Dr Rupy: A number of lifestyle related illnesses have uncontrolled inflammation at its core, whether that's obesity, heart disease or even dementia, inflammation appears to play a role. I've done actually a free mini series on inflammation that you can find on any one of my newsletters and I talk about the big drivers of inflammation, namely gut health, exercise, sleep and mindset. And we've done a number of episodes on inflammation on the podcast to determine what it actually is and why we'd all be better at reducing it. But in today's podcast, I want to zoom in on spices in particular. These are by no means the only spices with inflammation reducing potential, but possibly the ones that I use most commonly and are likely to have the biggest evidence base as well. If you enjoy this episode, please leave us a five star review and also check us out on YouTube where I show you the spices that I'm actually using and how I put them into recipes. We're doing a lot more stuff on recipes in the new Doctor's Kitchen studio. And another way to support our podcast is just to hit the notification bell on Apple or Spotify or whatever podcast player you're using. It really does help us out. I'm not too sure why, some wizardry in the algorithm, but whatever that mechanism is, it really would help if you do that. And you'll get a notification of the title of the podcast to see whether it influences or something that sparks your interest. The title of this podcast is Spices to Reduce Inflammation. Something about that title is the reason why you're here. And we're going to get straight into the podcast right now. I'm going to stop ranting, but remember, you can watch us on YouTube and you can find the full show notes including details and everything on our website. On to the podcast.
Dr Rupy: These are some of the anti-inflammatory spices that I have in my diet every day. Now, heart disease, stroke, cancer, diabetes, neurological diseases, all these health problems have one common thread, and that is chronic inflammation. How we live can either drive chronic inflammation or it can reduce it. And that's why scientists are looking at ways to reduce chronic inflammation from everything from the food that we eat and the lifestyles that we lead as well. Using spices and herbs is one of the easiest ways to integrate anti-inflammatory products into our day-to-day. I find them super accessible, I think they're easy to use and they add a wealth of joyful flavour to your cooking. I just want to say from the outset that inflammation is not inherently bad. Acute inflammation is something that's very normal. It allows your body to fight off invaders that cause infection. We need it to survive. But chronic inflammation, however, is very different. And that is basically where the fire that burns inside you is too hot. So to use a glib example of a campfire, you want to have a small smouldering campfire to keep you warm, to cook your food, to keep predators out. But if that campfire gets too big, it starts catching a light to your other tents, it sets the whole area alight, it burns uncontrollably, so you overcook your food. I'm using a very glib example, but that should give you an understanding of why we need balanced inflammation, not completely no inflammation or high amounts of inflammation. So, let's talk about three incredible spices that may help address the balance of inflammation in our bodies. The first one that I want to talk about is ginger. I love ginger. I think it's one of the easiest and most accessible spices that we have. There are so many different cuisines that use it. It is a wonderful, flavourful ingredient. It's the underground stem or rhizome of the ginger plant that's referred to as the Zingiber officinale. It's one of the most popular spices across the world, a common ingredient in traditional folk medicines, Indian medicines, Burma, Ecuadorian, Mexican, there are loads of different cultures that use this particular spice. Ginger's superpowers are linked to the combination of complex bioactive compounds called polyphenols. And the two standout ones are gingerols and shogaols. These account for the majority of the anti-inflammatory effects that we see, and they also contribute to the characteristic flavour as well. But chemical analyses have actually identified over 200 different compounds in ginger. So whilst we're talking about the shogaols and the gingerols today, that isn't to say that we know everything about ginger that could be leading to those anti-inflammatory effects that we see in research. Now, based on current research that we have looked at in the Doctor's Kitchen, there are three potential outcomes if you were to regularly consume ginger. Number one is reduced inflammatory markers. So in clinical trials, giving people daily doses of ginger supplements reduced their circulating levels of important markers of inflammation, CRP, tumour