Jenna: What happens if it kind of tumbles over into something that's not acute? It kind of hangs around and falls below the radar. You don't get those classic signs of inflammation, you don't have the redness and swelling and heat, you haven't got a fever 24/7.
Dr Rupy: Yeah.
Jenna: But there's something smouldering below the surface. And that this is what we call chronic inflammation.
Dr Rupy: Welcome to the Doctor's Kitchen podcast with me, Dr Rupy, where we're going to be discussing the most important topics and concepts in the medicinal qualities of food and lifestyle. We're going to be blending together the science with delicious recipes inspired by cuisines from across the world, as well as the topics that you're most fascinated by, and me as well. Today we've got Dr Jenna Macciochi back on the podcast to talk about eating for inflammation. Now, you might wonder why I've got an immunologist coming in to talk about inflammation. That will become very clear once we get into the conversation. She holds a PhD from the faculty of inflammation, repair and development at Imperial College. She's a lecturer in immunology at the University of Sussex, who uses rigorous scientific research with concepts both old and new, holistic and conventional to cultivate long-term health and well-being. She's brilliant. If you haven't listened to the first podcast that she was on, eating for immunity, I highly, highly recommend you do. We go into a little bit about her background, where she's from, and how she's come to this understanding of food, lifestyle, blended with the science and why it's so important for the health and well-being of our population. As well as being editor at the scientific journal Annals of Advanced Biomedical Sciences, she's a mother of twins and trained as a fitness instructor. In today's podcast, we talk about inflammation as a concept, why it's becoming so popular in the medical literature and why it's so relevant to a host of different medical specialities. Also, don't forget my new book, Eat to Beat Illness is going to be out on the 21st of March. You can pre-order on Amazon and all good bookstores as well. Listen right to the end where I summarise our talk and give you some actionable tips, as well as the show notes and where you can find Dr Jenna. Let's crack on with the podcast. Jenna.
Jenna: Hi.
Dr Rupy: Welcome back.
Jenna: Thanks for having me.
Dr Rupy: No worries. I mean, the response from our last podcast, and if you listeners haven't listened to the last podcast, definitely, definitely listen to it. It's in two parts on eating for immunity. Honestly, I had one of the biggest responses. The number of people it's helped, the number of people it's clarified information for, the way they see immune immunity and how it works, how it literally works. They were very, very thankful for it. So.
Jenna: Oh, super. Yeah, it was really nice, really nice to get so much good feedback. And even some students saying I've been studying this as part of my degree and it was quite helpful to untangle, you know, some of the things. So, yeah, super.
Dr Rupy: That's what we're here for. If it's helping university students, then yeah, we're doing a good thing.
Jenna: It's a complicated field, so yeah, it's probably a good kind of overview. So yeah, if anyone's not listened to that one, it might be a good idea to give a bit of context for today.
Dr Rupy: Definitely, yeah, because we go into a bit of your background, how you grew up, what you were eating, you know, your family ties and all that kind of stuff. But yeah, so today we're going to go into inflammation as a concept and why it's becoming so popular in the medical literature. It's almost become this unifying theory that ties lots of different lifestyle-related illnesses, like hypertension, diabetes, obesity. But I think a lot of people are going to be confused as to why I've got an immunologist talking about inflammation. So, why don't we clarify what we mean and why you're here in the hot seat again.
Jenna: Back in the hot seat. Yes, so immunology is the study of every bit of the immune system and inflammation is a component of the immune system. So I guess that's why it has a good fit with me. But the nice thing about the immune system is it kind of infiltrates into every aspect of our health and disease. But inflammation itself is it's not a single phenomenon, it's a whole kind of complex response that actually keeps us well and protects us from infections. So it's essential. It's really essential that we can mount an inflammatory response and defend ourselves. You know, I mentioned last time we live in this real microbial world. All the time these germs are trying to infect us, we're trying to evade them. There's this dynamic relationship that's always going on and inflammation is one of our weapons against them.
Dr Rupy: You know the analogy I like to use, just from the get-go, is that what we used to think about microbes about 30 years ago, as all being bad for us, is almost like how we view inflammation today. Like any sort of inflammation is bad for us, but as you just explained, you know, there are huge benefits to having inflammation and why it's a very important process when it comes to cell signalling, when it comes to host defence and a whole bunch of other facets of our health.
