over it, which is the role of the microbiome. And as a gastroenterologist, I think this is your area, which is the microbiome plays a huge role in regulating our immune system. And most people don't know that 70 of our immune system or 60 of anything you're talking to is in our gut. And it's because it's the first place where we interact with the outside world. Right. We put all this pounds of foreign stuff on our mouth every day, and it goes down there and has to be sorted through, and then you've got all this. bacteria and bugs and poop in there and it, you know, you have to lay in the right stuff but keep out all the bad stuff. And when we get a problem with the microbiome, we tend to get damage to the gut and more inflammation. So can you kind of walk us through that whole story of what we're doing to damage our micro palm besides just not eating fiber and what changes happen in our microbiome and how that starts to up ramp the inflammation cycle in our body? Right.

So, so, so when you look at the microbiome, When you see, for example, a mouse who grows in a sterile bubble with no microbiome, no germs on that mouse whatsoever, you find that this mouse actually tends to develop all kinds of abnormalities, like a deformed heart and lungs and a shrunken brain. So microbes actually train our immune system. They help our immune systems to develop. Our microbes are having conversations with our immune cells at all hours of the day, and this is a process that begins even before we're born, and once we're born, of course, and all throughout life. So we need to be having those essential conversations. And how do we foster those conversations? And again, it comes down to lifestyle. What kinds of foods are we eating? I had mentioned fiber, but there are so many other foods that are great for the gut microbiome, because we know also that a lot of the fats that we eat can make their way, some of them can make their way down into the colon. And we have that proportion of fats, for example, being metabolized. And we know that, you know, there are spices and herbs and all of these wonderful foods with polyphenols, which are amazing compounds for the gut microbiome, because again, some of those make their way down and are metabolized by the microbiome. So it's not just about the fiber, but all of these amazing nutrients that we find in foods. And what we know today, too, is that a dysbiotic microbiome or a microbiome that is an imbalance is very often an inflammatory one. So when you have microbial dysbiosis, when you're eating a poor diet and not exercising, you know, stressed out and not getting enough sleep or social connections, and you have a dysbiotic microbiome, we do know that you most likely have low-level chronic inflammation coursing through the body in those states. So our microbiome is incredibly important for the inflammation picture as a whole. And our immune system shapes the microbiome as well. We know that microbes do so much in the body from digesting nutrients we cannot digest to changing gene expression to modulating the inflammatory response.

Yeah, your specialty has definitely got a new renaissance with the microbiome revolution. I mean, I remember speaking to gastroenterologists like, I don't know, 20 plus years ago, and they were like, Really? you think food has an impact on what's happening in the gut? And I'm like, yeah, I mean, what a concept, right? And I think now it's finally like, you know, I mean, just amazed. The doctors say, well, what you eat has nothing to do with your health. Like it just, you know, your autoimmune disease, your colitis or your whatever it is, it's like, it's not connected. And it's just, it's kind of absurd, but food is the biggest single transducer we are interacting with every day. And it's either driving up inflammation or calming it down inflammation. And what we eat every day shapes our microbiome for better or worse. and so, you know, when you can have an inflammatory microbiome or an anti-inflammatory microbiome, and, and it's regulates everything from autoimmune diseases to a heart disease to obesity to cancer to Alzheimer's to autism. I mean, the list goes on and on and on. And so it, maybe it's probably one of the central things. When I'm actually treating patients for any problem, I mean, that it remotely could be inflammatory. And then pretty much every chronic disease we have, I always start with thinking about the gut. I always like, well, how is their gut? Do they have any symptoms? What's their microbiome? Like you mentioned lactoferrin, that's one test you can measure, but you can also look at the immune system in the gut. You can put the bacteria in there. You can look at Calprotectin, other eosinophil protein X, all kinds of biomarkers that can tell you if there's stuff cooking and causing trouble. And it might not be a full-blown autoimmune disease in the gut, but actually is something you need to pay attention to. So, I think that's really important. The microbiome, I think, is one of the key factors driving inflammation and the challenges of the microbiome.

What are some of the other things.

You'Ve found that might be driving inflammation?

Not things that people typically think about.

