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In Part I of this series, we looked at what inflammation is and how it contributes to cancer development and progression. In Part II, we examine how to discern if inflammation is an issue for you, some valuable assessments to consider to measure it, and the very specific actions you can take to lower inflammation levels that are elevated.
Assessing Your Status
Other than some obvious signs―puffy gums, sore joints, chronic stuffiness―how can you tell if your inflammation levels are higher than they should be? Several tests can be useful here.
C-Reactive Protein is a simple blood test that measures levels of C-reactive protein(CRP), a powerful inflammatory marker. The production of C-reactive protein is an essential part of the inflammatory process, and the measurement of this substance reflects the level of inflammatory activity deep within the body. We believe measuring inflammation with a high sensitivity C-Reactive Protein test is one of the most important steps you can take if you have had cancer. If the results are elevated, above 1.0, then it's time to take action to bring levels down. You might want to keep running that test on a three-month interval. If you don't have cancer but have risk factors, you may want to run the test on an annual basis as part of your regular physical exam.
An important contributor to blood clotting, fibrinogen levels rise in reaction to inflammation. For this reason, if inflammation levels are high, it may be wise to check fibrinogen levels as well. The Life Extension Foundation (www.lef.org) advises that optimal fibrinogen levels should range between 215 and 300 milligrams per deciliter (mg/dL) of blood. Bringing levels into normal range has the added benefit of keeping the blood flowing more smoothly, making it more difficult for metastases to develop.
Food sensitivity panel
If your inflammatory markers remain stubbornly high, consider the possibility of food allergies or sensitivities. Common allergens like casein (from dairy) and gluten (from wheat) are known to spark an inflammatory cascade in sensitive individuals. So, another measure to cool inflammation on a cellular level is to pay attention to your foods that may cause headaches, digestive upset or skin eruptions like acne or eczema. Keep in mind that as we age, foods that may not have bothered us before, like dairy and wheat, may trigger chronic low-grade inflammation. Even seemingly innocuous foods, when eaten repeatedly, can cause a food sensitivity to develop. If you think you might have a food sensitivity, we recommend going on an elimination diet for two weeks to see how you feel.
Thermography as an assessment of Breast Inflammation
Breast thermography provides one of the best visual clues we have to the presence of inflammation in breast tissue. Since inflammation often accompanies precancerous changes to the breast, and since it always produces heat, measuring the temperature of the breasts can provide us with vital information.
Temperature measurement as a means of assessing health has its roots in ancient Greece, when Hippocrates covered his patients' bodies with thin slurry of mud and observed temperature differences around diseased organs. With the advent of military infrared heat detection technology, specialized cameras were developed that could produce a detailed picture showing how the heat is distributed over the body. This picture could then be analyzed with computer software to determine regions of abnormal heat, suggesting injury or disease.
When it comes to breast health, here's how it works, according to Dr. Robert Kane, a Board Certified Clinical Thermologist who maintains a busy thermal imaging interpretation practice in Redwood City, CA. "Heat is produced in the breast by normal tissue metabolism and is carried to the surface by the blood supply," says Kane. "Our bodies naturally release heat to the environment in the form of infrared energy to maintain a normal body temperature of 98.6 deg F. This energy can be captured and visualized by a special infrared detector inside the thermography camera." (Kane. 2011)
Normal breast tissue will produce a characteristic temperature pattern when visualized with thermography. On the other hand, fast-growing, abnormal breast tissue (cancer or precancerous) will always produce heat through its faster metabolism. This heat travels through the circulatory system to the surface of the skin where it can be detected using a thermographic camera (Yahara, et al. 2003)
What's more, precancerous or cancerous tissue can dilate existing blood vessels and create its own blood supply via a process called neoangiogenesis or new blood vessel formation. (Anbar, M. 1994) Both of these occurrences can translate into a temperature changes at the surface of the breast and provide a means of detection with the thermographic camera.
Thermography findings are less dependent on the size of the abnormal tissue and are more directly related with the degree of inflammation, growth rate of the tissue and metabolic activity. (Gautherie. 1982) The more inflamed, aggressive and metabolically active the tissue, the more likely it will be seen on a thermogram by a trained interpreter. Thus, a very small highly inflamed area is more likely to produce findings on a thermogram while a larger less active region may potentially be missed.
Since highly inflamed precancerous growth represents the highest likelihood that cancer will develop, we consider thermography to be an excellent addition to standard breast imaging (mammography, MRI or ultrasound) to help identify smaller lesions that are growing quickly and may appear between annual examinations. Perhaps even more importantly, it provides invaluable feedback if you're attempting to lower your risk of recurrence through lifestyle and nutrition, allowing you to see if your actions are effective.