necrosis factor alpha and interleukin 6. These are things that we look at both in lab studies, but also in clinical practice as well. And the dosage that was used in these studies that showed the reduction in those inflammatory markers was anywhere between one and three grams per day. The second outcome that we have evidence for is reducing menstrual pain. There is mixed evidence, so not great, but mixed evidence showing that ginger can help reduce menstrual pain. A few trials gave women daily doses of either ginger powder or a non-steroidal anti-inflammatory drug, like ibuprofen, for days of their menstrual cycle, and they found that ginger reduced pain severity more effectively than placebo and just as effectively as ibuprofen, which is great because if you think about the potential downsides of using an anti-inflammatory drug regularly, those include GI disturbances, so disturbances to your digestive tract. Overuse of these kind of medications can lead to bleeding. There is a relationship between overuse of non-steroidal anti-inflammatories and heart attacks. Using it as and when and very intermittently is probably not going to be bad for you, but if there is an alternative that you want to explore that doesn't come with the potential downsides, I welcome that. The doses used in that particular study ranged from 750 milligrams to 2,000 milligrams of ginger powder per day. So that's less than a gram to about two grams of ginger powder. So that's a dehydrated, concentrated version of ginger powder. The third thing is reduced osteoarthritis pain. So this is in the collection of inflammatory conditions. There is some evidence from five trials, including one that looked at over 500 patients where ginger could reduce pain and disability in patients with osteoarthritis, a degenerative condition that is exemplified by pain on movement. And the daily dose of ginger in that particular analysis ranged from half a gram to a gram per day as well. So, now you've listened to me talk about those studies, mixed reviews, not the best studies, how should one be taking ginger if you're interested in this? Should I be taking fresh or should I be taking dried? Well, the interesting thing is that dried and fresh ginger contain different compounds in varying amounts. So the main compounds in ginger, in fresh ginger, are gingerols, whereas in dried, mainly freeze-dried powders, it's shogaols. These are dehydrated products of the gingerols in here. So I am always a big fan of diversity. It could be worth mixing it up between fresh and dried. If you're going to be taking a ginger supplement, it's most likely going to be dried. And I would always try and look for the freeze-drying process. Freeze-drying has been shown to preserve a lot of the nutrients that you find in the original product as well, better than drying it at a high temperature. And if you're looking for a dosage, dosage doses ranged from half a gram to three grams per day. So I would use the minimum effective dose. And how you would discover that is by using a small amount, monitoring your symptoms for a couple of weeks, and then increasing it as and when. Always, always check that there are no interactions with the milieu of different medications that you could be taking. It's always very, very important to make sure that you're doing this under the guidance of anyone that has been prescribed or prescribing those medications as well. And remember, a gram of the ginger extract is about a teaspoon of fresh ginger root or half a teaspoon of powdered ginger. How I try and get ginger in my diet is actually not via supplements. I don't feel the need to supplement with ginger using a powdered form unless I'm using it in cooking. Number two, you probably knew this was coming. It is the golden spice, turmeric, the relative of ginger, actually. It also comes from the underground stems, the rhizomes of the turmeric plant. There are different types of turmeric. I don't actually have any fresh turmeric in front of me if you're watching this on YouTube, but there is a white turmeric and the traditional sort of yellow turmeric that you can find. Interestingly, the white turmeric may have lower amounts of curcuminoids that give that characteristic yellow colour, but there may still be some benefits. I tend to just go for the yellow stuff because I love the flavour and the colour that it imparts as well. But very much like ginger, it contains a mix of different phytochemicals, but the beneficial effects are mostly attributed to a class of phenolic compounds known as the curcuminoids and specifically curcumin. Now, there are lots of different curcuminoids, so it can be quite complicated, but I'm just going to refer to them as curcumin and curcuminoids when I'm referring to a group of these different compounds. And like I said, they give that pronounced yellow, golden colour. Here is what we know