Chapter 31
Green Is Good
In addition to lower CRP levels, participants who ate more plant-based also tended to have lower white blood cell counts, which are considered a “stable, well-standardized, widely available, and inexpensive measure of systemic inflammation.” As I explain in my video see.nf/whitecount, an elevated white blood cell count can be an important predictor of cardiovascular disease and mortality, decline in lung function, cancer death, diabetes, and premature death in general. Even within the normal range, each drop of just one point is associated with a 20 percent lower risk of early death.
How can we lower it? As I show in my follow-up video see.nf/idealcount, avoiding secondhand smoke buys you half a point, losing a quarter of your excess body fat can be worth about one point, exercising one to two hours a week for two months can be rewarded with one and a half points, as can a whole-food, plant-based diet.
Green Is Good
The diet called Low Inflammatory Foods Everyday (LIFE) is based on Dr. Joel Fuhrman’s principle of high nutrient density. It includes one green smoothie a day, and the LIFE diet otherwise is bursting with fruits and vegetables. It successfully lowered CRP, but participants were also encouraged to limit their consumption of animal products in general. However, even among those who drank the green smoothie daily but otherwise changed nothing about their usual diet, the astonishing CRP reduction of 40 percent was documented within just one week—supposedly the fastest diet-induced CRP reduction ever reported in the medical literature. Here is Dr. Fuhrman’s recipe, in case you want to try it yourself: a half pound of dark green leafy greens such as baby kale, 2 1/4 cups of blueberries, one banana, one tablespoon of unsweetened cocoa powder, one tablespoon of ground flaxseed, a half cup of water, and a half cup of soy milk, either plain or vanilla-flavored, or unsweetened vanilla almond milk.
The secret of the green smoothie may lie in how it is prepared. High-speed blenders increase the release of nutrients. If you blend spinach, for example, the bioavailability of its beta-carotene is almost 50 percent higher than if you chop it, and 90 percent higher than if you eat the whole leaves. Same amount of food, but depending on preparation, more or fewer nutrients make it into your blood. The chlorophyll itself might also play a role. In petri dish and animal experiments, its anti-inflammatory effect has been demonstrated, where it reduced “paw thickness”—that is, how much the paws swell when the animals are injected with an inflammation-promoting irritant. Clinically, however, the anti-inflammatory effect of chlorophyll has not yet been tested.
Cruciferous vegetables, including kale, collard greens, and other vegetables in the broccoli family, appear to be especially anti-inflammatory, which may also partly explain why they tend to be associated with a longer life than other vegetables. Special components in cruciferous vegetables appear to block NF-κB, a central mediator of inflammation that controls an entire battery of pro-inflammatory genes, although you’d have to eat about 2 pounds a day to significantly lower IL-6 in two weeks. But just about 30 grams of broccoli sprouts per day can substantially lower CRP and cut IL-6 in half. Sprouts can easily be grown at home year-round in a canning jar, at a cost of about 25 cents per cup.
Hot Tomatoes
Can any vegetable besides green leafy greens be proven to reduce inflammation in humans? Yes: purple potatoes, tomato juice, and tomato paste (but not tomato extract supplements), as well as shiitake mushrooms. For details, see see.nf/veggies.
A Kernel of Truth
Consistent with the recommendations of leading experts in the fields of cancer and heart disease, I suggest eating at least three servings of whole grains daily. A meta-analysis of eleven studies estimated that this intake would translate into a 17 percent lower risk of total mortality. (Funny enough, the authors made a typo and wrote “morality risk” instead. Was a little devil sitting on their shoulder?)
The findings are not surprising, since consumption of whole-grain products is associated with a lower risk of death from cardiovascular disease, cancer, diabetes, and inflammatory diseases in general. Put simply, millions of people worldwide could save their lives every year if they ate more whole grains. But to pin down cause and effect precisely, intervention studies are required. In see.nf/grains I provide an overview of the randomized controlled trials that observed that the anti-inflammatory effect may be limited to certain subgroups.
The Flaxseed Connection
Just as with whole grains, population studies show an association between nuts and lower inflammation, as well as a lower risk of death from inflammatory diseases and from all causes combined. Data from intervention studies, however, are disappointing. Only two of the six inflammation markers tracked in longer-term studies responded to nuts. Certain seeds appear more promising in this regard. Check out see.nf/sesame to learn what a quarter cup of sesame seeds per day can do for osteoarthritis pain, and learn at see.nf/oxylipins what happens when subjects are randomized to receive flaxseed muffins versus placebo muffins. Although flaxseed also lowers the usual inflammation markers, the mechanism by which ground flaxseed lowers blood pressure appears to be based on the reduction of oxylipins, pro-inflammatory components that rise with age and are thought to have something to do with inflammatory aging. But middle-aged adults in the group that ate muffins with ground flaxseed were able, within just four weeks, to reduce their oxylipins to the levels of 20-year-olds.
The Spice of Life
Spices have been used for centuries to treat inflammation. You may remember: turmeric is the most anti-inflammatory food in the Dietary Inflammatory Index. In vitro, curcumin—the pigment that gives the spice its bright yellow color—has an anti-inflammatory profile that is stronger and more comprehensive than that of the potent anti-inflammatory corticosteroid medication prednisolone. Many preparations of turmeric have been shown to be beneficial in inflammatory diseases of the joints, lungs, skin, and gut, including purified curcumin, turmeric extracts, and about a half teaspoon a day of the plain market spice. Although the curcumin in turmeric itself does not appear to blunt the acute pro-inflammatory effects of, for example, a milkshake, when taken longer-term, randomized controlled trials clearly show a reduction in a whole range of inflammation markers.
As anti-inflammatory foods, ginger and garlic rank right behind turmeric in the Dietary Inflammatory Index. A meta-analysis of more than a dozen randomized controlled trials lasting between four and twelve weeks, using a half to a full teaspoon of ginger powder, found a significant drop in inflammation markers.
Ginger powder has been used successfully to treat rheumatoid arthritis and osteoarthritis. As a pain reliever, it is on a par with ibuprofen, and it tends to protect the stomach lining rather than damage it. One eighth teaspoon of ginger powder, which may cost a penny, can work just as well as the migraine drug Imitrex, but without its side effects. One third to a full teaspoon daily starting a few days before your period results in much less menstrual pain and no more heavy bleeding. Dried ginger works better than fresh, since the most powerful anti-inflammatory components are dehydration products that form during drying.
Garlic powder also reduces inflammation markers in the blood. In women with active rheumatoid arthritis, thanks to one third teaspoon a day, pain intensity, joint tenderness, fatigue, and disease activity improved significantly compared to a placebo. Notable side effects? Only body odor and bad breath.