The most inflammatory post you'll read today
Inflammation is one of the most widely recognised health problems we face today, with its association to chronic age-related disease and its tight links to the ageing process. Whilst we evolved with this immune response to protect us against threats as varied as pathogens and tissue damage, it can kill many more cells as it saves.
Chronic inflammation is the persistent and harmful sort, not linked with any obvious localised or imminent threat. Blood tests can measure this via using levels of C-reactive protein (CRP); a widely recognised inflammatory marker. IL-6 levels are also highly predictive of mortality and age-related disease risk. For centrenarians, inflammation may be an even better predictor than telomere length, which is generally the gold standard in predicting biological age. Indeed, steps to mitigate this “inflammaging” will be the focus of today's post.
Senescence and AGE accumulation are known drivers of systemic inflammation. One less obvious example however is maintaining skin health, as (unless you are obese, in which case it's body fat) the skin is generally our largest organ. Indeed, psoriasis and eczema are known risk factors for type II diabetes and atherosclerosis, and skin irritation triggers the release of inflammatory cytokines. Moreover, skin moisturisers reduce levels of these cytokines (observational results for humans, yet demonstrated in mice RCTs). A pilot clinical study showed that these products reduce levels of IL-6. In this case, the prevalent cosmetic narcissism of today is not just superficial, but in fact a positive development for our longevity!
As with many other drivers of ageing, calorific restriction has also been shown to help. Obesity is highly correlated with measures of inflammation, and Mendelian randomisation suggests the direction of causality is obesity causing elevated sustemic inflammation. In particular, dietary cholesterol, which accumulates in body fat, activates inflammatory signals so is likely a big contributor. Dietary intake is overwhelmingly concentrated in meat, eggs, dairy, and refined grains. However, the adipose tissue itself also produces more inflammatory peptides as we age. Exercise is anti-inflammatory independent of its effects on obesity. All this suggests that there is more to this pathway than obesity.
An obvious place for further steps (no pun intended on this longevity blog!) is dietary, and indeed researchers have compiled a dietary inflammation index (DII). Essentially, we just measure the sign of changes to CRP, TNF-α, and the IL markers after we consume a food item. You guessed it! Saturated fats and cholesterol are pro-inflammatory, whilst whole foods are generally anti-inflammatory. Yet how do we know that these transient pro-inflammatory signals contribute to chronic rather than solely acute inflammation? Or that DII isn't just a proxy for a healthy diet in general, and so inflammation effects are causally linked to mortality and age-related disease risk? Our best available data suggests a (possibly) causal link between DII scores and cardiovascular disease risk, and of course heart disease is linked to a range of age-related diseases, such as dementia. DII scores are also negatively linked to telomere length. Don't think that substituting for white meats will save you either, as broiler chicken is also high in saturated fats.
Are you, like me, a huge fan of steaks? Do you enjoy indulging in a juicy hamburger? If so, there's some good news! Avocados with your burger completely blunt its inflammatory effects. This is because polyunsaturated fats (concentrated in foods such as nuts, fish, seeds, olive oil, and avocados) actually tend to reduce LDL cholesterol, according to Gemini. Fish, abundant in anti-inflammatory Omega 3, has been shown to significantly increase levels of HDL cholesterol, thereby reducing cardiovascular risk. Likewise, with game (and presumably other lean meats such as offals) substantially lower in its pro-inflammatory effects, it seems that the hunter-gatherer diet is optimal from a longevity perspective [1]. In general, whole food diets appear to be anti-inflammatory, and if you find such insufficient for your desired protein intake, I recommend supplementing this with lean meats or fish, as opposed to red meats, poultry, eggs or dairy.
Want to supplement your rage against inflammatory responses further? Curcumin, the primary compound in turmeric (and the word for turmeric in most languages!), significantly reduces inflammation markers (for both IL-6 and TNF-α), particularly for those prone to chronic inflammation. Garlic is also highly anti-inflammatory, as are cloves and rosemary, and perhaps cinnamon to a lesser degree too. Ginger (my favourite spice) reduces CRP and TNF-α [2], yet the effects on IL levels are inconclusive at this stage. Again, avoid ready-made or frozen ultra-processed crap in favour of home cooking and your palate is not the only thing to benefit.
Cocoa (without milk) has demonstrated anti-inflammatory effects, and ambiguous (if any) results even with milk (especially compared to milk per se) [3], therefore dark chocolate connoisseurs reap the rewards. As for green tea, that beverage is so anti-inflammatory that it can be used as a mouthwash for potent pain relief after dental surgery!
Overall, I consider the following steps to be prudent in mitigating the tide of inflammation:
Moisturise your skin regularly. It's not just a superficial cosmetic trend.
Substitute white breads and pasta for brown or wholegrain.
Offset your inflammatory intake with anti-inflammatory foods such as fruits and vegetables, or those rich in fibre and polyunsaturated fats. Nuts and seeds form an excellent snack!
Use lean meats and fish as your main protein source, if you want more variety than plants.
Learn to cook! Inevitably you'll be adopting intensive use of proven anti-inflammatory spices, many of which also reduce pain. The ubiquitous use of olive oil is also a healthy habit to cultivate. In this sense, 2-5 can be seen as advocating for consumption patterns similar to the famous Mediterranean diet.
Learn to appreciate dark chocolates if you enjoy a sugary treat.
Drink plenty of green tea! This is fast becoming my favourite beverage.
Of course, agriculture is optimisd for mass-production, thereby alleviating the malnutrition that defined us until recent centuries, but in our new epoch of abundance the components of our diets become more salient relative to quantity.
Ginger can also be used to treat arthritis, as well as a range of gastric conditions, and menstrual bleeding. For those with the condition, its pain alleviating effects are comparable to that of Ibuprofen, and it can even alleviate migraines on par with some medications, without the side-effects. Garlic yields similar effects with respect to rheumatoid arthritis. Many traditional herbal remedies aren't just pseudoscientific new-age or superstitious fads after all.
This is fascinating as milk chocolates tend to be high in saturated fat concentration. I guess this is testament to the anti-inflammatory nature of cocoa itself. As far as confectionary goes, it appears that dark chocolate is amongst the least unhealthy.