about the effects of turmeric on health. It certainly does reduce inflammatory markers. We found a few meta-analyses examining the effects of turmeric or its key compound, curcumin, on inflammation. They found that turmeric or curcumin supplementation significantly reduced people's levels of inflammatory markers, the same ones that I mentioned for ginger, CRP, TNF alpha, and interleukin 6. They've also found that it reduced osteoarthritis pain as well. So in a 2021 review of 15 randomised control trials, they found that curcumin relieved osteoarthritis pain and stiffness as well as or better than non-steroidal anti-inflammatories. So ibuprofen, celecoxib, these are very commonly prescribed on a daily basis for people who are enduring pain every day. If you were able to safely substitute those class of drugs for a natural supplement, it can potentially reduce the likelihood of serious side effects. That was from a BMJ Open Sport and Exercise Medicine paper. I highly recommend you go and look at all the references will be down in the show notes as well. There are also lower quality evidence for its use in other inflammatory conditions, things like metabolic syndrome, for example. Just a quick note on metabolic syndrome. Metabolic syndrome refers to the cluster of different conditions that occur commonly together, things like raised blood pressure, insulin resistance, and it can increase your risk of things like heart disease, type 2 diabetes, and cerebrovascular disease, stroke. It's also exemplified by body fat, particularly fat found around the waist as well. There is some evidence that having regular turmeric, either supplemental or in the diet, can reduce the likelihood of the inflammation as a result of that metabolic syndrome wreaking havoc in the body. But there is mixed evidence and I'm nowhere trying to suggest that if you just have a bit of turmeric in your tea or in your daily cooking, it's going to massively reduce the chances of metabolic syndrome. It's just another contributing factor in a positive way that can dampen down the potential downside of having metabolic syndrome. There is a common question that I'm asked about turmeric, particularly when it comes to people who are experimenting with putting this into their into their diet by a supplement. Can it be absorbed by the body? Turmeric and curcumin have a variety of interesting biological activities, but they're challenging to study because curcumin is actually quite unstable and it has notoriously quite poor bioavailability. That's a fancy word which means not much of it reaches the bloodstream when you consume it, either in a supplemental form or if you're putting it into your cooking. But there is evidence that that might not actually matter so much. The activity of turmeric compounds in the gut could still be just as significant. There's evidence that the beneficial effects of turmeric may not be because of the curcuminoids themselves, but it might be explained by the bioactivity of the degradation products of turmeric. These are also referred to as the metabolites of turmeric by essentially the microbiota. So metabolite of turmeric will be produced by consuming the turmeric in its whole form or let's say in a supplemental form where you've got high amounts of curcumin. Your microbes will gobble that up and they will produce byproducts of that digestion. And it's these byproducts referred to as turmeric degradation products that can potentially be having that biological effect of reducing inflammation, reducing pain, etc. Another thing that you might have heard about increasing the absorption of turmeric into the bloodstream is black pepper. So having black pepper that has a chemical constituent called piperine is suggested to enhance the absorption and the bioavailability of curcumin when you're cooking with it or consuming it. It still remains to be proven whether it can actually help yield more benefits in humans, but it is interesting nonetheless. The mechanism of action may be that piperine, black pepper that you find in black pepper, irritates the gut lining slightly and that leads to more absorption into the bloodstream, but again, it's still one of those black box areas, I would say. There are also companies preparing something called liposomal curcumin. So this basically makes that curcumin chemical found in turmeric slightly more stable by essentially fixing it in a fat-soluble mixture, and that can potentially enhance its efficacy. The hypothesis, I think, is interesting, and anecdotally, speaking to practitioners, particularly in the nutritional medicine and nutritional therapy space, it seems to work, but it is lacking in an evidence base. And, you know, if I'm paying an extra sometimes 200% more for a liposomal version of a supplement, is that going to create a placebo effect whereby I feel the product works slightly better? Maybe, it's quite hard