Month: January 2022

Quick health quiz: how bad is inflammation for your body?

You’re forgiven if you think inflammation is very bad. News sources everywhere will tell you it contributes to the top causes of death worldwide. Heart disease, stroke, dementia, and cancer all have been linked to chronic inflammation. And that’s just the short list. So, what can you do to reduce inflammation in your body?

Good question! Before we get to the answers, though, let’s review what inflammation is — and isn’t.

Inflammation 101

Misconceptions abound about inflammation. One standard definition describes inflammation as the body’s response to an injury, allergy, or infection, causing redness, warmth, pain, swelling, and limitation of function. That’s right if we’re talking about a splinter in your finger, bacterial pneumonia, or the rash of poison ivy. But it’s only part of the story, because there’s more than one type of inflammation:

• Acute inflammation rears up suddenly, lasts days to weeks, and then settles down once the cause, such as an injury or infection, is under control. Generally, acute inflammation is a reaction that attempts to restore the health of the affected area. That’s the type described in the definition above.

• Chronic inflammation is quite different. It can develop for no medically apparent reason, last a lifetime, and cause harm rather than healing. This type of inflammation is often linked with chronic disease, such as
  • excess weight
  • diabetes
  • cardiovascular disease, including heart attacks and stroke
  • certain infections, such as hepatitis C
  • autoimmune disease
  • cancer
  • stress, whether psychological or physical.

Which cells are involved in inflammation?

The cells involved with both types of inflammation are part of the body’s immune system. That makes sense, because the immune system defends the body from attacks of all kinds.

Depending on the duration, location, and cause of trouble, a variety of immune cells, such as neutrophils, lymphocytes, and macrophages, rush in to create inflammation. Each type of cell has its own particular role to play, including attacking foreign invaders, creating antibodies, and removing dead cells.

4 inflammation myths and misconceptions

Inflammation is the root cause of most modern illness.

Not so fast. Yes, a number of chronic diseases are accompanied by inflammation. In many cases, controlling that inflammation is an important part of treatment. And it’s true that unchecked inflammation contributes to long-term health problems.

But inflammation is not the direct cause of most chronic diseases. For example, blood vessel inflammation occurs with atherosclerosis. Yet we don’t know whether chronic inflammation caused this, or whether the key contributors were standard risk factors (such as high cholesterol, diabetes, and smoking — all of which cause inflammation).

You know when you’re inflamed.

True for some conditions. People with rheumatoid arthritis, for example, know when their joints are inflamed because they experience more pain, swelling, and stiffness. But the type of inflammation seen in obesity, diabetes, or cardiovascular disease, for example, causes no specific symptoms. Sure, fatigue, brain fog, headaches, and other symptoms are sometimes attributed to inflammation. But plenty of people have those symptoms without inflammation.

Controlling chronic inflammation would eliminate most chronic disease.

Not so. Effective treatments typically target the cause of inflammation, rather than suppressing inflammation. A person with rheumatoid arthritis may take steroids or other anti-inflammatory medicine, which reduces their symptoms. But to avoid permanent joint damage, they also take a medicine like methotrexate to treat the underlying condition causing inflammation.

Anti-inflammatory diets or certain foods (blueberries! kale! garlic!) prevent disease by suppressing inflammation.

While it’s true that some foods and diets are healthier than others, it’s not clear their benefits are due to reducing inflammation. Switching from a typical Western diet to an "anti-inflammatory diet" (such as the Mediterranean diet) improves health in multiple ways. Reducing inflammation is just one of many possible mechanisms.

The bottom line

Inflammation isn’t a lone villain cutting short millions of lives each year. The truth is, even if you could completely eliminate inflammation — sorry, not possible — you wouldn’t want to. Quashing inflammation leaves you vulnerable to deadly infections. Your body couldn’t effectively respond to allergens and toxins or recover from injuries.

Inflammation is complicated. While acute inflammation is your body’s natural, usually helpful response to injury, infection, or other dangers, it sometimes spins out of control. We need to better understand what causes inflammation and what prompts it to become chronic. Then we can treat an underlying cause, instead of assigning the blame for every illness to inflammation or hoping that eating individual foods will reduce it.