Well, I think one big thing also is just the stress in our lives. And, you know, when we look at stress, we typically think of a bad boss at work or, you know, bereavement and things like that. One big, big stressor since the pandemic, though, has been just loneliness or lack of social connections. And I think this has been a huge and increasing stressor being lonely can be very detrimental to the health and loneliness is tied to all different kinds of diseases from heart disease and cancer to obesity. And it's a stress on the body and inflammation can be one mechanism by which stressors like loneliness can cause illness. And what happens is, you know, it's not the acute stress. I mean, if you're faced with a saber-toothed a tiger as an ancestral times, you know, you want to kill that tiger and, you know, go away, right? And it's not the acute fleeting stress, but it's these chronic slow going stressors that occur day after day. And for a lonely individual, you know, their bodies are going to react to that stress as they would to a germ. And it's kind of paradoxical because when you look at these hormones going through our bodies in acute stress like cortisol and norepinephrine and epinephrine. You actually have a dampening of the immune response initially, but chronically you actually have increased inflammation and you have increased cells, immune cells, being made in your bone marrow. You have an expansion of white blood cells in the body. So this is what chronic stressors like loneliness do. And I think also it's a systematic problem. It's a societal problem. It's not necessarily just an individual problem. problem that needs systemic solutions. Hey everybody, it's Dr. Mark.

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Doctor's Pharmacy.

People who are suffering the worst social oppression have the most profound expression of inflammatory disease. But in fact, everybody in industrialized nations is subject to getting these diseases. And what we looked at in this book is really, you know, going back 600 years to where a cosmology of thought came from Europe to this land to what was, you know, was now called the United States of this understanding of or the misunderstanding of life as, you know, humans over here and everything that's wild in nature over here, us being separate from the web of life, or man over here and woman over here, or mind over here and body over here, these errors of Cartesian dualism that were part of the ways of organizing structures of power in a era of colonial conquest of the rest of the world. So it's much easier to take someone's land and take their wealth and take their resources and enslave them if they're seen as subhuman or actually they're not really doing anything with that land in the first place. So let's just go take it over. And so that error of thought really has set us up to having very shallow medicine, shallow ways of addressing how we're getting sick and why we're getting sick. So when someone who is part of the elite or wealthy or white, let's say, gets diabetes, we offer medicines, we offer insulin, we offer injections, pharmaceuticals. We don't offer an analysis of all the ways that critical relationships that support our health and well-being have been disrupted by colonial capitalism. And that is what we're looking at in this book is really the root causes of the rise of inflammatory disease around the world. And that is, you know, when you're talking about diabetes and obesity and cardiovascular disease and Alzheimer's and cancer and even depression and suicide, all of these things have been tied to inflammatory phenomena in the body. And so we see that in our research and analysis, Raj and I, what we have seen is that the social structures and the environmental structures around the body are the place where the disease is. And the body's immune system is just reacting in an evolutionarily conserved way and a proper way to damage and the threat of damage. And that response is the inflammatory response. So it's not like we're doing something that's abnormal or wrong. The body is simply trying to correct it itself in the face of this damage. Whether the damage is coming from glyphosate in our cereals, whether the damage is coming from payday loans, whether the damage is coming from historical trauma of being having your land stolen, such as the Pima folks, that these toxicities in the world around the body are the damage that is provoking an inflammatory response in the body. And so usually the inflammatory response when there's damage is activated to correct the damage, to restore what we call homeostasis, the body's optimum working condition, and then it turns off. Unfortunately, in a colonial capitalist society, all of us are subject to ongoing damage because the air is polluted and because the water, the groundwater, even if you're growing organic wine, you're pulling from groundwater that's been contaminated by glyphosate. So there's actually no way to avoid the insinuations of environmental poisoning that has happened through the corporate control of our food system and our policies. And so this is what we looked at very deeply in this book is the summation of exposures, whether it's police violence, whether whether it's, you know, breathing the air here in East Oakland, whether it's being able to afford healthy food, these kinds of things add up into a toxic combination. When you talk about the Pima folks having 80% of them having diabetes, it reminds me of the impact of colonial expression in Lakota Dakota territory where I'm working to help set up a clinic with the community there, the Mini-Wichita Health Circle is what we're calling it now. It's a clinic and a farm.

And that, which by the way is a radical idea, bringing healthcare and farming together should be universal, but it's something that's really radically new.

Well, it's actually radically old. And so for these folks, for sure.

But not in America.