Jenna: Yeah, exactly. It's really important and we don't want to totally extinguish it. And obviously with it being a bit of a buzzword at the moment, it would sound like we have, you know, there's anti-inflammatory diets, anti-inflammatory lifestyles. We want to get rid of inflammation, but we don't actually. The point to make, I think, is that it's it's acute by design. So a lot of things in in biology are, you know, the form follows the function. So it's a short-term assault. It's only ever meant to be short-term. This short-term adaptive response.
Dr Rupy: Yes.
Jenna: Yeah, exactly. To get to, like a means to an end really. And it's supposed to cause damage because it's trying to remove something that might cause even greater damage to us. So it's trying to get rid of an infection. If anyone's ever been sick, or you know, if you cut your finger and you get, you know, some some bacteria in there, you're going to have a lot of damage to your own tissue. And that's mostly your immune system mounting a response, an inflammatory response to get rid of those pathogens, those germs that have got into your tissue. So that, you know, leads me to, I think one of the most important points is that there is some collateral damage that comes with mounting an inflammatory response. It's trying to get rid of something that's going to cause you damage, and as a collateral, you incur a little bit of damage yourself because it's a toxic process. I think it's also important to mention that it's it's it's a complete cycle. So people think about inflammation being switched on, but it actually has a beginning, a middle and an end. And that end is actually quite important. That's the resolution, that it's an active process that brings it all to a close and it's involved in healing and repair and getting us back to like a normal state.
Dr Rupy: That's a really good point because I think a lot of people think of inflammation in binary terms, like you either have inflammation or you do not have inflammation. And actually, it's kind of like a story.
Jenna: Yeah, exactly. It's a cyclical process. And each one of those parts to the inflammatory process triggers the next part. And so it's a kind of very delicately orchestrated process that one will lead to the next, will lead to the next.
Dr Rupy: The design of it, and when you're following, I remember doing this at medical school and absolutely hating immunology. I found it so just, it just wasn't intuitive to me. It wasn't until I actually had some clinical experience on the wards, witnessing what inflammation does and how it's related to a whole bunch of different things, and then going back to the science, I was like, ah, I get it. Now, like this is what's happening at this particular point in this patient's journey.
Jenna: Yeah, it's really interesting, isn't it? Because I've struggled with when I'm teaching immunology to the at the very beginning to bring it to life because they really just have to learn all these complicated pathways. In fact, this last week I was teaching them complement, the complement system. And they were just, I was like, you're all going to hate me. It's just the beginning of term, it gets better, honestly. But you know, when it comes to life, that's when the beauty and the sort of art of immunology, I think, comes alive.
Dr Rupy: I can imagine you being a very popular lecturer because you do bring it to life. I can imagine you being like, okay, this is complement, but this is why it's related to a particular condition or yeah.
Jenna: Well, one of the things I actually, just totally going on a tangent, the complement system is this really complicated cascade in the immune system. It's part of the inflammatory response really, but it also weeds out the the connections in our brain that we don't need anymore. So when we're growing as a child and we're making all these different neuronal connections, the complement system is part of the way that we remove the ones we don't need and strengthen the ones we do need. So it's really cool. And it's been implicated in Alzheimer's disease.
Dr Rupy: I haven't come across that. You must send me that.
Jenna: Yeah, check it out. It's so it's really cool. So like it it becomes this dull pathway that I'm teaching students, but then you're like, it's so relevant, you know, and this is why you need to know this. I think half the time they're just humouring me because I'm jumping about the the lecture theatre. In fact, the one yesterday when I was teaching, they they'd been sitting in the same lecture theatre for three hours and I had them at the the last hour and I immediately got them to all start running around the room and squatting and jumping because I was like, you have to move, you've been sitting in this room and it's hot and you're all going to be half asleep. And they had to do something crazy.
Dr Rupy: Oh, that's great. No, it's really good. I mean, we know that there's mitochondrial biogenesis when you when you start moving, you start doing that sort of hit training and stuff. So that will feed their brains literally.
Jenna: Yeah, so, yeah, they think I'm mad, but whatever it takes. Yeah, so yeah, inflammation is our warfare. It's part of what the immune system is using to to get rid of things that might hurt us, causes us a little bit of damage on the sideline, but it's okay because it's short-term. It's only ever meant to be acute. Part of the reason it damages us is because it uses a lot of oxidative stress to to cause damage to the thing that's that's infecting you or trying to cause you damage. And I think that's where we think about antioxidants and sort of put them on a pedestal because they're extinguishing this oxidative damage by the inflammatory response. But that's probably something we can go on to later when we talk about nutrition. But yeah, I think it's very simplistic to talk about inflammation as a single thing. There's like lots of different components. It's a really complex and its relationship to our health is also quite complex. So we need it, it's protecting us.