There’s no quick or simple fix for unhealthy inflammation. To reduce it, we need to detect, prevent, and treat its underlying causes. Yet there is good news. Most often inflammation exists in your body for good reason and does what it’s supposed to do. And when it is causing trouble, you can take steps to improve the situation.

It is estimated that worldwide there are more than 55 million people living with Alzheimer’s disease and other causes of dementia, and this number is estimated to rise to 78 million by 2030 and 139 million by 2050. There are simply not enough neurologists, psychiatrists, geriatricians, neuropsychologists, and other specialists to diagnose these individuals with cognitive decline and dementia. Primary care providers will need take the lead.

Although this may sound like the obvious and simple solution, my friends who are primary care providers remind me that they barely have time to do the basics — like blood pressure and diabetes management — and that they have no time to administer fancy cognitive tests. Even a simple test like the Mini-Cog (clock drawing and three words to remember) is too long for them. So how are we going to diagnose the increasing numbers of individuals with Alzheimer’s and other dementias in the next few decades?

A self-administered test can screen for memory loss

In 2010, clinicians at the division of cognitive neurology in The Ohio State University Wexner Medical Center developed a cognitive test to screen for memory loss that individuals can self-administer. This concept of a self-administered cognitive test can solve the problem of the time-crunched primary care provider. Individuals can take this test in the privacy of their own home and bring the results with them to the office. The results can then be used to determine whether additional work up and/or referral to a specialist is indicated.

The test, the Self-Administered Gerocognitive Examination (SAGE), has compared favorably to clinician-administered tests such as the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), as well as to standard neuropsychological testing. What was not known, however, is how well SAGE would be able to predict who would develop Alzheimer’s disease or another cause of dementia.

Predicting the future

To answer this question, the authors performed a retrospective chart review on 655 individuals seen in their memory disorders clinic, with a follow-up of up to 8.8 years. They compared their SAGE test to the MMSE.

Based on both initial and follow-up clinic visits, they divided their clinic population into four groups. Before I describe the groups, let me explain a few terms:

• Dementia is when cognitive impairment leads to impaired function.
• Mild cognitive impairment (MCI) is when there is cognitive impairment, but function is normal.
• Subjective cognitive decline is when individuals are concerned about their thinking and memory, but both cognition and function are normal.

The four groups they compared were individuals with

• Alzheimer’s disease dementia
• MCI who converted to Alzheimer’s disease dementia
• MCI who converted to another type of dementia
• subjective cognitive decline.

They found a surprisingly high correlation between the SAGE test and the MMSE in being able to predict how each of these groups did over time. Moreover, they found that the SAGE test could predict the conversion of an individual with MCI who would develop dementia six months earlier than the MMSE.

What is needed to bring this test into current practice

Even a self-administered test that individuals can do at home will still require training for primary care providers, to understand how the test should be used and how to interpret the results. There is no question, however, that such training will be worthwhile. Once the training is complete, the knowledge gained should be able to save literally thousands of hours of clinician time, in addition to missed — or improper — diagnoses.

Another question is how individuals will react when they are told that they need to perform a 10-to-15-minute cognitive test at home and bring the results to their doctor. Will they do it? Or will the ones who need the test the most avoid doing it — or cheat on it? My suspicion is that people who are concerned will do the test, as will people who generally follow their doctor’s instructions. Some individuals who would benefit from the information that the test provides may not do it, but many of those individuals wouldn’t do the “regular” pencil-and-paper testing with the doctor or clinic staff either.

A new model of cognitive screening

Previously, there were two types of screening instruments to help determine if someone is developing cognitive impairment that could lead to dementia: clinician-administered cognitive tests and family/caregiver questionnaires. Now there is a third type of screening instrument: a self-administered test. Use of these self-administered tests will be key in detecting the increasing numbers of individuals with Alzheimer’s disease and other causes of dementia who will be with us in the next several decades.

Want to test yourself?

You can download the SAGE test here. As it says on the website, please take the answer sheet to your doctor so they can score it and speak with you about the results.