Well, so these folks, you know, when the Missouri River was dammed, so when that dam went up, it flooded the cottonwood forests that the Lakota, Dakota, Nakota people used to get their food and medicine from. So they used to go and have this relationship with these forests. And once they were flooded, they became completely dependent upon the commodities that were sent by the state. So they became more sedentary. They didn't go out and harvest. The Buffalo were exterminated, I think, something like 60 million Buffalo, the largest genocide on this land. And so they lost those crucial contacts with their food and medicine ways. And they always knew that medicine and food were connected. It was never separate. And so that is really an exciting, you know, thing that connection to see that it is actually in the literal changing of the flow of rivers. So it's not abstract, it's not metaphorical, it's the literal changing of the way rivers run. has changed the way our bodies are responding. And Indigenous people have been most impacted here in this land.

Yeah, it's so true. And, you know, you talk about the idea of inflammation. I mean, the same story happened in the Hopi's where the Colorado River was damned and all their ability to grow food and their traditional food ways were all disrupted. And again, they're so obese like the guy met on the rafting trip. Because what you're really intimating here is that as a society we have a soul sickness. and that our souls have been disconnected from the origins of life, from our land, from our food, from our communities, and that we're seeing this epidemic of both mental health issues that you talked about earlier, Raj, from the suicide rates, or was that you? I can't remember. And the sort of the disconnection and the isolation and the sort of the social disempowerment as really being a soul sickness that needs to be healed by finding our place in the family of things. And that's what you're talking about. And I think it's a beautiful notion, a beautiful idea. And for someone who's been working in the food system for years and thinking about it for years, the challenge to me is I don't have any argument with the framework of what you're talking about. But given the way our society has been completely dominated by this colonialist capitalist model and the way in which our populations have been so disenfranchised and aren't even aware that they're disenfranchised, they internalized racism, they internalized structural violence.

How do we emerge from that?

Because other than just radically changing our society and radically changing our policies and radically changing our economic structures, how do we begin to address this pandemic? Because as someone who's on the front lines of chronic disease, it's a staggering phenomenon. I can tell you, I started doing this 25 years ago and I look at my slides from like 1996 and then, and I'm like, wow, I keep having to change the slides because it was, you know, 30% obese, then 40.

Then 50, then 60, then 75, and.

You know, diabetes should be chronic disease should be like maybe, three out of.

Ten people, then it's four out of ten, then it's five out of ten.

Then it's six out of ten. It's like every year I have to change my slides and it's getting worse and worse. And yet we understand it more and.

More and somehow we're not able to bridge that gap.

How do we do that?

I would say, first of all, I just want to give a shout out to- Everybody read your book. No, to Jack Forbes. Read another book called Columbus and Other Cannibals. He was a Native American scholar at UC Davis and he talks about the spirit sickness. which is called, he calls it Wetiko or Windigo, which is an Algonquin word. And it's literally the spirit sickness of colonial society and societies that dominate each other. He calls it like a vampire that you're sucking the soul off of other living creatures or other entities in a non-reciprocal, non-respectful way in order to support your own life, in order to support your own, and that this society is sick. He calls it a spirit sickness. And so the cure, Mark, is a radical re-imagining of our society. And the good news is that will address not just the rising rates of inflammatory disease that you've noticed, but also the burning of our planet. And so there is no tiny tweak we can do. There is no little, just move this around. There are things we can push for right now, Medicare for all, a Green New Deal, there are large policies we can try to move with. but truly what we need to do is reimagine every way in which we relate to each other in the web of life. Because the ones that we've inherited, the ones that we have been handed to us through a colonial capitalist cosmology are making us sick and making the planet uninhabitable for human life.

Anybody with any chronic disease, inflammation is a player. And so whether we have the typical things that we understand as inflammation like autoimmunity or allergy, or eczema or skin disorders, or whether it's the silent inflammation that's causing heart disease and cancer and diabetes and obesity and Alzheimer's. Anybody with a chronic condition is typically inflamed at some level. So my job is to then navigate and figure out what's causing it. Because when you get to the root of inflammation, you don't actually have to treat the diseases directly. I don't really treat diabetes. I don't treat Alzheimer's. I don't treat heart disease, I don't treat cancer. I simply change the biology of the body to normalize function to reduce inflammation. And as a side effect, these things go away. And I think that's a really important concept because if we don't understand that root cause medicine is the way we need to go forward, then we're going to just be constantly spinning out on all these new drug treatments and spending billions of dollars to address this. They found out, oh, Alzheimer's is an inflammatory disease of the brain. So what do you have to do? Well, they did a whole study taking Advil. It didn't work and it caused all these side effects. Why? Because they didn't get to the root of the inflammation. Recently, a big study came out on aspirin. Doctors have been saying, take aspirin to reduce inflammation to prevent heart attacks.