Dr Rupy: I think a lot of people struggle with the concept of oxidative stress as well, like you know, oxidative species being produced and causing this collateral damage essentially. It's not as, I mean, we're probably going to go into this with nutrition, but it's not as simple as you eat antioxidants and therefore, you know, you get rid of the oxidative stress. There's a whole bunch of other chemicals involved in this process.
Jenna: Exactly, and the field's kind of evolving. But yeah, so it's the short-term, I think, is really important to clarify. And also the sort of cardinal features, I'm sure you got taught this in medical school, the cardinal features of inflammation, the heat, the redness, the swelling, the pain, losing function. So we all can recognise if we've been sick and we get a fever, or you like the example when you cut your finger and it's swelling and red and these are the features we see.
Dr Rupy: I'm probably testing myself now, but there's the Latin terminology, right? Calor, dolor. We'll put it in the show notes, in the show notes.
Jenna: So I often use the analogy of the immune system as like an army. It's standing by, it's ready to mount this assault, this inflammatory assault when something's going wrong. But whenever you have an army, there's there's inbuilt peacekeepers inside the army. And this is the bit that I'm personally a bit more fascinated by because most of the time we don't have some kind of inflammatory response. Most of the time the peacekeepers are working hard to keep inflammation switched off. And you mentioned earlier that it's not a binary thing and I think this is really true of everything to do with the immune system. It's it's like an analogue, you know, a rheostat that you're adjusting, which is quite useful in a way when we start to talk about lifestyle medicine because although we might not be able to switch it off with a diet, we can maybe like, you know, just tweak it, adjust it and there are, you know, ways that it could act as an adjunct to more pharmaceutical level therapies for.
Dr Rupy: Exactly. That's why like, you know, it comes to a halt when I'm talking to patients about an anti-inflammatory diet, for example, because it gives the impression that this anti-inflammatory diet is going to switch off something very, very rapidly. Whereas like you said, it's like an analogue, it's like gently easing something. It's an adjunct to all the other therapies that we have. And I'm personally fascinating, fascinated by what keeps us in that environmental balance of like, you know, what dynamic changes are going on, what are the peacekeepers doing when nothing is actually, like right now I'm not suffering any inflammation. What is keeping me in that state?
Jenna: Yes, exactly. I think we often in in biology use the term homeostasis. So like keeping the stasis, everything staying the same. And I actually think it's a bit misleading because it's we're not we're never really in stasis. We're always kind of tipping one way or another.
Dr Rupy: That's a really good point.
Jenna: You know, it's just about trying to find that that kind of biting point and you know, it's normal to sort of sway from one to the other with whatever's going on in your life.
Dr Rupy: That's a really good point because I love the concept of homeostasis and I see this almost in everything in what we do, like the changing of the seasons or when we're, you know, just walking flat or just not having any thoughts or we're euthymic, where we don't, we're not happy, we're not sad, we're just in that kind of intermediate. And and keeping that sort of balance, that equilibrium, I think is fascinating. And now you said that, yeah, like it's more of a dynamic state rather than a static state.
Jenna: It's impossible to to be static really. It's it's, you know, but we can sort of go within a within a buffer that's that's keeping us healthy, but sometimes it might slide off too far one way or the other.
Dr Rupy: There's a huge psychological element to all this, I think, and there's a bit of philosophy involved as well.
Jenna: I've been thinking a lot about the the mind-body connection recently because especially talking about inflammation, it's a reaction to something that's going on in our environment. And how do we know what's going on in the environment? Like our cells can sense things at a molecular level, but they also are receiving information from what we're seeing and hearing and and sensing with our other senses. And that's relaying information to the immune system as well of what it should do. So it's gathering all this full picture and then deciding how it should respond.
Dr Rupy: Absolutely. And it only makes sense that it would marry like that, but we don't really tend to talk about them as as the sort of whole organism of mind and body working together.
Jenna: Yeah.
Dr Rupy: I think from a conventional medicine point of view, we look at that, we have a myopic focus, I think, on the internal stresses at the molecular level and trying to dampen them down with therapeutics. But like you said, we essentially have multitudes of different stimuli, whether it be psychological stimuli, whether it be molecular stimuli, whether it be gut, which is why you have this gut brain, the brain axis. And so many different things that could be resulting in an inflammatory picture.