So many physical abilities decline with normal aging, including strength, swiftness, and stamina. In addition to these muscle-related declines, there are also changes that occur in coordinating the movements of the body. Together, these changes mean that as you age, you may not be able to perform activities such as running to catch a bus, walking around the garden, carrying groceries into the house, keeping your balance on a slippery surface, or playing catch with your grandchildren as well as you used to. But do these activities have to deteriorate? Let’s look at why these declines happen — and what you can do to actually improve your strength and coordination.

Changes in strength

Changes in strength, swiftness, and stamina with age are all associated with decreasing muscle mass. Although there is not much decline in your muscles between ages 20 and 40, after age 40 there can be a decline of 1% to 2% per year in lean body mass and 1.5% to 5% per year in strength.

The loss of muscle mass is related to both a reduced number of muscle fibers and a reduction in fiber size. If the fibers become too small, they die. Fast-twitch muscle fibers shrink and die more rapidly than others, leading to a loss of muscle speed. In addition, the capacity for muscles to undergo repair also diminishes with age. One cause of these changes is decline in muscle-building hormones and growth factors including testosterone, estrogen, dehydroepiandrosterone (better known as DHEA), growth hormone, and insulin-like growth factor.

Changes in coordination

Changes in coordination are less related to muscles and more related to the brain and nervous system. Multiple brain centers need to be, well, coordinated to allow you to do everything from hitting a golf ball to keeping a coffee cup steady as you walk across a room. This means that the wiring of the brain, the so-called white matter that connects the different brain regions, is crucial.

Unfortunately, most people in our society over age 60 who eat a western diet and don’t get enough exercise have some tiny "ministrokes" (also called microvascular or small vessel disease) in their white matter. Although the strokes are so small that they are not noticeable when they occur, they can disrupt the connections between important brain coordination centers such as the frontal lobe (which directs movements) and the cerebellum (which provides on-the-fly corrections to those movements as needed).

In addition, losing dopamine-producing cells is common as you get older, which can slow down your movements and reduce your coordination, so even if you don’t develop Parkinson’s disease, many people develop some of the abnormalities in movement seen in Parkinson's.

Lastly, changes in vision — the "eye" side of hand-eye coordination — are also important. Eye diseases are much more common in older adults, including cataracts, glaucoma, and macular degeneration. In addition, mild difficulty seeing can be the first sign of cognitive disorders of aging, including Lewy body disease and Alzheimer’s.

How to improve your strength and coordination

It turns out that one of the most important causes of reduced strength and coordination with aging is simply reduced levels of physical activity. There is a myth in our society that it is fine to do progressively less exercise the older you get. The truth is just the opposite! As you age, it becomes more important to exercise regularly — perhaps even increasing the amount of time you spend exercising to compensate for bodily changes in hormones and other factors that you cannot control. The good news is that participating in exercises to improve strength and coordination can help people of any age. (Note, however, that you may need to be more careful with your exercise activities as you age to prevent injuries. If you’re not sure what the best types of exercises are for you, ask your doctor or a physical therapist.)

Here are some things you can do to improve your strength and coordination, whether you are 18 or 88 years old:

• Participate in aerobic exercise such as brisk walking, jogging, biking, swimming, or aerobic classes at least 30 minutes per day, five days per week.
• Participate in exercise that helps with strength, balance, and flexibility at least two hours per week, such as yoga, tai chi, Pilates, and isometric weightlifting.
• Practice sports that you want to improve at, such as golf, tennis, and basketball.
• Take advantage of lessons from teachers and advice from coaches and trainers to improve your exercise skills.
• Work with your doctor to treat diseases that can interfere with your ability to exercise, including orthopedic injuries, cataracts and other eye problems, and Parkinson’s and other movement disorders.
• Fuel your brain and muscles with a Mediterranean menu of foods including fish, olive oil, avocados, fruits, vegetables, nuts, beans, whole grains, and poultry. Eat other foods sparingly.
• Sleep well — you can actually improve your skills overnight while you are sleeping.

You don’t have to look far to find claims that taking vitamin D supplements is great for your health. It’s supposed to be good for everything from preventing cancer and dementia to avoiding infections and heart disease.