Well, if you read my stuff over.

The years, I've always said, bad idea. There are maybe some people who would benefit, but aspirin is not a side effect free drug and kills as many people as asthma or AIDS a year because of bleeding, stomach bleeding, gastrointestinal bleeding, brain bleeding, strokes, hemorrhage. So the recent studies showed that, oh, sorry guys, we were wrong. You can't just take aspirin to reduce inflammation and prevent heart attacks because it's going to kill you. It's more likely to kill you than the heart attack, so stop taking it, which was a huge shocker because if you talk to any cardiologist, you talk to any primary care doctor, everybody was on board. And I was kind of shocked because I looked at the actual science that was supporting this, and I even look at the American College of Cardiology risk calculator. There's actually a calculator on the American College of Cardiology website to put in whether or not you would either get harmed or have benefit from aspirin. And most of the people who are on aspirin actually don't even qualify or didn't qualify according to the previous guidelines. Now, there's a whole bunch of people who shouldn't even, according to those guidelines, be taking it. So, I think it's backwards to say we're gonna shut off inflammation with anti-inflammatories or immune suppressants. I mean, they're talking about using drugs like Humira, which is a $50,000 a year anti-inflammatory drug that's used for autoimmune disease for depression. Why? Because depression is inflammation in the brain.

The key isn't to shut off inflammation with the drug, is to get rid of the source of inflammation. How does traditional and conventional medicine, again, well-intentioned, how does traditional and conventional medicine look at and treat chronic inflammation? Like how do they, where do they think it comes from? And then how do they decide how to tackle it?

You know, it's just shocking to me that there really isn't a conversation about why. Oh, we know Alzheimer's is inflammatory. Oh, we know depression is inflammatory. We know heart disease is inflammatory. We know cancer is inflammatory. okay, so we need to give you anti-inflammatory drugs. There's no questioning of, gee, why in the first place is your immune system so pissed off? What's creating inflammation? And we know so much about it. It's not hard. It's our diet, our inflammatory diet, it's stress, it's our microbiome issues, it's triggers that, for example, might be from latent infections or allergens. or toxins, all these drive inflammation. So as a functional medicine doctor, my expertise is in being an expert in understanding toxins, allergens, microbes, stress, and diet, because those are the things that drive inflammation. And so every individual has a different cocktail of things that are off. But my job is to figure out what is their particular triggers and get rid of them and then help their body, on the other hand, calm the inflammation down. so there's a whole bunch of things that cause inflammation, but there's a lot you can do to reduce inflammation. And it's not by taking Advil or aspirin or steroids or some chemo drug or a biologic that costs 50 grand a year. It's by the simple things that we.

Know how to do.

Food is medicine, anti-inflammatory exercise is medicine, anti-inflammatory sleep is anti-inflammatory meditation is anti-inflammatory yoga is anti-inflammatory. And then there's a whole bunch of supplements you can take to help reduce inflammation like omega-3 fats and vitamin D and probiotics and zinc and all the phytochemicals you can eat in your food that actually help reduce inflammation, all the spices and all the colorful fruits and vegetables. So there's so much you can do to reduce inflammation in the ways that we see. Now, if you have some latent thing, if you have a lot of heavy metals or if you have a terrible bug in your gut or bacterial overgrowth or you have some particular gluten sensitivity, you're gonna have to deal with those things too. But for most people, the basics just work so well.

Well, let's talk about those basics. You talked about food and you talked about some of the foods that help and we'll chat a little bit more about that. But what are some of the examples of the foods that might hurt? What are some of the foods that are out there that could be driving or at least supporting the process of chronic inflammation and why do they support that?

Well, it's both. what we're eating, what we're not eating. Right. So we're eating too many inflammatory Foods. 60 of our diet in America is Ultra processed food.

It means what is that? Talk about the stuff that you see on the Shelf. What is an example? Because, you know, one thing I've realized and why I want to break this down is that if you go to Times Square, if you go here in Santa Monica where we're recording, and you go up to most people and you say, hey, do you eat healthy? Most people are going to say, yeah, I eat healthy, because everybody has a different definition of what it is. Or you ask somebody, do you eat.

