#301 – AMA #59: Inflammation: its impact on aging and disease risk, and how to identify, prevent, and reduce it

In this “Ask Me Anything” (AMA) episode, Peter delves into the often misunderstood concept of inflammation. He first defines inflammation and differentiates between acute inflammation and chronic inflammation, the latter of which is linked to aging and a plethora of age-related diseases. Peter breaks down the intricate relationship between chronic inflammation, obesity, and metabolic health, and highlights the signs that might suggest someone may be suffering from chronic inflammation. From there, the conversation centers on actionable advice and practical steps one can take to manage and minimize chronic inflammation. He explores how diet plays a crucial role, including the potential benefits of elimination diets, and he examines the impact of lifestyle factors such as exercise, sleep, and stress management. Additionally, he discusses the relevance of food inflammatory tests and concludes by examining the potential benefits and drawbacks of drugs and supplements in managing inflammation.

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We discuss:

• Defining inflammation (and the cultural impact of Napoleon Dynamite) [1:45];
• Acute vs chronic inflammation [8:00];
• The connection between chronic inflammation, aging, and age-related diseases [11:00];
• The impact of inflammation on metabolic health [18:30];
• Understanding and diagnosing chronic inflammation: blood tests and other approaches, and challenges with measurement [20:00];
• Factors that contribute to low level chronic inflammation [28:00];
• Minimizing inflammation through diet [29:45];
• The important role of fiber for gut health and inflammation [33:45];
• A closer look at the impact of trans fats and saturated fats on overall health [34:45];
• Why Peter prefers dietary fiber from food sources over supplements [38:30];
• Debunking “superfoods”: emphasizing proven methods over marketing claims for reducing inflammation [39:00];
• Is there any value in over-the-counter food inflammatory tests? [42:30];
• Food elimination diets: how they work, symptoms and markers to watch, challenges and limitations [45:15];
• Identifying dietary triggers for gut-related symptoms through low-FODMAP diets like the “carnivore diet” [51:15];
• Dairy: the complex role of dairy on inflammation and individual responses [55:00];
• Wheat: the complexities and conflicting evidence around wheat’s inflammatory effects [57:45];
• How exercise influences inflammation [1:02:00];
• How sleep quality and duration impacts inflammation [1:07:00];
• The potential impact of chronic psychological stressors on inflammation [1:13:00];
• The impact of oral health on inflammation and overall well-being [1:15:00];
• The role of medications in managing chronic inflammation [1:18:15];
• Supplements: evaluating the efficacy of various anti-inflammatory supplements [1:22:15];
• Parting thoughts and takeaways [1:27:00]; and
• More.

Defining inflammation (and the cultural impact of Napoleon Dynamite) [1:45]

• Peter is in a good mood as he is “reflecting on 20 years almost since Napoleon Dynamite came out and just reflecting on what an important contribution that was to mankind”
• Peter says (in a tongue-in-cheek manner) that “Tina the llama is on a low FODMAP diet” and that “those chickens were large, probably due to some of the inflammatory changes in the talons.”

Figure 1. Tina the llama getting fed by Napoleon Dynamite. Source: napoleondynamite.fandom.com

Defining inflammation

• Inflammation is just such a buzzword that gets thrown around so much with no meaning
  • it is important that people have a very clear understanding of what we’re talking about and what is often misconstrued in popular circles
• Inflammation is a biological response of the immune system to defend against some sort of stimulus, usually harmful, but not always, and to eliminate the cause of injury.
• Inflammation is not always bad—oftentimes, inflammation is essential—it is the fundamental issue for tissue repair for the clearance of infectious pathogens, and obviously, the immune response plays a very important role in that
• You have the acute inflammatory response (i.e., things get red, things get swollen, things get sore, etc.)
  • That, of course, results from both the infection and also the response of the body
• But there’s something that is more chronic in its nature, and truthfully that’s really where we’re going to spend our time today
• If acute inflammation goes unresolved then becomes chronic, then we should talk about that, but again, what we’re here to really talk about today is the maladaptive side of inflammation

Acute vs chronic inflammation [8:00]

Acute inflammation

• Anybody who’s had a mosquito bite or who’s cut themself knows what acute inflammation is
• If you think about a mosquito bite, it’s going to be warm, it’s going to be painful, it’s going to be swollen. You might even have loss of function.
• This is a very important aspect of healing the insult or inflammation

Chronic inflammation

• What we’re here to talk about is chronic inflammation which can be something that lasts from months into years
• You don’t tend to have the same physical signs or symptoms, the redness, the swelling, the pain, the obvious things
• Oftentimes, we think of this as low-grade inflammation
• It’s often asymptomatic, although there are some examples of maybe where it’s not, for instance, when it’s diet-induced
• Chronic inflammation is important because of the role that this plays in disease and ultimately in life

What do we know about why acute inflammation is a “good” thing but then becomes a bad thing in the context of chronic inflammation after the acute trigger is gone? 

• Acute inflammation is essential to heal the body, so we have an innate immune system that is able to react immediately with soluble antibodies to harmful infectious pathogens
  • example, if you have injury, tissue is damaged, so damaged tissue needs to be cleared
  • All of these things have to happen really, really quickly and very efficiently, and anything that inhibits that process, by the way, is often quite deleterious.
• People who have shortcomings in their immune system, especially for that type of acute stuff, are going to have significant problems
  • There are, of course, certain disease states that do that. 
• It’s when inflammation becomes more chronic, even after the acute problem has resolved or sometimes when it lingers, that it becomes maladaptive and the balance tips against the organism or the host, which is us
• A prolonged immune activation can lead to a persistent release of inflammatory cytokines or mediators
  • That can also damage healthy tissue. 

“Inflammation really becomes chronic once it’s persisted for several months, but it can persist for much longer than that.” —Peter Attia

{end of show notes preview}