to disentangle that piece around just the expense and the amount that you're investing more in a particular supplement versus the efficacy of the supplement itself. And that yields another question, how much should you be eating to have these wonderful potential anti-inflammatory effects? Well, a teaspoon of turmeric powder, so something that I've got in front of me if you're watching on YouTube, will have anywhere between 30 and 90 milligrams of curcumin. And in research, the doses range from 40 milligrams of highly bioavailable curcumin to 1500 milligrams of curcumin. That's a whopping dose that you're very unlikely to get from cooking amounts of turmeric, unless, I mean, everyone's got a joke about how much haldi, which is the Hindi word for turmeric, in their kitchens. But, you know, even somebody who absolutely loves their haldi or turmeric, you're not going to get that amount of curcumin in your in your cooking. And in most clinical studies, an important thing to note is that they use turmeric extract with increased concentrations of curcumin, as high as 95%. And that's really high. And just to put that into context, turmeric contains around 3 to 8% curcumin. So if you're using an extract with an enhanced concentration of curcumin of 95%, that's really, really high. So the doses of curcumin to give benefits are likely to be a lot more than you can get in your cooking, but it's hard to know how much the whole spice can actually yield these beneficial effects. Anecdotally, I think, you know, especially from my family and looking at ancient practices of medicine, having turmeric with something that's quite fatty, something like a milk, also referred to as golden milk these days, we just used to call it haldi doodh, which is like a full-fat hot milk with turmeric mixed into it. You know, people swear by it. People feel that, you know, it gives them pain relief, it settles their gut, it reduces brain fog, all these like things that people have attributed to having a bit of turmeric in their diet. I think it's, you know, up for debate, how much of that is evidence-based. It's, I don't think, I don't think there's much there if I'm being really, really honest, but it cannot harm you to have a little bit of turmeric into your diet. And I use it pretty much all the time. I tend not to have it in golden milk, but I do have it in curries, in pastas. I'll add a little bit to my bolognese even. Sorry, Italians. I know that's going to be really offensive to a lot of Italians watching or listening to this, but just that earthiness in the background and the extra colour that you get, you know, it's not going to damage the flavour at all. If anything, it's going to enhance it. But you can add it to things like rice, you can add it with cinnamon to porridges. It's a great, easily accessible spice that may have benefits and that's why it's in my repertoire of anti-inflammatory spices. The third spice that I absolutely love is cinnamon. Now, it's made from the dried inner bark of an evergreen tree found in Sri Lanka with glossy leaves known as the Cinnamomum verum. And the beneficial compounds that are attributed to its anti-inflammatory effects are cinnamaldehyde, cinnamic acid. These are the main compounds that are isolated from the bark of those cinnamon trees that make it powerfully therapeutic if you ask certain people. But it also contains eugenol and linalool. These are things that you also find in clove, as well as a whole milieu, a whole mix of other polyphenols. And together, at least I think so anyway, they contribute to the health-promoting properties that could include reducing inflammation and even modulating the immune system as well. What evidence do we have for this? So, reduce inflammatory markers. There are several clinical trials giving people cinnamon powder supplements, and they found that it reduced those same markers of inflammation that we've referred to earlier, the TNF alpha, CRP. It also increases antioxidant capacity. This was summarised actually in a large analysis of 12 trials using cinnamon powder ranging anywhere between 1.5 to 4 grams per day. So how much? Well, 1.5 grams per day is less than a teaspoon. That's sufficient for potentially these health benefits that were observed in these studies. There's also a recommended maximum daily intake of two grams of specifically cassia cinnamon. And that's because of the presence of something called coumarin, which can be harmful at prolonged and high doses. It can be hepatotoxic or liver toxic. For most people, eating it as a spice does not exceed those safe levels. But if you decide to take supplements, it's something to be very aware of. And if I was to take supplements, or even in cooking actually, I always opt for something called true cinnamon, also known as Ceylon cinnamon. It might be a better option because there are far lower levels of coumarin, which is, like