Unfortunately, many supposed benefits of vitamin D supplements remain unproven. Yet, millions of people take vitamin D regularly, thinking it will help prevent a wide range of illnesses, including certain autoimmune conditions. But does it? A new randomized, controlled study published in TheBMJ looks closely at that question.

Why would vitamin D prevent autoimmune disease?

Although the cause of most autoimmune disease is largely unknown, the leading theory is that the regulation of the body’s immune system goes awry. The immune system normally defends the body from invaders such as infections, and helps repair damaged tissues. When an autoimmune condition develops, the immune system attacks its host. For example, with rheumatoid arthritis, immune cells attack joints, lungs, and other parts of the body.

Research has shown that vitamin D can interact with immune cells, affect genes that regulate inflammation, and alter the response of the immune system. So it makes sense to investigate whether supplemental vitamin D is an effective way to treat or prevent autoimmune disease.

The BMJ study drew on data gathered during a large trial published several years ago. More than 25,000 older adults were randomly assigned to take

• 2,000 IU of vitamin D or an identical placebo (inactive pill) daily. (This is higher than the recommended daily amount for adults, but lower than the upper limit of 4,000 IU.)
• 1,000 mg of omega-3 oil or an identical placebo daily.

After an average of five years, new diagnoses of autoimmune disease among study participants were tallied.

What did the new study find?

The answer may depend on where you heard or read about the BMJ study. It’s true that the researchers found that adults taking vitamin D supplements had a lower risk of developing autoimmune disease. But here’s what some of the more enthusiastic news headlines said:

• Vitamin D supplements really do reduce risk of autoimmune disease (New Scientist)
• Taking Vitamin D Daily Can Help Prevent This Disease, New Study Says (Eat This, Not That!)
• Taking vitamin D and omega-3 fish oil supplements every day cuts your risk of developing arthritis by 22%, study suggests (Daily Mail)

Sounds great, right? But is it true?

What does a closer look at the study tell us?

The researchers reported that

• 123 people taking vitamin D developed autoimmune disease, compared with 155 people in the placebo group. This represents a 22% reduction. That sounds like a lot, but the actual decrease in risk for developing an autoimmune disease fell from about 12 people in 1,000 to 9.5 people in 1,000.
• Rheumatoid arthritis, polymyalgia rheumatica, and psoriasis were the most common conditions. No single autoimmune disease was reliably prevented by vitamin D supplementation. Only when the numbers of all the autoimmune diseases were combined did researchers see a benefit.
• The benefit of vitamin D was more obvious when only the final three years of the study were analyzed. This suggests that it takes a while to benefit from a daily supplement.
• Those assigned to receive omega-3 fatty acids did not have a lower risk for confirmed autoimmune disease.
• Side effects were minor and similar in those taking supplements and those taking placebo.

This randomized study is among the best to explore the impact of vitamin D supplementation on the risk of developing autoimmune disease. Yet the study relied on self-reported cases, later confirmed by medical record review. So it’s possible that some cases of autoimmune disease were overlooked.

In addition, the study only included older adults (average age 67). This is important because some of the most common autoimmune diseases, such as lupus and rheumatoid arthritis, typically begin in early adulthood. The results might have been different if the study had included younger participants.

Should we all be taking vitamin D supplements?

Based on this study, I’d say no. For one thing, these findings need to be confirmed by other independent researchers. And despite overly enthusiastic headlines, actual risk reduction was just 2.5 cases out of 1,000. Hundreds of people would need to take vitamin D daily for years to prevent a single case of autoimmune disease. Vitamin D can interact with other medicines, and taking high amounts of vitamin D can be harmful.

The bottom line

Is vitamin D a safe, all-natural wonder drug that can prevent or treat a litany of diseases? Based on current research that’s not clear yet, though I think it’s best to keep an open mind. We may find vitamin D does little for the average person but is highly beneficial for others; the trick is figuring out who is most likely to benefit. For example, perhaps supplemental vitamin D will be especially helpful for people who have a strong family history of certain autoimmune diseases.

Right now, we have the latest chapter in the story of vitamin D. Future research may reveal that a different dose or formulation of vitamin D might be particularly beneficial. Perhaps most importantly, this study and others to come could provide a better understanding of the role of vitamin D in the development of autoimmune diseases.

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