You probably don’t think of inflammation when you think about heart disease, cancer and numerous other big killers. But that may change soon, as researchers seek an explanation for the 25 percent or more of those who show up at the hospital — or morgue — with a heart attack or stroke without conventional, well-known risk factors.
The word “inflammation” has been cropping up recently in numerous places, and not in its usual context. For example, a current study in the journal Circulation, showing that two inflammation-related molecules, interleuken-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), were better predictors of heart disease and stroke than the standard risk factors. In fact, they proved even better than C-reactive protein (CRP), an inflammation marker recently in the news. Researchers at the University of Michigan medical school have found new evidence to support the idea that the formation of blood clots in deep vein thrombosis (DVT) is an inflammatory process. And a study presented at the American Heart Association’s annual meeting in November suggests that the benefits of the Mediterranean diet may be linked to lower levels of various measures of inflammation.
Inflammation as a key factor
This new attention to inflammation doesn’t surprise Health & Wellness Advisory Board member Richard M. Fleming, M.D., a cardiologist specializing in nuclear and preventive medicine, whose latest book is titled Stop Inflammation Now! Fleming is the founder and director of the Fleming Heart and Health Institute in Omaha, Nebraska. He also heads The Camelot Foundation, a not-for-profit foundation funding research and education for heart disease and cancer.
According to Fleming, most heart disease treatment has three major pitfalls. First, although medications typically provide short-term relief, they don’t treat the real underlying risk factors. Second, most doctors don’t adequately stress dietary and lifestyle changes required to reverse heart disease. And, as Fleming discovered in a 1994 study, even following the dietary recommendations of the American Heart Association (AHA) frequently isn’t enough to reverse heart disease.
“People aren’t addressing the underlying problem,” says Fleming. He believes a major contributor to heart disease (and numerous other chronic illnesses) is inflammation caused when oxidation damages tissue, triggering an immune system response.
You’ve seen swelling and redness associated with inflammation disappear as a cut finger heals. But eating habits, extra weight
and a sedentary lifestyle may contribute
to internal inflammation that you can’t see and which, without changes, becomes chronic and harmful.
A plant-based approach
Fleming asserts that lack of proper nutrition, and the resulting systemic damage, is behind many common American health problems. For Fleming, good nutrition starts with plants. He notes that, except for vitamins B12 and D, plants provide all the essential vitamins and minerals your body needs. “And animal foods are only nutritious because animals eat plants,” he says.
Although processing can concentrate an enormous amount of food into a small volume, Fleming finds most processed foods, stripped of their fiber and phytochemicals, nutritionally deficient. He notes, for example, that it takes many pounds of potatoes to produce a single pound of potato chips. Although one large, 200-calorie potato is nutritious and satisfies your hunger, some people opt instead for a pound of potato chips — about 2,400 nutritionally poor calories — at one sitting.
Fleming suggests avoiding foods altered from the way nature made them or foods produced largely from artificial ingredients: sugar, syrups, breads, rolls, crackers, chips, cookies, muffins, pastries, waffles, pudding, candy, soda, cereals, hot dogs, sausage and similar foods. “Look at the wealth of foods in the fruit and vegetable section of your grocery store — and then realize that the rest of the food in the store was manufactured,” says Fleming.
“We’re missing the big picture,” says Fleming. “We’re trained like dogs to eat when we come home, when we go to a sporting event — when we go anywhere. We’re a society of overeaters.” Fleming believes this contributes to immune system breakdown and inflammation.
“The very system that has sustained human existence for nearly 2 million years is now the basis for our destruction,” says Fleming. “In the past 50 years we have turned nature on its head. Why? Because we insist on eating foods that nature never intended for us to eat. The poisons in those foods have transformed our bodies into breeding grounds for disease.”
Desperation is common among Fleming’s patients. “Just think about someone considering stomach surgery,” he says. “They’re actually saying, ‘I’m so far out of balance for what my body needs that I must get a handle on it.’ And that’s what the first phase of my diet addresses. It’s not designed to last a lifetime.”
Unlike the typical diet, which fills your stomach with calories, but doesn’t necessarily provide good nutrition, Fleming’s diet aims to eliminate inflammation, improve circulation, strengthen and support your heart, cause significant weight loss, boost your immune system and increase your energy level. Phase 1 of the two-phase anti-inflammation diet consists basically of:
• vegetables and fruits
• a daily multivitamin
• 6 to 8 large glasses of pure spring water
• an optional cup or two of black or green tea
• and, with permission from your doctor, a leisurely 30-minute walk three to seven days a week.
Fleming notes that various fruits and vegetables have anti-inflammatory properties and provide important antioxidants. His diet responds both to the disappointing outcomes of patients on the AHA’s reduced-fat diet and to what he considers potentially very risky outcomes of the currently popular high-protein, low-carbohydrate diet.
In Phase 1, 50 percent of calories are from fruits (13 servings) and 50 percent of calories come from vegetables (23 servings). Fleming distinguishes vegetables by color, which
frequently indicates the presence of specific phytonutrients.
Since Fleming stresses variety over quantity, his method of counting servings varies from most. It doesn’t track serving size, but rather whether even a small portion of a food appears in the menu. One apple is one fruit serving and a medley of three vegetables constitutes three servings, even if it contains only modest amounts of each.
Although his approach seems extreme, Fleming isn’t trying to create extremists. “This doesn’t mean you’ll never see other foods again. In fact, depending on the health issues you have, you may not even need Phase 1. But it gives you a kick-start on weight loss and is tremendously effective for a number of heart problems,” says Fleming. “It’s a simple, hard-to-screw-up regimen.”