Jenna: I mean, all of our immune cells have receptors for different neuropeptides and neurotransmitters. So they're responding to what's happening in our brain and that's responding to what we're seeing around us. And so it's kind of only makes sense, but it's only now, I think, that people are starting to integrate that idea.
Dr Rupy: Yeah, that whole idea of a neuropeptide, so just for the listeners, that's essentially a receptor for a production of of like a amino acids produced by the brain.
Jenna: Like it could be something like adrenaline or there's different stress hormones.
Dr Rupy: So the very fact that these cells have receptors on them essentially tells us that there's an evolutionary purpose as to why we are receptive to things produced by the brain.
Jenna: Exactly. Yeah, it makes sense. That's the kind of, we've kind of talked about inflammation and the acute sense. And I kind of feel like that's that's not the end of the story. That's not why we're here talking about inflammation. That's not why it's everywhere in the in the media and anti-inflammatory diets and everything. Because it, as I said, by design, it's supposed to be acute, but what happens if it kind of tumbles over into something that's not acute? It kind of hangs around and falls below the radar. You don't get those classic signs of inflammation. You don't have the redness and swelling and heat. You haven't got a fever 24/7. But there's something smouldering below the surface. And that this is what we call chronic inflammation. And this is a little bit more of what we're probably going to expand on today.
Dr Rupy: When it comes to related to lifestyle related diseases, not something that you can see in the form of a swollen joint or you know, something that's quite obvious to look at. It's just the the sort of like indolent symptoms.
Jenna: More subtle. And I think that you know, there's got to be a stimulus for inflammation. There's got to be a trigger. And in the early days of immunology, people thought that was seeing an infection because the molecules on top of germs and viruses, bacteria look very different to what we look like. So our body could say, oh, that's a germ, I'm going to mount an inflammatory response. But now we realise that the immune system, again, it's not that binary. It doesn't just recognise germs, but it it recognises danger inside our bodies. We use that term danger to really encompass anything that's sort of moving us off track. So, chronic inflammation can be triggered by stress. So that's a danger system. We've just talked about, you know, different activity in the brain and what that's transmitting through the body. It can even be triggered by exercise. So exercise is very stressful, can be very stressful on the body.
Dr Rupy: Yeah, a lot of people don't realise that, that we have like a dynamic relationship with the stresses from exercise. There is a dose response where too much is detrimental, too little is detrimental, there's a sweet spot.
Jenna: Exactly, finding the sweet spot. Smoking's a classic one. Gut permeability, so leaky gut. Again, it's one of those kind of terms that sounds a bit woo-woo, but I spent, you know, eight years in Switzerland working on leaky gut and it's definitely not woo-woo, but it just needs to be portrayed the right way.
Dr Rupy: And eating tons of chocolate as well. Yeah.
Jenna: And cheese. And yeah, and I think one thing that's probably quite topical today is obesity. I don't really like the word obesity, it's a bit of a problematic word, but how the concept of of how what we're eating can trigger inflammation. So it could be these kind of danger signals to our body.
Dr Rupy: It's quite a tough one that one, isn't it? Because obesity as a term has fallen out of favour. There's got to be a more sort of objective way of describing what we mean by obesity. I suppose like, you know, to use a medical term, adipose excess or the particular adipose tissue that you find around your visceral organs, which is the most metabolically active and therefore inflammation producing. Which isn't necessarily picked up by your BMI measurements or even by looking at a person.
Jenna: Yeah, exactly. Yeah, so these things are a little bit more insidious. You know, they're not like when you get hit with a a really bad infection and you get this huge inflammation and it goes away within a week. These are slow, smouldering away, kind of insidious triggers that sort of creep. And one thing that I've been personally interested in and professionally now in a lot of the research I'm doing is what is the cumulative effect of having low-grade chronic inflammation? No one's ever really done those studies. So that's something I'm kind of trying to pursue, like, you know, normally we have a lot of checks and balances in to switch off inflammation when triggers go away. And that cyclical process I mentioned earlier where there's like a complete resolution. But these get worn out. It's like anything, you know, if you never get your car serviced, you know, you're going to wear them out. And
Dr Rupy: I like that analogy. There's a lot of analogies going on today, but I do like that analogy.
Jenna: This morning, actually, I sent my bike off to get like a bit of an MOT because I've worn out the the brake pads from like going down the hills in Brighton. And it was like not braking anymore. But you know, like these feedback loops, they get worn out. They get desensitised. So when inflammation spills over into something chronic and it's going on long-term, but it's it's much more subtle. It's a much more lower level, like almost below detection.