A lot of processed foods? And most people say, no, I don't eat that much, a little bit here and there.

So describe it. What are we talking about here in Ultra processed food?

There are a few commodity crops that are supported by all our government supports from the farm bill that are the raw materials for processed food, corn, wheat and soy. And they're turned into all sorts of weird products. The corn is turned into all sorts of food additives and high fructose corn syrup. The wheat is turned into highly pulverized flour, which is highly inflammatory. The oils that come from soybeans and corn are often highly processed and inflammatory. So we're eating a lot of ingredients that are derived from these commodity products and ultra-processed food that we're not even aware of. So when you read maltodextrin or something on a label, you don't know where that came from. That's a byproduct of corn from a science project in the factory. when you eat high fructose corn syrup, same thing. So we're eating ingredients that are made from commodity crops that are basically the same three ingredients made into all sizes, colors, shapes of chemically extruded food like substances. So if you actually cover over the packaging and look at the ingredients, you literally would see the same ingredients on almost every processed food. we know with a few little tweaks here and there. And you can actually even tell what it is by reading the ingredient list. That's an ultra processed food. If you buy a can of tomatoes and it says tomatoes, water and salt, you know what that is. The ingredient list is, you know, 14, 15, 35 items and half of them you can't pronounce, don't recognize and wouldn't have in your medicine cupboard or your kitchen cupboard, then you should not eat them.

Right?

I mean, why should we be eating butyrate hydroxytoluene or, or, orthodextrose or all kinds of weird compounds that are not our natural food supply? So those are ultra processed foods and it's a huge component of our diet and it's highly inflammatory. So that's 60% of calories on average. And when you think of all the people who don't eat that much processed food, and people are eating, it might be 70, 80%, right? When you average a lot over all Americans, it's about 60%. And kids, it's even worse. It's 70%.

70% for kids.

I think 67 is something. It's like terrifying to me. So that is really what we should be focused on not eating. It's driving inflammation. And sugar and starch is number one, two and three. All the food additives, we eat about five pounds of food additives a year, and they can be inflammatory. For example, all the thickeners, emulsifiers, things like carrageenan and gums that are used in processed food, they often have something called microbial transglutaminase, which is a gluten product that they use to hold the food together. And all these emulsifiers, they cause leaky gut. So these damage your gut. And when you have a damaged gut, then guess what? The floodgates open. Like we talked about earlier in the podcast, you start getting food proteins and bacterial proteins leaking into your bloodstream. Your immune system gets all pissed off. and it creates this vicious cycle of inflammation. So eliminating all that weird stuff is so important. If you read the label and you don't know actually everything that's on there and you can't pronounce it, you wouldn't have it in your medicine cabinet, don't eat it.

Let's talk about next another category that is directly connected into inflammation and that is sleep. And one of the biggest drivers of sleep that is affecting so many people is sleep apnea. Talk about sleep apnea and its direct connection to inflammation for most people and how it can increase weight gain and a whole list of other things that are there.

It reminds me of this guy actually. Sleep apnea is basically where you have multiple episodes of stopping breathing at night. So, you will snore, you might stop breathing for seconds or minutes, your sleep's interrupted, and it's often not diagnosed because you're asleep and you don't know you're doing it. Your partner might yell at you or scream at you or move to another room or put in your earplugs, but you can actually use devices. One of them is a great little app. It's called Sleep Cycle, and it just records your sleep on your phone, and you don't need anything. It's just you put your phone by your bed, and you can have it on airplane mode even, and it records your breathing and your sleep and your snoring. And so you can see and here you're snoring from the app. So I know my stepfather was a big snore. He never believed it. He had severe sleep apnea, and I literally recorded him with my cassette recorder back in the 70s because he didn't believe me when you can hear him just snoring like a. An elephant, you know? So it's really common. It's often associated with being overweight, with having a thick neck, with sometimes structural issues, narrow palate, various things with your teeth. So you can be thin and habit, but there may. airway issues. There can be central sleep apnea, obstructive sleep apnea, so it can come from your brain or from your obstructive airway. And what that does have those repeated awakenings through the night and the decreased quality of sleep, it actually causes insulin resistance, it actually causes diabetes, it actually makes you crave more sugar and eat more sugar and carbs. And you can often fix weight issues or diabetes or obesity unless you fix sleep apnea. and it reminds me of a patient I had when I was at Canyon Ranch who was a lawyer and he's like, look, I can't lose this weight. I'm 50 pounds overweight. Can you help me? I'm like, okay, well, something about your life. Well, I'm a lawyer. I'm like, okay. And so I get into how do you sleep? Well, okay. And I said, well, I'm tired all the time. I said, well, what do you mean? Oh, yeah. Well, I have to have a standup desk. This is before standup desks were possible or, I mean, were popular, like, you know, 25 years ago, because if I don't, if I don't stand up, I fall asleep at my desk. I'm like, okay, well how about we check for sleep apnea? And he had terrible sleep apnea. We gave him a treatment for it, a CPAP machine, and he lost 50 pounds like that. And his insulin resistance went away simply by sleeping. So sleep is so important in regulating.

