**Episode Title: "EP415: Inflammation—What, How, Why?"**
**Dr Warrick Bishop:** Welcome, my name's Dr Warrick Bishop. I'm a cardiologist, an author, and a keynote speaker. I'm the CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes, someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, and cholesterol for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love.
**Warwick:** Hi, it's Warwick here and welcome to my podcast and videocast station. Today I'm going to talk about inflammation. It comes up a fair bit. In fact, it's really, really important. I'd like to talk about what it is, how we define it, and where it's important. I'd like to talk about the causes, how we might detect it, and lastly, what we can do about it. We'll see how we go.
So, what is inflammation? Well, it's probably easiest to think of it as a response to injury. If you twist your ankle, it swells up. If you get a splinter in your thumb, it swells up. And that's an acute response. It's a good thing; it's your body responding to that damage. It's making sure extra blood goes to that area, extra cells get the opportunity to repair.
But often, when we think about disease states, we're thinking about low-grade inflammation, which is a different story. It's not necessarily loud and red and painful. It sort of simmers in the background. We believe, and we're finding evidence, that it's linked to things like heart disease, Alzheimer's, type 2 diabetes, obviously autoimmune conditions, and different sorts of cancers. So, it's sort of important. It ties in with a lot of chronic disease.
So, what do we think causes it? Well, we think a lot of it is caused by issues surrounding modern life, highly processed foods, and some of the preservatives and colorings associated with that. We know that visceral fat is a really big player. When I talk about visceral fat, that's the fat that clings around organs. We can have fat that doesn't cling around our organs, and we might carry that fat a bit like a sumo wrestler outside the abdominal cavity.
So, sumo wrestlers who train and keep physically fit, even though they eat enormous amounts of food and are very fat, tend to have their fat outside their abdominal cavity. Interestingly, as soon as they stop training, that fat tends to migrate into the abdominal cavity and basically surrounds their organs. That becomes visceral fat. For the average person who's not a sumo wrestler and who's not particularly active, that waist weight around the tummy, that sort of pot belly from beer drinkers, is a really strong indicator you probably have visceral fat.
Well, why is that important? Well, it turns out that visceral fat of its own generates inflammation within the body. Sedentary behavior, sort of not exercising, seems to increase inflammation. Poor sleep, something that we've really started to realize in recent years of research, is a big player. Stress, as you might imagine, can drive inflammation partly through the cortisol and adrenaline that's released during those times. Environmental toxins, and we think about autoimmune diseases—that's obvious. People with rheumatoid arthritis, but also chronic infections. One of the really common ones is gingivitis, where your gums are infected.
Now, not only do you have chronic infection occurring there, but you also then have the opportunity for molecules to get directly into the bloodstream. So, look after your teeth.
So, how do we detect inflammation? Well, normal blood tests don't tend to show it, so we need to think of slightly different blood tests. A test called high-sensitivity C-reactive protein can be helpful. It is a general marker of inflammation, and it's probably worth asking your doctor to check it from time to time. There are other markers which are far more specific and far less frequently used. There's IL-6, which is interleukin-6, and there's tumor necrosis factor alpha. These are highly specialized tests. Your doctor may request them if there's a reason, or if you request them. But HS-CRP, high sensitivity C-reactive protein, is not a bad start.
One of the tests that I still use that doesn't tend to pop up much anymore is one called ESR, standing for erythrocyte sedimentation rate, giving us an indication of how quickly cells settle in a tube of blood from an individual. It turns out that if those cells, the little red blood cells, settle very quickly, then there's no nasty proteins within the solution of the plasma holding them up. If there's inflammation and some of these inflammatory proteins floating around and there's increased protein within the serum, then the cells don't settle very quickly. Therefore, an increased erythrocyte sedimentation rate can be seen in very specific inflammatory conditions. So maybe ask your GP about that one. It's not particularly expensive.
Often, things like high triglycerides, low HDL levels, increased insulin resistance, and increased waist circumference can all point to the likelihood of some underlying inflammation. So just be aware of that.
Having said all of the above, what can we actually do about it? Is there much you can do to bring down inflammation naturally? There are medications that will impact inflammation. The most common that we will have heard of are steroids. But we can't take those long-term because steroids of their own have plenty of other side effects which preclude us from using them long-term. But they're good in the short term in very specific circumstances.
But what can you do naturally? It turns out sleep is super duper important, so lock that in. Don't forget good sleep hygiene, good sleep habits. Physical activity is really, really important. When you think about this on a cellular level, what you're actually doing is burning up energy within the mitochondria, which otherwise might end up being oxidized and creating oxygen-free radicals. So using up some of that extra energy through physical activity is really important.
We mentioned stress before, so stress reduction, mindfulness, and breathing techniques are really important. Anti-inflammatory foods, things like fibers, are really important. Eating the rainbow. Omega-3 oils—I’ve actually had patients who commenced on Omega-3 oil therapy for maybe their triglycerides or irregular heartbeats only to have them come back and report that their inflammatory disease, whether that's in inflamed bowel or arthritic joints, has improved as a consequence.
It's really important to avoid ultra-processed foods. Sugar doesn't help, and neither does excess alcohol. Strength training can seem to help as well because it seems to reduce visceral fat and improve insulin sensitivity.
So, is inflammation the root of all evil? Not quite. We need acute inflammation; otherwise, we can't fight infections. But chronic low levels of inflammation long-term can be problematic. They can impact all sorts of things from heart health to dementia, to diabetes, and even cancer. So, be aware of your risk of inflammation. Remember some of the causes: processed foods, visceral fat, fat around the organs, poor sleep, sedentary lifestyle, and how we can detect it—some of those blood tests, high-sensitive C-reactive protein, but an ESR is a super easy and super cheap test.
And don't forget, things like sleep, physical activity, and stress reduction are all super duper important.
Well, if you've listened this far, thank you so much. I really appreciate you tuning in. I hope you found this podcast on inflammation informative. I'd love you to subscribe, please, and if you like my podcast, please share it with others. If you have any questions or any feedback, I'd love you to share it.
Do stay tuned for the next few podcasts. I'm looking forward to talking a bit about cholesterol, how to age with strength, and maybe some other bits and pieces, maybe even the benefits of saunas. So, if you're interested in any of that, stay tuned. Oh, subscribe, then you won't miss it.
For now, I am going to wish you the very best. I do hope you live as well as possible for as long as possible. Take care and bye for now.
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