© Whole Foods Magazine

March 2003


The Inflammation Syndrome

An interview with Jack Challem, The Nutrition Reporter

By Richard A. Passwater, Ph.D.

I hope that, over the past several columns, you have noticed my increasing emphasis on inflammation as a cause of heart disease. Research linking inflammation and heart disease has been emerging during recent years and is now very strong. Inflammation, oxidized low-density lipoprotein (from free-radical attack) and homocysteine are now recognized to be more important verifiable heart disease risk factors than dietary cholesterol ever was. Now there is a book that tells the story about inflammation and heart disease, as well as inflammation and about 20 other diseases, including arthritis, skin problems, allergies and asthma. This important new book is by Jack Challem, a prolific health industry author and owner/editor of The Nutrition Reporter, an industry newsletter.

I have known Jack Challem since the days when he wrote nutrition articles for Bestways, starting in 1974, and Let’s Live, starting in 1978. Jack, who calls himself, as well as his publication, "The Nutrition Reporter," has written for many periodicals, including GreatLife, Modern Maturity, and the Saturday Evening Post. He also has written more than a dozen books including Syndrome X: The Complete Nutritional Program to Prevent and Reverse Insulin Resistance, with co-authors Burt Berkson, M.D. Ph.D., and Melissa Diane Smith (Wiley, 2000, $14.95), and The Natural Health Guide to Beating the Supergerms, with Dr. Richard Huemer (Simon Schuster 1977).

On two previous occasions, Jack was our guest in this space. In June 1997 we discussed "Supergerms," and in March 2000, we had a conversation about "Syndrome X." Jack’s body of work includes his books, his newsletter (http://www.nutritionreporter.com) and more than one thousand magazine articles. I had the honor of editing Jack’s first booklet, Spirulina, as part of the Keats Good Health Series in 1978, and Jack has edited my booklets, Pycnogenol, Selenium and Antioxidants, as part of the Avery FAQ series. Jack is currently the series editor for the Basic Health Publications’ User’s Guide Series of health books, a collection of paperbacks that is available in many health food stores. His new book, which is the subject of this interview, is The Inflammation Syndrome: The Complete Nutritional Program to Prevent and Reverse Heart Disease, Arthritis, Skin Problems, Allergies and Asthma (Wiley, March 2003, $24.95).

Passwater: Jack, why did you write The Inflammation Syndrome?

Challem: You know that I am always reading and writing about nutrition research and occasionally publishing scientific articles on subjects of interest to me. A couple of years ago, I saw medical research shaping up for one of those major turning points, a new paradigm to explain a major cause of disease. Specifically, there is a new appreciation of the role of inflammation in disease.

Traditionally, inflammatory diseases have been defined as arthritis or allergies and the larger group of "-itis" ache-and-pain diseases. The new view is that coronary artery disease, Alzheimer’s disease, and some types of cancer are also the result of chronic, long-term, low-grade inflammatory processes in the body. This is a revolutionary change, and the research is advancing very quickly. For example, obesity and diabetes are now recognized as having strong undercurrents of inflammation. When you get right down to it, virtually every disease has an inflammatory component.

Passwater: Isn’t inflammation a normal process?

Challem: That’s right, inflammation is a normal process, but chronic inflammation is not. Inflammation is part of the body’s immune response to threats, and it prevents minor or routine infections from killing us. That’s why most of us don’t die from paper cuts or colds. Inflammation also helps initiate the healing process after an injury. But inflammation can go out of control, leading to an immune system that is chronically stirred up and releasing chemicals that attack and damage normal tissues, such as those in our joints or blood vessels.

Passwater: What causes inflammation to go out of control?

Challem: Normally, the body should turn off its inflammatory response after getting the upper hand on an infection or after an injury heals. But if biological "switches" malfunction, the inflammatory response doesn’t turn off. It’s a little like leaving a car running at high idle for hours. The engine will overheat. In a sense, chronic inflammation overheats our tissues and damages them in the process.

