Anti-Inflammatory Supplements

Beyond C-Reactive Protein

By Bonnie Jenkins, Advanced Natural Medicine Bulletin

If you’re a regular reader, you already know about C-reactive protein – the biological marker of chronic inflammation. Alternative health reporters have been warning people about this risk factor for heart disease for years. Now it looks like mainstream medicine has finally “discovered” the threat that elevated CRP levels can pose.

In fact, this inflammation marker has attained near celebrity status, making the pages of Newsweek and even snagging a spot on the Today Show. I’m actually quite happy that conventional medicine has finally seen the light. After all, studies suggest that inflammation may be the underlying causes of many, if not most, chronic diseases – so it’s critical that doctors and their patients understand its importance.

The only problem is, CRP is so . . . well, yesterday.

Inflammatory remarks

In case you’re a newbie, here’s a quick recap of how chronic inflammation works:

Inflammation is the simply body's response to injury. When you catch a cold or sprain your ankle, your immune system kicks in, triggering a chain of events called the “inflammatory cascade.” The familiar signs of normal inflammation — fever, pain, swelling — are the first signals that your immune system is being called into action. When the problem has resolved itself, your immune system stops sending these inflammatory signals. It’s all part of the healing process and it usually works extremely well.

Problems occur when the inflammatory response doesn’t shut down. This leads to chronic low-level inflammation throughout your body that can cause many seemingly unrelated diseases, including heart disease, stroke, cancer, diabetes, osteoporosis, Alzheimer’s and autoimmune diseases like rheumatoid arthritis and psoriasis.

One way to tell how much inflammation you’ve got is by measuring CRP. CRP is a strong predictor of a first-time heart attack, even when cholesterol levels are normal. One study of 1,086 men by researchers at Harvard Medical School found that those with the highest levels of CRP were three times more likely to suffer a heart attack. Other research by the Pacific Health Research Institute in Hawaii found that men with high CRP levels are twice as likely to suffer a stroke than those with normal CRP levels.

But more recent research has some scientists wondering if CRP might be more than just a harbinger of disease. According to a new study in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, CRP may interact with white blood cells and stimulate the production of a whole slew of factors that can cause inflammation. Of more concern, researchers at the University of California , Davis found that CRP isn’t just  produced in the liver – it’s also made by the cells that line the walls of our arteries – which means that CRP may be able to trigger inflammation directly.

The new marker on the block

As important as CRP seems to be, it turns out that it isn’t the only marker of inflammation. Researchers have found another marker that may be even more critical than CRP because it can predict both heart disease and stroke with an even higher degree of accuracy. It might also be directly implicated in causing atherosclerosis.

Lipoprotein-associated phospholipase (Lp-PLA2) is an enzyme that circulates in the blood and attaches itself to LDL cholesterol particles. High levels appear to trigger a cascade of inflammatory events that can affect people who don’t have any of the classic risk factors for heart disease. In fact, a study by Baylor College found that people with normal LDL levels have twice the risk for a heart attack if they have high levels of Lp-PLA2 in their blood. And if Lp-PLA2 and CRP are both elevated, the risk of a heart attack triples.

What makes Lp-PLA2 so dangerous is that once it hitches a ride on LDL particles, it oxidizes the LDL and becomes part of atherosclerotic plaque. It also produces signals within the plaque that promotes inflammation. The effects of this process were recently shown during a population-based, follow-up study of 7,983 people over 55. Researchers found that those with the highest levels of Lp-PLA2 has a 77 percent higher risk of heart disease than the participants with the lowest levels. And participants with the highest Lp-PLA2 levels were 76 percent more likely to have a stroke compared to the subjects with the lowest levels of Lp-PLA2.

Fortunately, like CRP, Lp-PLA2 can be measured by a simple blood test known as the PLAC Test, which was recently approved by the FDA. While there is still a lot that researchers need to learn about the role Lp-PLA2 plays in heart disease, stroke and other chronic diseases, you shouldn’t wait to check your levels. While your levels can range from 120 nanograms per milliliter (ng/mL) to 376 ng/mL or more, the average woman will have levels around 174 ng/mL. Men on the other hand average 251 ng/mL. But average doesn’t necessarily mean healthy. Although there’s still a lot we don’t know about Lp-PLA2, one thing is clear – lower is definitely better.

