Inflammation and complications

I am a long time reader here (I've found amazing hope and resources through so many discussions). I came across this article (by Ginger Vieira, FWIW) about inflammation being key to cell damage from high blood sugars.

Diabetes Daily

I'm sorry if this is something well known or regularly covered here but I would love to hear anyone's thoughts on the article. I am a Type 1 and work very hard to control my sugars but still find I have many unexplained and erratic highs that frustrate and scare me as I get older.

Any personal experiences or tips or tricks on lowering inflammation? I am already quite active and eat few carbs (another gift from here!).

In the last 2 1/2 years, since adopting a lower carb way of eating, I've done a lot of reading about diet and inflammation and heart disease. Many articles in the medical literature call out inflammation as the key factor that leads to heart disease. I don't think that this has been definitively proven but it helps explain many contradictions.

If high levels of low density lippoproteins (LDL) cholesterol in the blood cause athlerosclerosis and lead to heart disease-caused death, then why don't all people with high LDL cholesterol die of heart disease? Conversely, if high LDL is the absolute cause of heart disease, then why do people with normal LDL levels still die from heart disease (see Tim Russert's case)?

There must be some other yet to be understood factors involved in the process and inflammation may well answer some of these questions.

As to what may be causing inflammation, that is the great unanswered question. Some nutrition experts point to the imbalance of omega 6 fatty acids to omega 3 fatty acids in our blood. Omega 6 polyunsaturated fatty acids (from vegetable oils, grains, legumes, and nuts) and omega 3 polyunsaturated fatty acids (fish and flaxseed) over our human evolution have been found to be consumed in a 1:1 ratio.

During the last hundred years or so that ratio has drastically changed. Here's what nutrition writer Chris Kresser has to say on this topic:

Vegetable oil consumption rose dramatically between the beginning and end of the 20th century, and this had an entirely predictable effect on the ratio of omega-6 to omega-3 fats in the American diet. Between 1935 and 1939, the ratio of n-6 to n-3 fatty acids was reported to be 8.4:1. From 1935 to 1985, this ratio increased to 10.3:1 (a 23% increase). Other calculations put the ratio as high as 12.4:1 in 1985. Today, estimates of the ratio range from an average of 10:1 to 20:1, with a ratio as high as 25:1 in some individuals.

In fact, Americans now get almost 20% of their calories from a single food source – soybean oil – with almost 9% of all calories from the omega-6 fat linoleic acid (LA) alone! (PDF)

This reveals that our average intake of n-6 fatty acids is between 10 and 25 times higher than evolutionary norms. The consequences of this dramatic shift cannot be overestimated.

Chris goes on to write this in the same article:

In plain english, what this means is that the more omega-3 fat you eat, the less omega-6 will be available to the tissues to produce inflammation. Omega-6 is pro-inflammatory, while omega-3 is neutral. A diet with a lot of omega-6 and not much omega-3 will increase inflammation. A diet of a lot of omega-3 and not much omega-6 will reduce inflammation.

This seems like a credible explanation to me, even though science has not yet made this conclusion. Due to our limited lifespan, sometimes we can't wait for the definitive science and instead must act with our best instincts.

If high levels of low density lippoproteins (LDL) cholesterol in the blood cause athlerosclerosis and lead to heart disease-caused death, then why don't all people with high LDL cholesterol die of heart disease? Conversely, if high LDL is the absolute cause of heart disease, then why do people with normal LDL levels still die from heart disease (see Tim Russert's case)?

That's easy...correlation does not imply causation.

I understand that, brboyer ;-) What I don't understand is all the medical advocate organizations and most practicing clinicians buy into this understanding of heart disease and their consequent reflexive statin prescriptions.

The same reason that they all treat people with diabetes, that are overweight and have hypertension as Type 2. When in fact not all of us are.

It's amazing and encouraging that one study after the next these days seems to be validating the health benefits of simply eating real food. It seems so obvious when you think about it, and millions of years of evolution validate it, but so much of our conventional wisdom still mistakenly believes that processed "low-fat-whole-grain" food is healthy.

I couldn’t have said this better myself. Preach it.

I have a dumb question. When the scientific data links inflammation between heart disease and diabetes and states omega 3 reduces it, does that also apply for RA inflammation as well? Because I have high inflammation due to RA but I have yet to run across anything stating omega 3 reduces inflammation in severe RA. I have only been prescribed Vitamin D3 5,000 mcg a day as far as supplements with my RA medications.

Yet, both my rheumy and my endo state that my diabetes and RA feed off each other--if I can keep my RA under control, my diabetes should do better as well and vice versa. But my CRP and SED levels have never been normal or close to being normal.

In the case of microvascular complications (e.g. retinopathy, kidney disease, etc.) there's been for decades, since first DCCT early releases, really compelling evidence that these are tightly tied to average bg levels.