I believe the underlying cause of chronic inflammation is nutritional: most people are eating too many of the "bad" inflammation-promoting fats and not enough of the "good" inflammation-reversing fats. In addition, I think people are either exposed to or are generating too many free radicals and not consuming enough antioxidants. In addition to causing cell damage, free radicals also stimulate and prolong the inflammatory response. Because antioxidants quench free radicals, they have anti-inflammatory properties.

Passwater: I would like to come back to the role of diet in inflammatory response. But there have been a lot of news stories recently about the role of inflammation in coronary heart disease. What exactly is the connection?

Challem: Several years ago, Harvard Medical School researchers developed a very sensitive test for systemic (body-wide) inflammation. The test, called high-sensitivity C-reactive protein, or hsCRP, measures extremely minute amounts of C-reactive protein. The hsCRP test is far more sensitive than the older CRP test.

Basically, elevated C-reactive protein levels indicate low-grade inflammation and inflammation of the artery walls, resulting in damage and setting the stage for subsequent cholesterol deposits. But CRP is not just a marker of inflammation. It is a potent inflammation-promoting cytokine. Cytokines are cell-communication proteins that, in this case, tell cells to release large numbers of many different inflammation-causing substances. CRP is a byproduct of interleukin-6, which may be the most pro-inflammatory of all the cytokines.

Passwater: So, how does inflammation promote heart disease?

Challem: There are a couple of ways. Oxidized low-density lipoprotein (LDL) cholesterol may be a key instigator, along with homocysteine. You and I and your readers will immediately see the nutritional links, but the average physician seems to ignore the obvious. LDL cholesterol carries fat-soluble nutrients, such as vitamin E, through the blood. LDL is not inherently "bad" as so many people think it is. Without LDL, fat-soluble nutrients like vitamin E would never get from the gut to the heart. The problems start when LDL becomes oxidized, and oxidized LDL is a sign of either excessive intake of refined polyunsaturated fats or inadequate antioxidants.

Oxidized-LDL, but not normal LDL, attracts white blood cells, which are one of the body’s defenses against foreign proteins (such as bacteria or viruses) and other things that don’t belong in the body. The white blood cells swallow the oxidized LDL—they recognize that oxidized LDL is not normal—and then the white blood cells stir up an inflammatory response through a number of mechanisms. For example, white blood cells release free radicals, which stimulate inflammation and activate adhesion molecules, enabling the white blood cells to stick to artery cells. The white blood cells also release pro-inflammatory eicosanoids, which are byproducts of arachidonic acid, an omega-6 fatty acid. This activity is directed in large part by the cytokines, such as IL-6 and CRP.

With the other mechanism, homocysteine levels rise when a person does not consume enough folic acid and vitamin B-6. Homocysteine is toxic to the cells forming blood vessel walls, and it damages the cells lining arteries, triggering an inflammatory response. Kilmer McCully, M.D., and other researchers believe that cholesterol deposits form after homocysteine damages blood vessel walls. It is sometimes difficult to determine exactly what happens first because so many things are occurring simultaneously. In chronic inflammation, cytokines and other inflammation-promoting substances travel in the blood throughout the body, stirring up inflammation in a variety of tissues.

Passwater: Why so much attention on C-reactive protein?

Challem: Elevated CRP levels are a more accurate predictor of heart attack risk than cholesterol, LDL cholesterol, homocysteine, or triglyceride. People with elevated CRP levels are four and one-half times more likely to suffer a heart attack, compared with people who have normal levels. But that is only the tip of the iceberg.

The underlying idea is that low-grade chronic inflammation—and sometimes much more obvious inflammation—brews for years and eventually causes heart disease. As researchers have tested other types of patients for CRP, they are finding inflammation common in most serious diseases. People with arthritis, cancer, Alzheimer’s Disease, and diabetes typically have elevated CRP levels. Even people who are overweight have high CRP levels.

It turns out that the average person’s level of inflammation—measured by CRP, IL-6, and other inflammatory markers—increases with age. Basically, that tells us what we all knew—that the risk of inflammatory diseases increases with age. Part of the reason relates to the age-related breakdown of tissue, which is cleaned up in part through inflammatory processes. But I also think that part of the reason relates to the cumulative effect of eating a pro-inflammatory diet for decades, which is what most Americans do.