Numerous studies have documented the presence of physiological changes consistent with breast cancer, prior to detection with mammography. Gautherie, for example, observed that 38% of the patients with 'false positive' thermograms developed cancer within four years. (Gautherie, et al. 1982) Stark further noted that 23% of the patients with 'false positive' thermograms developed cancer within 10 years. (Stark. 1985) According to Gutherie, a high-risk thermogram is considered 10x more significant than a first order family history of breast cancer. (Gautherie, et al. 1982) (Almaric, et al. 1981) Hobbins further states that a sustained high-risk thermogram carries with it a 22x greater likelihood of developing breast cancer than a low risk examination. (Hobbins. 1977)
In short, if thermography can be used to identify physiological signs that precede cancer and signal future risk, we can also use it to track the success of our anti-inflammatory strategies, adding a great deal to your piece of mind between conventional screenings.
Steps to take to lower inflammation
Exactly how does diet influence inflammation? Let us count the ways.
Change your oil
The type of fat that you eat is, quite possibly, the most important dietary factor affecting the level of inflammation in your body. That's because fats are precursors to both pro-inflammatory and anti-inflammatory chemicals. Note that we are not saying that all fat is bad for you. Fat is as necessary to good health as protein, carbohydrates and nutrients. What we are saying is that there is a world of difference between healthy fats and unhealthy fats. Here's why.
Unhealthy fats are objectionable
Fats stimulate a variety of chain reactions in your body. Picture a run of dominoes. When you push on the first one in line, the rest topple. Inserting unstable or unhealthy fats into the system will eventually cause the system to collapse in the same way.
When you consider that every cell in your body is surrounded by a lipid (fat) layer that is just the right constituency to let all necessary nutrients in while allowing all the critical waste material to pass out, you can see that altering the composition of that cell membrane is risky business. Yet, that's exactly what unhealthy fats do. They will "gunk up" your cell membranes and, what's more, they initiate a domino effect that ends with a host of pro-inflammatory ecosinoids (molecules composed of fatty acids) running rampant.
Trans fats are among the worst offenders (Mozaffarian, et al. 2004) Although they exist nowhere in nature, they line supermarket shelves in large quantities in the form of snack foods, fried foods, baked goods, and vegetable shortening. Trans fats also create a wealth of free radicals that damage healthy cells and trigger inflammation. Hundreds of studies like the one above have now confirmed the insidious link between trans fats and inflammation.
Mind your EFAs
EFAs, or essential fatty acids, are fats that the body can't live without, and must get from food sources. The EFAs we need to survive are known as the Omega 6 fatty acids and the Omega 3 fatty acids. Simply put, omega-6 fatty acids start the fire of inflammation and omega-3 fatty acids put it out. Since we need to both start and stop inflammation, we need both types of fat. That's why nature provided us with plenty of both. For example, most grains, nuts and seeds contain large amounts of Omega 6 fats. These Omega 6 fats work their way up the food chain in several ways. For example, cattle that used to feed on grass created meat and dairy products that were high in Omega 3 fats. These days, cows are fed primarily corn and soy in feedlots, which produces a much higher level of Omega 6 in the meat and dairy products that result. Because of this and the ubiquitous use of corn, soy, canola and other omega 6 rich vegetable oils in processed food and on supermarket shelves, our fat consumption habits have changed dramatically in the last century. Whereas our ancestors are believed to have eaten about twice as much Omega 6 fat as Omega 3 fat, many experts believe Americans now eat 10 to 20 times more Omega 6 fats than Omega 3 fats. The result is an unbalanced inflammation response.
An ideal balance of Omega 6 to Omega 3 fats would go a long way in keeping inflammation under control. Omega 3 fats act as natural COXS-2 inhibitors, much like Advil or Celebrex, but without the potential side effects. Your job is to get your Omega 6 fats from whole grains, seeds and nuts, and avoid the refined, bleached and processed oils you find on supermarket shelves (corn, soy, canola, safflower, etc.). Incorporate more Omega 3 fats into your diet by adding wild salmon, halibut, sardines and occasional tuna; and by eating lots of flax seeds, chia seeds and walnuts, all high in Omega 3 fats as well. Salmon is a particularly rich source of eicosapentaenoic acids and docosahexaenoic acids, the two potent omega-3 fatty acids that douse inflammation. Try to include some oily fish such as wild Alaskan salmon in your diet twice a week. If your c-reactive protein levels are not where they should be, you might consider adding a fish oil supplement to your regimen, which have proven themselves to be a valuable asset in keeping cancer at bay.
