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Health, Food and Lifestyle Wisdom
Winter Fires: Inflammation and Your Healthy Heart
By Susan E. Fekety, MSN, CNM
As we slip into the dark months, one yearns for fires and lights and warmth. On a sharp and wicked cold day, simply imagining the body’s “fire within” feels comforting. Inflammation (the heat, redness, pain, and swelling you experience after encountering an irritant or a toxin or a germ or a candle flame, when you hammer your thumb putting up the holiday lights, or pull a muscle hoisting a mug of wassail) is an essential part of your body’s healing toolkit -- but when it’s in overdrive, it’s a component of most of the diseases you don’t want to get.
Truly healthful diets (like the Mediterranean diet) effectively block inflammation; one reason you feel good when you’re eating well is that you’re not wasting energy on smoldering anymore. Loaded with antioxidants and fiber from fruits and vegetables, and healthy fats from vegetables, nuts and fish, short on sugar and fast, refined carbohydrates – an anti-inflammatory food program is fresh and powerful. You’d think I’d be thrilled that beating inflammation has hit the headlines, thanks to a recent article by Dr. Paul Ridker (one of my heroes) and his colleagues, in the New England Journal of Medicine. Instead my knickers are totally in a twist. How can this be?
I’d like to set the scene for you. Take first the pharmaceutical manufacturers, who want to get more and more of us identified as in need of their drugs, for life if possible. To this end, they‘re understandably supporting a bumper crop of research looking at new reasons to use medications already on the market. Frequently, these studies define as dangerous some common physical findings that have been considered perfectly normal for years.
Take second a passel of compassionate health care providers who hate it that half of their patients who have heart attacks and strokes have stone normal cholesterol levels, violating the ancient teaching that You Cure Cardiovascular Disease By Lowering High Cholesterol, typically via a prescription for a statin drug. (Statin drugs work best for people who have already had a heart attack and don’t want to have another one – but most folks on statins haven’t had a heart attack yet. The reasoning seems to be, if statins can prevent a second heart attack, surely they can preclude some first ones? Actual evidence of this is surprisingly scarce for men and virtually nonexistent for women.) Care providers do not like it when the evidence steers us towards uncertainty, lack of control, and an inability to prevent suffering. We like problems we can “fix.” And fast – the average office encounter now lasts eight minutes.
Enter the crucial relationship between inflammation and heart disease. Evidently the initial “thing” that happens to start the development of an atherosclerotic plaque is inflammatory damage to the blood vessel wall, which the body then smears with cholesterol and platelets and gunk like a plasterer gone wild, till the vessel is occluded or the plaque ruptures and you have a stroke or heart attack. (Gross simplification, but close enough.) The theory is that if you avoid inflammation you can nip this process in the bud. Increasing evidence to support the theory is forcing us to pry our rigid fingers away from the cholesterol hypothesis (and by implication, from the statin solution.) You can imagine how difficult this is.
One can test for inflammation with an inexpensive blood test called a “high sensitivity C-reactive protein” test, or hsCRP. Until this study came out, patients with high hsCRP were instructed to lose weight, eat better, get some exercise, quit smoking, work on reducing stress – and maybe take some fish oil capsules or a daily aspirin. Except for the fish oil and aspirin, these interventions are not “fast.” Patients generally need support to make changes in lifestyle, and your schedule gets way backed up. There is much gnashing of teeth. Failure. Suffering.
But guess what! Deus ex machina, now we can give statin drugs for inflammation! To prevent a first heart attack or stroke in people with normal cholesterol levels! Yes, this article which is now flying around media outlets like sparks up the chimney indicates that giving a very powerful (and expensive) statin drug (Crestor) to people with normal cholesterol levels but high hsCRP tests reduced their risk of severe cardiovascular events and death. The effect was so strong they stopped the study early. Wow.