Passwater: It sounds like obesity is being reclassified partly as an inflammatory disorder.

Challem: Interesting, isn’t it? People who are overweight tend to have high levels of CRP. In general, CRP is produced in the liver. But fat cells, particularly those that form around the belly—what most people call a beer belly—secrete large amounts of IL-6 and CRP. Thus, being overweight is indeed an inflammatory disease.

But the story gets much more interesting than merely saying this or that is an inflammatory disease; it leads, in fact, to why my book is called "The Inflammation Syndrome." Let’s talk about a syndrome. Being overweight increases the risk of type 2 (adult-onset) diabetes. Part of the cause of overweight and diabetes is related to eating too many sugars and refined carbohydrates, which boost blood sugar and insulin levels. There is a powerful inflammatory undercurrent in diabetes. This diabetic inflammation is related to two things: one, excess body fat, which increases CRP and inflammation levels; and two, high glucose levels, which oxidize, generate free radicals, and activate an inflammatory response. Now, consider that both overweight and diabetes increase the risk of heart disease. One of the connections between obesity, diabetes, and heart disease—three major inflammatory disorders—is inflammation. It’s an example of the inflammation syndrome.

Passwater: A big part of the problem is that most people’s intake of fats is greatly unbalanced.

Challem: Absolutely right. I’ve come to believe that the worst culprits among the fats are the trans-fatty acids. At the present time, these are hidden in processed foods as "partially hydrogenated vegetable oils," but they will soon be listed on food labels. It is clear that trans-fats increase the risk of heart disease and that they are much worse than saturated fats. But most people have missed the details of why trans-fats are so bad.

Passwater: In a three-part discussion with Dr. Mary Enig in 1993/1994 (November 93 – January 1994, we emphasized that the stereochemistry of trans-fats, which are man-made and introduced into human diets only relatively recently, was very different from natural fats. This difference causes structural abnormalities in cell membranes. And of course, we called attention to the fact that trans-fats were more hypercholesterolemic than most saturated fats. What is it about trans-fats that make them pro-inflammatory?

Challem: Basically, trans-fats damage the desaturase and elongase enzymes essential for the body’s processing of fats. For a variety of reasons, the anti-inflammatory omega-3 fats are more likely to be hurt. In a very real sense, trans fats poison the omega-3 chemical reactions needed to moderate the inflammatory response and keep it from going out of control.

Passwater: Why is that?

Challem: The pro-inflammatory omega-6 pathways are far more biologically active than the anti-inflammatory omega-3 pathways. There’s a reason for this. Throughout time, infections have been the leading killer of people. Until 1900, infections were the leading killer of Americans, and infections are currently the third leading cause of death in the United States and the leading cause of death worldwide. Biologically, we were designed to produce an aggressive inflammatory response to protect us from infection.

This situation puts the omega-3 pathways on the disadvantage under normal circumstances—and even more so when the diet is rich in omega-6 fats, which are found in corn, safflower, soy, and most other cooking oils. The omega-3 fats are technically less inflammatory, but their effect is anti-inflammatory. You need a lot of omega-3 fats to offset all of the omega-6 fats in the diet.

Gamma-linolenic acid (GLA), an omega-6 fat, behaves more like an anti-inflammatory omega-3 fat. People are often puzzled by GLA as an anti-inflammatory omega-6. But the truth is that it is part of the normal checks and balances in the omega-6 pathways. When people consume a lot of highly refined omega-6 fats, it actually seems to impair their GLA production. Similarly, omega-9 fats, found in olive oil, macadamia nut oil, and avocados, also have potent anti-inflammatory properties.

Passwater: In your book, you discuss 20 common diseases that have an undercurrent of inflammation. Many of these diseases, such as heart disease, Alzheimer’s disease, and cancer, are age-related conditions. You make an interesting argument that the aging process itself is related to inflammation.