Most people only need this portion of Fleming’s diet for a month or two, until they meet the initial goals of their treatment plan. “Then, after you start feeling better, lose some weight and get a handle on your health conditions, you can start reintroducing foods — in appropriate quantities. You relearn eating to live, rather than living to eat.”
Have your doctor monitor your progress on this diet. If you are on medication, he or she may adjust the dosage as your health improves.
Life after Phase 1
While Phase 1 avoids all animal foods, oils, processed foods and flour products, as well as foods with refined white sugar or artificial sweeteners, Fleming uses a transition phase to re-introduce whole grains as a primary dish. During a transitional month or so, Fleming recommends including 17 daily servings of vegetables, 10 of fruit and two of whole grains. He also provides numerous recipes and menu recommendations for an approach to whole grains new to most Americans.
Phase 2 of Fleming’s diet is highly flexible, providing greater food choices, especially in restaurants — a lifestyle that maintains benefits realized in Phase 1. It builds on the fact that it takes about 10 calories a day to maintain a pound of weight, and includes about 15 percent protein, 70 percent complex carbohydrates and 15 percent fat.
This phase puts vegetables at the center
of your diet and includes a serving of whole grains like brown rice, barley and millet, noodles and pasta every day. It introduces six small (3.5 ounces) portions of fish, skinless poultry, eggs and lean meats each week and includes a tablespoon a day of certain vegetable oils, including olive and sesame oil. It allows skim or low-fat dairy foods three times a week, and half a cup of nuts and seeds a week. And it includes the daily vitamin supplement and beverages of Phase 1. Phase 2 also encourages a variety of exercise options.
Fleming uses a number of tests with his patients — many in life-or-death situations — to detect and track inflammation. But most doctors don’t routinely order these tests, and most insurance wouldn’t cover them.
So what can you do to avoid being a heart event statistic? “Go ahead,” urges Fleming. “Treat your body with the respect it deserves. Make the appropriate lifestyle and dietary changes that will greatly reduce your risk.”
Lynn Madsen writes about medical topics for print and electronic media. She’s authored three books, parts of many others and numerous articles for consumers.
You may be tempted to write cardiologist Richard Fleming, M.D., off as a kook — until you see other experts draw conclusions simailar to his. In Stop Inflammation Now! Fleming spells out a radical new, plant-based dietary approach to numerous maladies. Interestingly, Walter Willet, M.D., head of the department of nutrition at Harvard Medical School and author of Eat, Drink and Be Healthy: The Harvard Medical School Guide to Healthy Eating, has devised a similar diet.
“These diets may be valuable,” says cardiologist Gerald F. Fletcher, M.D., professor of medicine at Mayo Medical School, Mayo Medical Clinic, Jacksonville, Florida. “But we need more data from large clinical trials.”
And, although he is concerned about restricting calcium and finds Phase 1 of Fleming’s diet rather extreme, Robert H. Eckel, M.D., professor of medicine, University of Colorado School of Medicine, and chairman of the American Heart Association’s (AHA) Council on Nutrition, Physical Activity and Metabolism, also hopes to see more research on this approach.
“We do know inflammation and heart disease are related, and people with modest chronic inflammation are at a greater risk for heart disease,” he says. “A diet that promotes fruits and vegetables points in the direction of less heart disease, cancer and stroke.”
“Fleming’s diet has a lot going for it,” says Keith T. Ayoob, Ed.D., R.D., doctor of nutrition education and registered dietitian, spokesperson for the American Dietetic Association and associate professor of pediatrics at Albert Einstein College of Medicine, Bronx, New York. “Initially, this diet most benefits people with heart disease. But it’s a severe diet.”
However, Ayoob considers it a major improvement over currently popular diets that allow hefty fat intake while touting weight loss. “We have to stop evaluating diets solely on whether or not they lower weight,” says Ayoob. “So does fasting — it works 100 percent of the time for 100 percent of people, but I wouldn’t recommend it.”
Ayoob also believes people on the high-fat, low-carbohydrate diets haven’t been followed long enough. “Less than 18 months is not sufficient. The great washout period is 12 to 18 months.” And he agrees with Fleming’s whole-food approach. “If you require a lot of vitamin supplements, something is wrong. And you’re back at square one with the question of what you’re actually going to eat.” But Ayoob is also concerned about the dramatically reduced dairy calcium intake in Fleming’s diet.
Although inflammation is well established as a cause of cancer, it’s frequently not the focus of most oncology discussion, according to Keith I. Block, M.D., medical director, Block Center for Integrative Cancer Care, Evanston, Illinois, and assistant professor, University of Illinois College of Medicine in Chicago. But Block uses a multi-faceted approach, including the anti-inflammatory diet, to help patients control inflammation.
He describes a 50-year-old patient who came to him three years ago with lung cancer metastasized into her liver. She’d found chemotherapy intolerable, having lost 45 pounds in three months. Testing indicated marked inflammation. “She was slipping rapidly downhill,” says Block.
Now, three years after starting an
anti-inflammatory diet with some supplementation, she’s regained her lost weight and tolerated the full course of chemotherapy administered at optimal times of day for her circadian rhythm. Her scans are free of cancer. In fact, notes Block, at a gala event she recently attended, she danced tirelessly through the night.
Clearly, larger studies need to verify Fleming’s assertions and outcomes. But his initial success is hard to ignore.
short-term relief, they don’t treat the real underlying risk factors.
system that has sustained human existence for
nearly 2 million years is now
the basis for our destruction.