This was a big, international, expensive study involving men over 50 and women over 60. hsCRP values in the group getting the statin went down around 40% -- though for many, they’re probably still way too high. Average “bad” cholesterol levels (normal to begin with, remember) went WAY down on the statins – even lower than where cardiologists want them in people at risk for a second heart attack. Nobody knows if that’s safe and for how long. A significant bunch of people developed diabetes on the drug, which puzzles everyone (and definitely gives me the creeps.) There wasn’t much written about drug side effects, which include muscle damage and musculoskeletal pain, liver problems, and inhibition of an essential nutrient called co-enzyme Q 10. Still – there are those who would like to have this kind of medication available over the counter – even (I hope jokingly) put in the water supply. Heart attacks and strokes are unarguably really awful; I can see wanting a solution like this. But still.
So, trust me, hsCRP testing and statin prescriptions will probably catch on like wildfire. It’s a dream come true for the drug folks: a whole new indication for millions of lifelong prescriptions. For time-crunched practitioners, it’s a simple mental algorithm and new hope for controlling a frustrating, worrisome clinical situation.
But wait! What about nutrition, and exercise, and stress reduction, and quitting smoking? What about how good it feels to modify health risk factors with preventive medicine you administer yourself? Are those of us who favor such things going the way of the dodo? Happily, there ARE voices in the wilderness; some well-credentialed medical authorities have voiced concerns about the perils of omitting lifestyle modification and passing out statins to millions of Americans for the rest of their lives. Still, until we have a health care system that knows how to help people change behaviors, I predict that you’ll hear fewer conversations about lifestyle in many busy practices, and more about medicines. It’s so unfortunate. Oh, no, there go those knickers again.
Transitioning to an anti-inflammatory lifestyle is delicious and satisfying. People do it every day, and you could too, if you haven’t already. Besides the stuff I mentioned above, other anti-inferno dietary elements include our friends ginger and curcumin – the stuff that makes turmeric so blindingly yellow. Here’s a recipe that uses both – served with a nice piece of wild Alaskan salmon, you’ll have the coolest warm and spicy dinner ever!
Clean-Out-The-Fridge Versatile Veggie Curry
Makes about 8 servings, depending
2 carrots; peeled and cut into ½ inch thick slices
2 small eggplants, in one-inch cubes
1 red bell pepper, seeded and chopped into one-inch squares
1 head cauliflower, cored and cubed
1 bunch broccoli, trimmed and chopped
2 medium sized zucchini, in one-inch cubes
3 tablespoons cold pressed organic olive oil
2 large onions, diced
2 cloves garlic, minced
1 1/2 tablespoon fresh ginger, minced
1/2 teaspoon cayenne pepper
2 teaspoon ground cumin
1 teaspoon ground turmeric
1/2 teaspoon sea salt
2 cups chicken or vegetable stock
Handful of chopped cilantro
Heat oil in a large skillet that has a lid. Saute the onion, garlic, and ginger, and cook together over medium heat for about 10 minutes, appreciating the aroma and letting your shoulders relax. When onions are translucent, add cayenne, cumin, turmeric, and salt. Appreciate again. Stir to mix well and cook for 5 minutes. Add stock and stir to blend with spices and onions. Add carrots and eggplant, cover, and simmer for 15 minutes. Add broccoli, cauliflower, and red pepper; cover and simmer for another 5 minutes. Add zucchini and cook uncovered for 5 minutes or until zucchini softens. Remove from heat and serve with cilantro sprinkled on top.
Note: This recipe will accept any number of other vegetables you may have on hand, like greens or tomatoes. Or a can of garbanzo beans.
© 2008 Susan E. Fekety
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SUSAN FEKETY, RN, MSN, CNM is a Yale-educated advanced practice nurse with special expertise in nutrition and dietary therapies. She provides comprehensive women’s health care at True North Health Center in Falmouth, and coordinates True North’s First Line Therapy program (a clinically-proven, user-friendly program for improving health, weight, mood, and energy in men and women.) Her book of affirmations for pregnant women can be foun
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