Challem: It’s an argument that adds cohesion to the concept of the inflammation syndrome. Part of what I wrote in the book on aging was speculative, but as I was making the final changes a major study was published confirming my thinking. The study, in the November 11, 2002 Archives of Internal Medicine described a strong relationship between frailty in elderly men and women and high levels of CRP and other signs of chronic inflammation. In addition, frail elderly people also were prediabetic, with elevated levels of glucose and insulin. The kicker was that the researchers noted that the 4,700 seniors in their study were healthier than most other people their age. In other words, the situation is actually worse.

You’re probably wondering about the exact link between inflammation and aging. We know that free radicals damage DNA and cells. The body cleans up most dead or seriously damaged cells, and it uses white blood cells to do most of this cleanup. In the process, the white blood cells release more free radicals, along with CRP and IL-6 and many other inflammation-promoting substances. Until about age 27, our growth and metabolism outpaces the damage. According to Denham Harman, M.D., Ph.D., who developed the free radical theory of aging, the damage starts to outpace our ability to repair it after age 27.

So, when you look at all of the evidence, inflammation is one of the age-promoting processes in the body. You can slow these processes, as you well know, by increasing your intake of antioxidants, B-vitamins, and many other micronutrients. Basically, antioxidants are also anti-inflammatory nutrients.

Passwater: What is your diet plan like?

Challem: The diet plan gets back to basics, most of which should be familiar to people in the natural foods industry, but perhaps with a twist. My approach to nutrition is built around eating for maximal nutrient density. When you eat this way, you eat fish, chicken, lean meats, good fats (such as olive oil), and a lot of non-starchy or low-starch vegetables and fruit. You cut out, or way back on, calorie-dense foods, which include pasta, pizza, bread, muffins, soft drinks, and just about anything that has no resemblance to what it looked like in nature.

This is a protein-rich diet, not a high-protein diet. Protein should fill about one-third of your plate, and vegetables should fill the other two-thirds. All these vegetables fill the gap left by cutting out empty carbohydrate calories. This is essentially a Stone Age, or Paleolithic diet, in modern terms.

Passwater: And your supplement program?

Challem: I am very big on anti-inflammatory fats and oils. These include the omega-3 fats, with emphasis on EPA (eicosapentaenoic acid). GLA (gamma-linolenic acid), while an omega-6, is a powerful anti-inflammatory fat. Both work by increasing the production of eicosanoids that dampen inflammation. Extra-virgin olive oil is my chief cooking oil; it is anti-inflammatory.

At least three clinical studies have so far shown that natural vitamin E supplements lower CRP levels by 30%-50%. Vitamin E’s anti-inflammatory properties have also been demonstrated in two studies on rheumatoid arthritis. I think the anti-inflammatory effect of vitamin E is one reason why it reduces the risk of heart disease. The flavonoids, as a family, are very potent anti-inflammatories, with Pycnogenol, grapeseed extract, and quercetin being the most notable. As more research is done, I think other antioxidants will also be shown to have clear anti-inflammatory properties.

Let’s face it, every nutrient is essential for health. Those that I just mentioned are among the most important in terms of inflammation specifically. But there are others. Glucosamine, chondroitin, and vitamin C are crucial for preventing and reversing osteoarthritis, but I happen to think that they have broader tissue-building roles in the body.

Passwater: So, you don’t recommend anti-inflammatory drugs.

Challem: You’re making me laugh. You know me well enough to know that I think drugs are sublethal doses of poisons. The non-steroidal anti-inflammatory drugs (NSAIDS), including aspirin and ibuprofen, accelerate the breakdown of cartilage in joints. About 1 million of the 5 million cases of heart failure in the United States have been attributed to NSAIDS. NSAIDS are also toxic to the liver because they deplete hepatic glutathione levels. I think anti-inflammatory drugs treat nothing more than symptoms while the underlying disease continues or accelerates. In general, nutrients take longer to work, but many people see a positive response in just one day.

Passwater: Your previous book, Syndrome X: The Complete Nutritional Program to Prevent and Reverse Insulin Resistance, has been very successful. And now you’ve written The Inflammation Syndrome. Do you have a thing with syndromes?