Remember to keep your oils tightly covered in a colored glass bottle Exposure to air, light and heat oxidizes oils, rendering them rancid, and rancid oils are potent provocateurs of inflammation.
What about olive oil?
Olive oil belongs to a family of fatty acids called the Omega 9s, which, not classified as "essential" yet nevertheless provides great anti-inflammatory value. For this and all of its other wonderful health benefits, we highly recommend the regular consumption of olive oil. Like other precious oils, be sure to store in a dark container.
Lower your glycemic load
Refined sugar and other foods with high glycemic values elevate insulin levels and put the immune system on high alert. Recall that the glycemic load measures the impact of a food on blood sugar levels; bursts of blood sugar trigger the release of insulin. High insulin levels stimulate the release of pro-inflammatory compounds; what's more, they activate additional enzymes that raise levels of arachidonic acid, another inflammatory compound, in the blood. A 2005 study from the Harvard School of Public Health found that women who ate high-fiber diets rich in fruits, vegetables, and whole grains had lower levels of C-reactive protein than women whose diets consisted of primarily refined grains. (Esmaillzadeh, et al. 2006)
Yet another reason to avoid sugar and refined flour products.
Keep your antioxidant levels high
As we discussed earlier in the chapter, free radical damage is an unavoidable side effect of being alive. But, you mount a strong defense against the oxidative stress and inflammation caused by free radicals by keeping your antioxidant intake high. By eating a diet rich in vegetables and fruits, you'll boost your antioxidant capacity in these ways:
- You'll support the main antioxidant enzymes that the body produces internally – glutathione, superoxide dismutase and catalase .
- You'll get plenty of antioxidant vitamins, minerals, and phytonutrients (Vitamin A, C, E, selenium, carotenoids, bioflavonoids) from the colorful fruits and vegetables, whole grains, nuts and seeds you eat.
Resveratrol is a powerful antioxidant worth trying in supplement form. Produced in plants in response to environmental stressors, this compound has been found in dozens of plant species, but appears most prominently in the skins of red grapes. Scientists have noted that it exerts a variety of anti-cancer effects, among them, the inhibition of nfKappaB, one of the harmful inflammatory compounds mentioned earlier. (Gao, et al. 2001) Bill Sardi, resveratrol expert and author of You Don't Have to Be Afraid of Cancer Anymore, recommends 30-50 mg. as a preventative dose, and 300 mg. or higher for those with an active tumor.
Don't forget these key nutrients
Magnesium is good for so many things and inflammation is no exception. The National Health and Nutrition Examination Survey (NHANES) 1999-2000, a U.S. national survey, found American adults who consumed less than the RDA of magnesium (approximately 320 mg./day) were 1.48 to 1.75 times more likely to have elevated CRP levels compared to those who consumed at least the RDA. This same survey found that 68% of the population surveyed consumed less than the RDA of magnesium. Remember your food sources of magnesium: whole grains, especially buckwheat and oats; nuts, beans, artichokes and most green leafy vegetables.
Vitamin D can not only enhance immunity and cell differentiation, it can also help activate the p53 tumor suppressor gene. But it turns out it can do a lot more than that. As published in the Archives of Internal Medicine, a University of Missouri nutritional sciences researcher found that vitamin D deficiency is also associated with inflammation.
Increased concentrations of serum TNF-αlpha, another significant inflammatory marker, were found in women who had insufficient vitamin D levels. This was the first time the scientific community learned of an inverse relationship between vitamin D levels and concentrations of TNF-αlpha in healthy women. (Petersen and Heffernan. 2008) This may explain the vitamin's role in the prevention and treatment of other inflammatory diseases, including heart disease, multiple sclerosis and rheumatoid arthritis.
*Note: it is critical to include Vitamin K2 as part of a Vitamin D protocol to avoid the complications of hypercalcemia and potential arterial calcification.
Monitor food allergies and sensitivities
Any time you eat a food that your body has an allergy or sensitivity to, your body views the food as a foreign invader and mounts an immune/inflammatory response. There are many labs that will do this for you (see Appendix) but you can also test yourself without too much fuss. Here's how to do it.
An Elimination Diet, first developed by Dr. William Crook in 1987, removes the most highly allergenic foods from the diet in an effort to allow your body to recover from any symptoms that may be caused by sensitivity to these foods. Sensitivity issues can include bloating, diarrhea, constipation, itching, mental fogginess, and cravings for that particular food. We encourage people to use a food log to journal during this period to ensure the notation of any symptoms, their cessation and their possible return. The foods typically removed from the diet are dairy, eggs, gluten (wheat, barley, rye, and spelt), soy, corn, red meat, peanuts, nuts, citrus, and shellfish. These foods are avoided for approximately 21 days. At the end of the 21 day period foods are added back in, one at a time, every 3-5 days while noting the potential return of any symptoms.