Dr Rupy: Yeah, and that's why when I try and explain it, and actually this is something that I talk about in the chapter on inflammation in the book Eat to Beat Illness, they can be very vague and they're very hard to actually ascertain. And because of how vague they are, you know, it's not something that someone could measure. It's not necessarily something you can pick out on a clinical history, even though that's exceptionally important. It's just something that you just need to be a little bit aware of. Is it, you know, that excess fatigue or is it like a cognitive dysfunction or is it, you know, the inability to lose some weight or, you know, and there's so many triggers for it. Like we were saying, smoking and and diet and also.
Jenna: And it's probably like multiple triggers involved. It's probably very rare that it's just because you're a smoker or just because you have a poor diet. It's probably the whole composite of lifestyle.
Dr Rupy: And this is why I think inflammation is almost like the poster boy for lifestyle medicine because it's very holistic in terms of the way we have to think about it and the way we have to treat it. And by essentially plugging all these different holes and putting your sleep, you know, making sure that you're getting exposure to nature, you know, your psychological stimuli, being part of a functioning, cohesive community and, you know, a sense of purpose and all these different things. That's how we actually ameliorate inflammation imbalance.
Jenna: Exactly. Like thinking of this rheostat that, you know, you might not be able to change certain stresses in your life or things that you're doing that are maybe causing this low-level inflammation, but you can maybe tweak it a little bit to take the edge off with certain diet and lifestyle changes. So yeah, this chronic inflammation is really kind of shot up in the last few years in the literature as as a proxy to to disease, non-communicable diseases, so non-infectious diseases that we didn't previously think about in the context of inflammation. So things like atherosclerosis, you know, cholesterol was really in the limelight for a long time and no one was really saying that inflammation is is upstream of atherosclerosis. And now they are. Now it's like, oh, wait a minute. But how, it's not a simple plumbing problem. There is a lot more to it than that.
Dr Rupy: Exactly.
Jenna: And I think the questions we don't know is how long has the inflammation been going on before it causes you a problem? And what's the cumulative effect of, you know, is it several years, several decades? I think when you think of the immune system and the inflammatory arm, what we see is as we age, that becomes much easier to trigger. So it's, I don't know, I guess from an evolutionary perspective, we kind of want to get past the time when we pass on our genes and then evolution doesn't really care what happens. I know that sounds really like cutthroat.
Dr Rupy: That's a very good point. It's we're not designed to go into like a hundred, like past a hundred really because there isn't an evolutionary purpose for having a hundred-year-old as we're not fertile.
Jenna: Yeah. So I mean, evolution doesn't really care about anything else but passing on the genes, you could argue. And I think, I think this term inflammaging, have you heard that? That's been coined in the few years, the last few years. And it was a pathologist who coined it because they found that whenever they were looking at biopsies from, like a liver biopsy from a child versus a liver biopsy from an 80-year-old, they would already be able to tell by looking at the sample under the microscope which one was from the elderly person and which one was from the child, even if they were blinded to it, because there's a subtle low level of inflammation, this infiltration of these immune cells that are inflammatory that you can see in the tissue of an older person. So it just creeps up as we get older.
Dr Rupy: Yeah. And there's a whole bunch of reasons for that, right? Because I was, we were just talking before the show about how my last modules for my nutritional medicine masters was talking about immunosenescence. So that's the whole concept of your immune system becoming less functioning as we age. And how that as a peacekeeper role is less likely to do its job and therefore inflammation essentially creeps up. And also if you combine that with the knowledge that our microbiota serves less of a function and it becomes less diverse as we age as well from a multitude of different reasons. There's that and there's also if you combine that with sarcopenia, which is essentially, you know, you're losing your protein, your muscle stores and it's being replaced with fat and you know, that's going to be inflammation. So there's a whole host of reasons why we see inflammaging.
Jenna: Yeah, exactly. I think one thing, maybe we even mentioned it last time, when you said about sarcopenia, so this muscle wasting, the muscles when you work them, the skeletal muscles produce these particular cytokines that stop the thymus from shrinking. And the thymus is is producing the T cells, which are like the master controllers of the immune system and the T regulatory cells, the peacekeepers as well. So getting your exercise in even when you're, you know, well into your old age is really important to preserve that part of the immune system and it keeps the inflammation in check. So, you know, I think it's natural as you age, things go wrong, you know, like with my my bike analogy, it's like 12 years old and, you know, I ride it to death. And in Brighton as well, there's a lot of salt in the air there.