The purely inflammatory type complications, though, the relationship is not nearly so compelling. In the cases that are most obviously inflammatory (e.g. frozen shoulder, hypothyroidism, RA) it appears that there is no relationship with average bg, or maybe the statistics shows that folks with lower average bg are more likely to be afflicted by these complications. In fact maybe using the term complication for things like hypothyroidism and RA isn't correct, it's more likely to be related to the autoimmune root of all of hypothyroidism, RA, and type 1 diabetes

There is a crossover point between the two extremes though and I think this is where Ginger Vieira's article seems to hit. e.g. inflammation can manifest in the macrovascular system as elevated blood pressure, which is a huge additional risk for the microvascular complications as well. I think this is the most likely relationship.

Unfortunately there is a big difference in the grand scheme between recognizing something as a truth and doing something about it… We seem to have a problem as a civilization with bridging that gap. Look how long we’ve known cigarettes are very bad for people, yet people continue to smoke, and new smokers start every day. It’s obvious to anyone who pays attention that the “healthy diet” as presented over the past few decades is actually killing us, but changing the recommendations hasn’t happened on any large scale, and likely wont any time soon…

Thanks Tim and all! I don't claim to actually understand all that is discussed (though I am actively learning and reading more all the time) but I do appreciate the dialogue. It seems that inflammation is a complicated issue and though there may not be complete evidence, reducing inflammation certainly can't hurt and possibly could help.

Since reading the article I have been looking into buying tumeric supplements (in addition to implementing some dietary changes) but those are rather pricey! Does anyone use the supplements? Do you think they are worth it? Any intel on more affordable access? I am in Canada.

Thanks again for the conversations.

For all the microvascular complications, high blood pressure is an enormous risk factor in and of itself (never mind the multiplicative factor of potentially high bg's too). The easiest way to reduce risk of kidney disease, retinopathy, etc., is to make sure both bg and blood pressure are well controlled. If for some reason you can't control both, then make sure at least one is controlled!

Even if your blood pressure is not very elevated, it makes good sense to have some kind of ACE/ARB inhibitor to help prevent the microvascular complications.

Thank Eucritta and Tim. I did try omega-3 for almost a week once at the recommendation of a colleague, but I couldn't stomach the nausea the pills caused. I don't know if they clashed with other meds I was taking or if they didn't agree with my system, but yuck! I just couldn't take the burping, and these were supposed to be the best on the market to prevent that side effect.

I am type 2 diabetic, and have been fighting to lower my numbers. I am learning that there are diseases due to the higher numbers. I was diagnosed with gastroenteritis just a couple of weeks ago. My doctor had prescribed Victoza a couple of years ago. I kept telling him it was doing nothing to help and I fought nausea and stomach problems from the time they put me on it. My husband pressed them for a referral to a Endocrinologists. The new doctor said that if I had issues with slow digestion that I should never be on any of the Victoza type of meds. Sure enough, that was my problem. I also found out it is a disease common to diabetics and due to having high numbers. I hope that others can avoid this disease because it is really difficult to deal with.

CJ---I experimented and finally found an easy way to ingest some of these things. On my daily "ration" of blueberries, I sprinkle 1 Tbsp of ground flax(a sweet, nutty flavor), 1/4 tsp each of turmeric powder, cumin and ginger, 3 anti-inflammatories---we hope! These lovely spices so beloved of the Indian sub-continent mix really well with fruity flavors. Blueberries are considered in many circles to be the biggest bang for the buck when you have to limit your fruit intake. I have found that in season, I also don't get spiked by fresh strawberries or raspberries. I add a dollop of unsweetened almond milk, a dollop of heavy cream and a few drops of liquid stevia to honor the last remnants of my sweet tooth......

If you have something like a Costco near by, their large jars of these spices are reasonably priced (and often harvested in reliable places) when you consider the small amounts you are using so that they last a long time......

I do take some supplements, but we are all very individual and what works for me may not work for you! You just have to do the research and carefully test your own reactions. Unless I have an immediate reaction such as nausea or diarrhea, I give it a 3-month trial and test a lot!......Blessings and good luck!.....Judith in Portland

Sorry, I see that I posted that I was diagnosed with gastroenteritis, and it is actually gastroperisis. I will be going to specialist in November, but in the mean time I get to educate myself on what foods I can and cannot eat.

Good luck to you! There is so much learning and self advocacy in disease management of any kind. That's where forums like this are so great - learning from the experiences of others.

Thank you Judith! It is helpful to see how you have added in these spices. I much prefer the idea of using food sources over using supplements and your method sounds quite yummy I must say :)

CJ---I forgot one yummy ingredient, silly me----Cinnamon. 1 tsp. That actually started the whole experiment along with the flax....Enjoy!