Challem: You’re making me laugh again because you know my views. Allopathic medicine tends to reduce diseases down to a symptom or a set of symptoms defining a disease. The thinking is one disease, one drug. Health and disease are not as simple as reductionists would like to make them. There are, of course, various syndromes in medicine, and Syndrome X is a cluster of pre-diabetic signs and symptoms (which include abdominal fat, hypertension, and elevated blood lipids). But if you really look at things clearly, most of the conditions that bother people are syndromes, clusters of symptoms, some being more obvious and others less obvious. When you recognize a condition as a syndrome, you see its many tentacles. A syndrome begs for a holistic response that includes diet, supplements, physical activity, and stress-reduction strategies. In other words, seeing diseases as syndromes creates the framework for a holistic way of preventing or reversing them.

Passwater: What would you like retailers to do to help get this message out?

Challem: I think the role of inflammation in disease is going to be one of the biggest medical stories of our lifetime. And like so much else, solving it boils down to eating a wholesome diet and taking supplements. That’s an original idea, isn’t it? I would love to see retailers reading and recommending The Inflammation Syndrome. It would be another step toward making the world a better and healthier place.

In a broader way, I think that it’s important for retailers to take the time to continually educate themselves, their staff members, and their customers about the latest nutrition research. I realize this can be difficult with all of the day-to-day activities related to operating a business; after all, there’s only so much time. But I think it is crucial that the owners and employees of health and natural food stores maintain their expertise and continue to coach customers on diet and supplements. If they provide this advice from a solid foundation of knowledge, they can withstand the usual attacks by conventional and misinformed physicians and dietitians.

Passwater: I think, on a personal note, a lot of people are curious about how you became interested in nutrition research and nutritional therapies.

Challem: Like a lot of people, I was drawn to this field because of personal issues and to gain more control over my own health. In 1965, when I was 15 years old, my older brother was diagnosed with cancer. Basically, I watched him die over nine months. I felt that no one should exit life in this way. I think most of your readers can relate to this experience. Four years later, I had a biology professor who one day made some comments in class about suppressed cures for heart disease and cancer. I talked with him more about these things after class. This was in 1969, and we were at the height of the Vietnam War. There was a lot of government deception about what was going on. It was easy to believe that the government or some other forces were suppressing effective nutritional treatments.

It didn’t take long before I started taking vitamins. My college focus was on sociology, including political sociology. I learned that our social institutions don’t always operate by the book. For example, we are taught that scientific controversies are discussed rationally and everyone agrees with the conclusions. That’s bull. There are careers, money, and power at stake with every decision. The politics in medicine are every bit as nasty as those in Washington, DC. I’m more interested in nutrition than sociology, and have been for most of my adult life, but sociology gives me the framework to understand some of what’s going on in medical politics and economics.

I’m not sure there is a thought-out conspiracy against vitamins or nutritional therapies. There certainly are economic interests that are hostile toward simple, low-cost, low-tech approaches to health. But I think a lot of the hostility toward vitamins and nutritional therapies has come out of ignorance and the repetition of ignorance and lies. You have some people who have opinions and don’t want to be swayed by the facts. All the evidence is out there. Just type the word "vitamin" or "antioxidant" into the Medline database, and you’ll see how many tens of thousands of studies—mostly positive—have been published. What I write really reflects a personal evolution in my thinking. There’s a clear evolution between Syndrome X and The Inflammation Syndrome, and it will continue in my next book.

Passwater: Well, we certainly have something to look forward to with the next book. Right now, however, I recommend that our readers read The Inflammation Syndrome. I think that many readers will find that your book explains new research linking many diseases and disorders that previously were said to be due to other causes. The good news is that nutrition plays a major role in the prevention and control of these syndromes. Thanks for sharing your information with us Jack, and I know you will keep us up to date on the subject via your website, http://www.stopinflammation.com. WF


© 2003 Whole Foods Magazine and Richard A. Passwater, Ph.D.

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