If you do have higher than average levels, don’t expect your doctor to offer any suggestions on how to lower your Lp-PLA2. Most doctors seem to be stuck on trying to reduce the risk of heart disease and stroke by pushing statin drugs to lower cholesterol. Fortunately, there are a number of natural strategies your doctor may not know about that can help you keep the inflammatory process in balance.

One of the easiest, most effective ways to dampen inflammation is with the foods you choose to eat. While red meat, eggs, refined sugar and dairy can trigger inflammation, there are a number of anti-inflammatory foods that make tasty additions to your diet. Fresh fruits and vegetables, beans, nuts, seeds, tea, red wine and pomegranate juice are potent antioxidants that can thwart inflammation before it even begins. Try to include at least one of two of these foods with each meal or snack.

One last thing . . .

When it comes to anti-inflammatory supplements, omega-3-rich fish oil is hard to beat. Derived from fatty fish like salmon and sardines, omega-3 supplements have been recommended to ease arthritis and other inflammatory conditions. But new research shows that this healthy fat may also help to regulate low-level inflammation throughout the body.

According to a study by Harvard Medical School , omega-3 fatty acids contain a new kind of fats called resolvins which can control inflammation. Omega-3s also help to balance prostaglandins – molecules that can either reduce or encourage inflammation. To make sure you’re getting enough omega-3s to tame inflammation, take at least 3,000 mg. of a cold-pressed pure marine lipid fish oil every day. Available in capsule form, fish oil supplements are an easy way to reduce inflammation. But since fish oil can cause gassiness and the tendency to “burp fish,” it’s best to  take the supplements mid-meal to avoid any unpleasant after effects.

Adding the curry spice turmeric to your diet can also help reduce inflammation. In fact, research shows that this Indian staple rivals the anti-inflammatory potency of drugs like aspirin and ibuprofen in clinical trials – but without the side effects common to pharmaceuticals. If you’re not a big curry fan, try taking 250 to 500 mg. of supplemental tumeric three times a day.

This just in . . .

I recently came across some research that I can really sink my teeth into. Researchers at Athens Medical School in Greece have just added more credibility to earlier studies showing that chocolate is actually good for you.

During their study, 17 healthy young volunteers munched on 100 grams of dark chocolate over a three hour period. When the researchers checked their blood-vessel function, they found that eating the chocolate not only increased blood flow, it improved the elasticity of the arteries, resulting in a seven percent decrease in aortic stiffness. Based on these findings, the researchers speculate that chocolate may have a protective effect on the entire cardiovascular system.

Earlier epidemiological studies also suggest that the high flavonoid content in chocolate contributes to its heart healthy benefits. One reason is that the antioxidants in chocolate help block LDL oxidation that leads to clogged arteries.

But don’t just grab the first Hershey bar you see. These healthy benefits only come from dark chocolate – not milk chocolate. And this good news doesn't mean that you can consume an unlimited amount of chocolate. Treating yourself to 1 to 1½ ounces of chocolate a day will give you about the same antioxidant boost as a 5-ounce serving of red wine.

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References:

Curb JD, Abbott RD, Rodriguez BL, et al. “C-reactive protein and the future risk of thromboembolic stroke in healthy men.” Circulation 2003;107:2016-2020.

Devaraj S, Du Clos TW, Jialal I. “Binding and Internalization of C-Reactive Protein by Fcgamma Receptors on Human Aortic Endothelial Cells Mediates Biological Effects.” Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:1359.

Hoogeveen RC, Ballantyne CM. “PLAC test for identification of individuals at increased risk for coronary heart disease.” Expert Review of Molecular Diagnostics. 2005;5:9-14.

“Lipoprotein-associated phospholipase A2 activity is associated with risk of coronary heart disease and ischemic stroke: The Rotterdam Study.” ESC Conference 2004, abstract no. 1376.

Vlachopoulos C, Aznaouridis K, Alexopoulos N, et al. “Effect of Dark Chocolate on Arterial Function in Healthy Individuals.” American Journal of Hypertension. 2005;18:785-791.