Dr Rupy: Exactly.
Jenna: And it sits outside because I don't have anywhere in to keep it covered. You know, so I haven't had it serviced in quite a long time. So there's like a wear and tear and this is the same with our body.
Dr Rupy: And you're going downhill all the time as well.
Jenna: Yeah. Normally rushing for work. When we think of like this inflammaging and you start to think about, well, what do people die of in old age? You know, and it's like heart disease and cancer or falling from, you know, muscle wasting and, you know, metabolic dysfunction. These are all things that happen to us naturally as we age, but if we have heightened levels of this sort of low-grade chronic inflammation, it seems to just bring them much earlier in life. So, you know, as we age, we would all get these things anyway, probably. But it seems to happen much sooner.
Dr Rupy: Yeah. This chronic low-level of inflammation has been termed or there's a term meta-inflammation in the literature.
Jenna: Yeah.
Dr Rupy: I quite like that because it kind of sort of like it's it's not inflammation from one thing, it's just like inflammation from multiple sources that we've just described.
Jenna: Yeah, yeah. And they tend to kind of make the link to when there's a problem with the metabolism as well. So not in an infectious component because classically we're, you know, we're all trained to think of inflammation to protect us from infections. But then they call it like sterile inflammation. There's no infection present, but it's being triggered by something that's going on below the surface.
Dr Rupy: Yeah, there isn't a an argument about Alzheimer's having an inflammatory component. And one of those is from indolent viruses or bacteria that are causing low level of inflammation. So things like EBV, some viruses from the herpes family.
Jenna: Yeah, exactly, because they sit dormant in our in our nerves and can live there for a really long time.
Dr Rupy: Yeah, yeah. So I'm I'm I'm watching that research like just seeing what's coming out of it. I'm just I'm so exciting.
Jenna: It's very exciting to watch because it's almost like someone has to pin all these different things together because you can't just go down one route. You can't just think, okay, well there's indolent viruses or microbes that are causing inflammation. Thus, if we just give them, you know, antivirals or antibiotics, we're going to cure the Alzheimer's, we're going to reverse it or prevent it. There's so many other things going on.
Dr Rupy: Yes.
Jenna: Exactly. Yeah. And I think that's an important message for generally what people who are listening that people are always seeking for a magic bullet. And I think it's going to take a multi-pronged approach when you have these more complex scenarios with things that are, you know, smouldering away low-grade inflammation and that being upstream to a whole host of kind of age-related disorders. I think, you know, it's not ever going to be one thing because these are very complex biological processes under the surface. So we have to kind of come from different angles.
Dr Rupy: There's a whole bunch of things that I can think of being a general practitioner and, you know, people coming through the door and they have these sort of vague symptoms and, you know, there's so many different diagnoses you can pin on someone with these sorts of diagnoses, whether it's low-grade depression, whether there's an underlying infection, whether it's something gut-related. You know, there's so many different presentations of low-grade inflammation. It's very hard to actually pin down. And we're taught in a conventional, so I'm going on a tangent now, we're taught in a conventional model of healthcare to come up with a diagnosis. What's the diagnosis? And treat on the basis of said diagnosis with usually one agent, if not two or something like that. So, yeah, that that whole model has to change.
Jenna: Yeah, it has to change because our healthcare problems have changed. I think that grew from, you know, pre-antibiotic era when, you know, people got serious infections and needed to be treated. And you didn't see so many of these conditions that we're talking about, the sort of more metabolic dysregulation and, you know, things associated with obesity and type two diabetes, like they were not so such big problems. So the, yeah, the healthcare system has to change, but it's a big ship to turn, you know.
Dr Rupy: It is huge, yeah. And I kind of despair when there's a lot of like people out there who are becoming very distrusting of doctors for that reason because we go in there and we've been taught to essentially like treat one thing. Whereas actually, you know, there's going to have to be a whole paradigm shift amongst medical practitioners, which I think a lot of people, particularly the younger generations, are very willing to entertain. But also, we actually have to teach patients to become the experts of their own health and take a lot more responsibility than has previously been put on them before where, you know, people from older generations, I believe, were taught, if you've got the sniffles, go see the doctor. If you have anything like, you know, that's like that might be a symptom, go see the doctor. And it's that kind of relationship that probably has to evolve.