I said, toxic to your liver. The other thing to be aware of is if you are on blood thinners, you want to make sure that you're not using cassia as well, particularly at those levels above two grams per day because it can interfere with the efficacy of those medications as well. So the way I use cinnamon, you know, it's a festive favourite. It's incredibly versatile. It pairs beautifully in savoury meals as they do in sweet meals. So in savoury meals, I use it in stews just to add like a slight sweetness, a slight spice that creates a more sort of robust, complex flavour. You know, with fish, I mix it with a pinch of olive oil, garlic, sumac, tarragon, salt, a little bit of cinnamon. I know it sounds a bit crazy, all those different cuisines coming together. Rub it over fish fillets before baking. It gives a wonderful complex flavour. And then, you know, you can put it in oats, yogurt, adding a little sprinkle of cinnamon just to add natural sweetness. You can use it with Greek yogurt, you can put it in with coconut yogurt as well, fruits, nuts, seeds, a little bit of cinnamon. And that combination of cinnamon and chilli that you find in Chinese cooking, Szechuan, you'll find it in Chinese five spice, you'll also find it in Indian cooking with like a garam masala. I love that sort of antagonistic pairing. I think it's a great way to sort of impart a lot, just a more complex flavour that just gets your gets your taste buds firing. And also, it encourages you to eat more healthful ingredients. So things like pumpkin seeds or cashews with chilli and cinnamon, it's a great pairing, very, very simple to do as well. I also put it in my drinks like coffee, hot drinks, cacao, cinnamon, a bit of cashew milk or regular full-fat dairy milk again, lovely, natural sweetness, you're not going to be spiking your sugar levels. It's a it's a great way to to add natural sweetness as well. So to recap, spices like turmeric, ginger and cinnamon, they add so much more than just flavour to a meal. They're a treasure trove of active compounds that could reduce the expression of pro-inflammatory cytokines. It could be enhancing to a meal that is full of other anti-inflammatory ingredients as well. The likelihood is that there is a synergistic effect across all these different spices. We were looking at studies that use them in isolation, but when you're using them together, the sum of them is likely to be greater than just their parts alone. And they may play an important role in inflammation-related health problems. But I want to underline this point. Overall, these spices are fantastic and I try and use them as much as possible in cooking. But when it comes to the impact on your overall inflammatory burden, whilst these are great to include in your diet and it can potentially lead to some benefits, the major impact on inflammation levels is not going to be by sprinkling these little spices onto your food and hoping that that's going to massively reduce them. It's not. The big, big levers when it comes to reducing inflammatory burden, thereby reducing the risk of the things that I started this podcast with, type 2 diabetes, stroke, cardiovascular disease, all those inflammatory related conditions, they're those are going to be the the big four, which are exercise, ensuring that you are committing to an exercise regime that is regular, intense enough and includes aerobic activity. These are going to be massively anti-inflammatory. Your overall pattern of diet, which is going to be plant-centric. I'm not, I've got a shirt that says berries on my boys here. I'm not vegan or vegetarian, I'm an omnivore, but a more plant-centric diet that includes whole sources of plants is going to be net anti-inflammatory. We also have an inflammation index that's on the app as well, something called the DII or the dietary inflammatory index. So the matrix of foods that you consume every day is going to have the ultimate impact on reducing inflammation. Thirdly, it's going to be things like stress levels. So you can eat the most nutrient-dense diet every single day, littered with spices that have a genuine anti-inflammatory effect. If you're eating in a stressed state, if you are stressed at work, if you don't take enough time for yourself to have a mindful moment, your stress levels are going to overcompensate for the inflammation that you could be experiencing. So stress levels are super important. And then sleep. Sleep is one of the most anti-inflammatory acts that we get to do every single day. So ensuring that you are putting enough time and dedicating enough resources towards sleep, I think is going to have a much bigger impact on your overall inflammatory burden. So making sure you're getting those big, big levers to reduce inflammation. Now, spices are wonderful. I think spices can contribute a small amount to your inflammatory burden, but don't rely on them alone.