Rotation Diets allow people to help moderate how often they eat certain foods, with the aim of avoiding potential allergic or sensitivity responses by eating certain foods too often. By rotating how often you eat foods to which you may have a potential low-level sensitivity, you can reduce your exposure and your symptoms. This diet also allows you to clearly identify which foods you are reacting to, since you are only eating them every 4-5 days. In our experience, following a rotation diet can allow the immune system to repair itself through the avoidance of cumulative exposure.
Spice up your life
A wholesome dose of curry may do more than add spice to your life. Widely used in Eastern cuisine to flavor most foods and used in Ayurvedic medicine for centuries, scientists now recognize its powerful antioxidant and anti-inflammatory active ingredient: curcumin. Research in the last 50 years has repeatedly shown curcumin's ability to suppress the COX-2 and LOX enzymes and to inhibit metastasis, or tumor spread. (Aggarwal, et al. 2006) (Bachmeier, et al. 2008)
In a mouse study of breast cancer, 68% of the mice that received curcumin showed no or very few lung metastases,. The animals that did not receive curcumin were not so fortunate. 83% showed extensive metastases. (Bachmeier, et al. 2007)
Curcumin has shown such power as an anti-inflammatory, anti-metastatic, and apoptosis-inducing agent, that it's been the subject of several clinical trials at M.D. Anderson Cancer Center. Not bad for a kitchen spice!
Boswellia is a premier natural LOX inhibitor. The most active component of this powerful herb, known as frankincense to our ancestors, is acetyl-11-keto-beta-boswellia acid (AKBA). (Flavin. 2007) Ginger is another powerful LOX inhibitor, and additionally useful in lowering levels of the inflammatory substance PGE2 .
While space restricts a detailed explanation of all the herbs and spices that have anti-inflammatory effects, suffice it to say, there are a great many. Use the chart below, compiled, in part, by Dr. Keith Block to help you remember what to pick in the grocery store, the farmer's market, or ideally, in your own garden. (Block. 2009)
Anti-inflammatory herbs and spices
While activity throughout a person's lifetime is important, activity at any age can help lower breast cancer risk. Exercise does more than help you maintain a healthy weight: A 2002 study from the Emory School of Medicine found that people ages 40 and older who exercised four to 21 times a month experienced decreased or lower levels of C-reactive protein. (Abramson and Vaccarino. 2002)
Bringing down elevated fibrinogen
Omega 3 oils found in flax and chia seeds, walnuts, salmon, anchovy and halibut, will not only help to lower elevated cr-p levels, they exert a mildly thinning effect on the blood, bringing down elevated fibrinogen levels. Since "thicker" blood helps cancer to proliferate, some former cancer patients use nattokinase, an enzyme extracted from a fermented Asian soy dish called natto, to keep fibrinogen levels at a moderate level. Garlic, Vitamin C and the enzyme bromelain are also helpful in this regard.
TO DO LIST
1. Monitor your levels of inflammation by asking your doctor to check your blood levels of c-reactive protein and fibrinogen. Thermography is also available in some communities to examine inflammation patterns in the breasts.
2. Change your oil to keep inflammation levels under control. Choose monounsaturated oils such as olive oil (extra virgin) for cold or low heat use and coconut oil for higher heat use. Avoid Omega 6 "supermarket" oils, especially the "big four" genetically modified ones: corn, soy, canola and cottonseed. Eat wild fatty fish, flax or chia seeds, and/or take a fish oil supplement regularly.
3. Keep glucose and insulin levels under control, as they are both highly inflammatory.
4. Be alert for food allergies and sensitivities as a cause of systemic inflammation, and test for these, if suspicious.
5. Use culinary herbs and spices liberally in your cooking, as virtually all herbs and spices have anti-inflammatory effects, particularly turmeric, ginger and boswellia.
6. Get sufficient rest and exercise in moderation.
7. Have a nice day!
And, as my co-author Ed Bauman likes to say, "having a nice day" is probably the best thing you can do for your health!
- Helayne Waldman, Ed.D., M.S., is a holistic nutrition practitioner (www.turning-the-tables.com) and co-author of the book The Whole Food Guide for Breast Cancer Survivors (www.wholefoodguideforbreastcancer.com), from which this article is based. Find her on Facebook at Whole Food Guide for Breast Cancer and on Twitter, @helaynewaldman.