Jenna: Yeah, yeah, definitely. And I think a lot of the work you're doing, like people on the same page as you trying to get the word out. My mini Instagram following. I think, yeah, we could we could mention the inflammasome. Yeah, it's a cool word.
Dr Rupy: I really like the word inflammasome. It's brilliant.
Jenna: I think you posted about that graphical abstract on your Instagram. And I I think that was one of my first Instagram posts. It's like a little picture of like. Oh, nice. I'm going to look back at that. Yeah, like a year ago or something. Yeah. So the inflammasome, apart from being a cool name, is it's a thing that the immune system uses to sense what's going on in its environment. And it's particularly sensitive to things that change in our body to do with diet and, you know, danger, things like having oxidised cholesterol, stuff that we know is bad. And it switches on inflammation. It has, it turns on this transcription factor, NF-kappa B, is kind of like the daddy of all the bad guys.
Dr Rupy: The daddy of, I like that. Yeah.
Jenna: NF-kappa B comes up literally all the time. Whenever I'm reading like papers and stuff, NF-kappa B, right?
Dr Rupy: It's basically the switch that turns on all these different inflammatory cascades. There you go. Go off and run with it. So you kind of want to not only turn it on when it's necessary. And it can also sense stress with our mitochondria, so the powerhouse of the cell that's providing the energy. And it can it can sense when we have an an excess of calories. So this is why I find obesity quite a tricky term because I think it's not just obesity, but just eating too much and eating some of the wrong things as well and not having the, you know, the antioxidants and everything that we do need to some degree in the diet.
Jenna: Yeah, that's why you can get some people who have just as much of an inflammatory component, but not have the obesity for a number of different reasons, whether it be microbiome or whether it be genetic even. But if you're eating an excess of the wrong type of calories that are nutrient poor, energy dense, you're going to have this inflammation component.
Dr Rupy: And you're not countering it with other things in the diet that are going to be really beneficial.
Jenna: Yeah.
Dr Rupy: Yeah, absolutely.
Jenna: So the gut is a source of inflammation. When we eat a meal, the gut naturally kind of opens up. And when you said about stress and the microbiome, actually when we're stressed, the gut opens up even more. And the reason for that is because we need that food quickly. We've got to run, we've got to do something crazy because it's fighting or flight mode. So the gut is opening up even more. And unfortunately, that's that's good because, you know, it's helping our digestion, it's helping us absorb nutrients that we need. But at the same time, there's some collateral, that give or take. And some of the microbiome, the bugs that live in your gut, they slip through into the bloodstream and then they become a problem because they are bacteria after all. They're meant to live in the gut, they're not meant to live in the bloodstream. Bits of them are floating around in the body and they contain patterns that switch on the inflammatory response because inflammation is fine-tuned to recognise when there's there's germs around. And so you get this inflammation in the blood and you can measure it. And you can measure it in, you know, me or you, healthy people with no underlying health conditions. If you have a large meal, you will see what they call postprandial endotoxemia. So that's when bits of bacteria are in your blood after eating and you get a postprandial inflammatory response and you can see inflammatory markers in the blood and they should kind of go away again after maybe four hours and then back to normal. And then it starts again and the process, you know, you have your next meal and there are certain things that make it worse. So we know.
Dr Rupy: A lot of people get really freaked out by the fact that I talk about how inflammation, like digestion by virtue of what's going on in your gut is a pro-inflammatory process. It isn't to say you shouldn't be eating. It's just another way in which we need to re-establish what we mean by inflammation, re-establish the importance of inflammation as well. It's very important.
Jenna: And we've started to piece together what triggers leaky gut more than others. So having a very heavy calorie dense meal kind of tends to open up your gut and make it more leaky. Saturated fat, we know that this just causes the tight junctions to open. So, and we also know that fructose, so really high doses of fructose causes the tight junctions to open up the gut, make it leaky. So you've got more of this bacteria seeping through. But we also know that there's a few things that seal it up again and make it really tight. So fibre is the key one. Fibre is having a moment. I'm so happy about this.
Dr Rupy: Whenever people ask me about immune boosting foods, I'm like, fibre.
Jenna: Just fibre. Yeah, because it's it's it's the fuel for our microbiome. And it's not the fibre per se, but it's what the microbiome does with it. They break it down, they make a whole multitude of things that we call postbiotics. And the key ones are probably the short-chain fatty acids. So they've probably been most well researched. And one of the things that they do is they seal the gut back up again, so they make it tight.