Your metabolism and inflammation. And, you know, we think of snoring as kind of like a funny thing and we might hit our partner or laugh at our parent or grandparent, but really, as a dear friend of both of ours, Dr. Steven Lin, a dentist down in Australia, and he says, snoring is choking. So you have to think of snoring as choking at night. So if you know if you're snoring or anybody else is snoring, you're choking and you're choking and that prevents you from getting the right amount of air. And another version of that that's milder is breathing through your mouth. You've done some episodes on this. I've done some episodes on this. If you're breathing through your mouth at night and not through your nose, which is how we're designed to, that's also a sign that you might have a mild form of sleep apnea that needs to be addressed because it's directly tied into promoting inflammation in the body. Let's talk about another category of things that is a driver of inflammation and that's our sedentary lifestyle. Talk to us more about that.

Yeah, I mean sitting is inflammatory as we sit here and do our podcast and that's why so much of us are struggling is because when we don't move, we are actually increasing the poor metabolic function that we have, increasing the risk for muscle loss, increasing the risk for insulin resistance, increasing risk for just chronic inflammation in our body. So being sedentary is a huge risk for inflammation. On the other hand, exercising enough, but not too much, right? If you over-exercise, if you're an ultra-marathoner or marathon runner, it creates more oxidative stress and inflammation in the body. But if you do regular exercise, you literally can reduce the inflammation in your body. And that's one of the most important things besides your diet for regulating inflammation.

You talked about stress. When you sit down with your patients and you talk to them about their lifestyle, what are the biggest contributors that you see over and over again? top level that are the big factors that drive chronic stress individually from patients. You know, what is it? Is the relationship, is the lack of meaning and purpose? Like what are the things that are out there that you see time and time again that are really the drivers of the stress that everybody's dealing with?

It's a great question. You know, why are some people more resilient than others? Why does people roll with the punches and others just get completely knocked off center? One of the things we use in our practice at Cleveland Clinic and Lenox and the Ultra Wellness Center is we call the ACE questionnaire or adverse childhood events. And it's essentially a set of 10 questions or so that you get a score for that tracks trauma. Were you abused as a child? Were you unsafe? Just a whole series of questions that help understand if as a child you experience lack of safety or worse abuse, trauma, incest, so forth. The higher your score, the more chronic disease risk you have. the more inflammation risk you have, the.

More likely you are to have autoimmune.

Disease, to have allergies, to have chronic illness. So looking at someone's childhood is so important and those impacts of trauma. And I think we're just beginning to understand how widespread that is. And, you know, for example, one in four Americans is a victim of sexual abuse as a child. Think about that. One in four Americans it's like 80 million people. That's a lot of people. Okay. I wonder if that's the 80 million that has autoimmune disease. I don't know, but it might be. And so as you begin to look at how do we manage the inflammation response, that's the first place I start. And then. And then I look at how do people navigate their minds, because your mindset plays a huge role in. chronic disease. And so if you're able to regulate your thoughts, if you're able to not be constantly triggered and activated by your environment, if you're able to have a level of equanimity which can be cultivated and developed through practice, right? That's what meditation does and yoga does and prayer does. And there's a whole series of practices of whatever calls to you that you can do that really helps to reduce the the level of stress in your system. If you don't learn how to do those things, then you just kind of have this unregulated, unmitigated stress response that drives so much chronic disease that keeps you inflamed.

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in.

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