Dr Rupy: One thing I came across recently was how, you know how you can get lots of cereals with added fibre and stuff. It's quite short-sighted because the type of fibre that they're adding is usually just one type, whereas actually when you have fibre in the form of an apple, for example, you're getting multiple different types of fibre of which there are hundreds. And those different types of fibres can actually blunt the sugar response because they form almost like a lattice inside your intestines. So it reduces the absorption of the sugar and it actually improves that sort of the intestinal hyperpermeability that you get, the tight junction opening. So again, another reason to eat whole forms of fibre.
Jenna: Yeah, exactly. And it it kind of reduces the the caloric availability of the food, like what you mentioned with the apple. And I think, you know, if you're eating fibre poor food, it's much easier for your body to absorb all those calories and you can overeat and we know that overconsumption of food, as we mentioned earlier, can feed into this whole chronic inflammatory thing.
Dr Rupy: Yeah, yeah, absolutely.
Jenna: So the gut is a source of inflammation.
Dr Rupy: As expected, we have really gone down the rabbit hole.
Jenna: We can start to, I don't know, maybe we could talk about the microbiome. You mentioned the microbiome and stress. Well, I spent quite a lot of time working on leaky gut, which when we're talking about inflammation, strangely enough, the gut is actually a source of inflammation. I don't want people to be alarmed. But, you know, we throw all sorts of stuff down our our gut tract. We're swallowing stuff in the air, all sorts of things. And we have this really delicate lining in the gut. And I've looked at many biopsies of guts over the years and it's really hard to find a healthy gut that doesn't have some kind of inflammation there because it's doing a lot all the time and inflammation is trying to protect that barrier, make sure it's all okay.
Dr Rupy: I suppose a healthy gut would have natural inflammation, right? It shows that A, the immune system is working and B, we are tolerating an environment that is essentially hostile.
Jenna: Exactly. Yeah. And I think everything that we know about or think about diet and disease all has the microbiome as its interface. So I always think, you know, your diet is only as good as your microbiome. If you're eating, you know, the most fantastic diet in the world, but you've had a bad history with, you know, poor gut health for whatever reason, lots of rounds of antibiotics and all sorts of things, then, you know, if that hasn't recovered properly, then you're not really going to be getting the best out of your food.
Dr Rupy: This is a nice segue into our rapid fire round of questions actually. Because we've been chatting for ages.
Jenna: Oh, yeah.
Dr Rupy: Intermittent fasting and inflammation. This is a super interesting topic because from what I've seen of fasting and and just as a caveat, you know, fasting is only appropriate for those who have a comfortable relationship with food, who, you know, are doing it conscientiously. But the evidence base looking at what happens when you fast to inflammation, to upregulating autophagy, removing these senescent cells that are just hanging around causing inflammation. And the microbiome effect, I think it's it's brilliant. It's really, really interesting.
Jenna: It's profound, isn't it? And I, yeah, I really hope that we get some concrete picture coming out of the literature soon because already people are talking about their own different protocols that you should do and people are dipping their toe in it. And I kind of think, why does it have to be all or nothing? So we know that a lot of people self-report fasting or even like a low-carb diet really helps with their symptoms if they have some inflammatory disease. And it's probably just because they're withholding fuel. So the inflammatory thing can't keep running anymore. So you're like say fasting functions on many levels. It does a lot of things, but it's, you know, reducing the energy intake. We know that energy surplus can stoke the inflammatory fire. And it's also mildly stressful, like you say, it kills off the old cells. It's kind of concept of like the hormetic effect I find fascinating as well, right? Where a little bit of bad is usually good because it encourages your body to essentially have a resilient effect. You know, it's kind of encouraging the mechanisms that need to survive.
Dr Rupy: Exactly.
Jenna: Encouraging you to be able to utilise your fat stores and not just, you know, keep stoking the inflammatory fire. And that, yeah, I think it's, you know, have you ever heard of that kind of old phrase, feed a cold, starve a fever?
Dr Rupy: Feed a cold, starve a fever. Yeah, yeah, I've heard of that. Yeah.
Jenna: Well, you know, it's like an old wives' tale, but there is actually some truth in it because when you have a fever, so the saying goes, starve a fever, you know, that's that's a huge inflammation on the body because you've got a high fever and temperature, you're very, very sick. And they did a lot of work into this like several years ago to see if it was actually true. So what this huge immunologist in in the US, and it's actually a way of stopping so much damage in the body. Because by having a fever, you don't want to eat, you're taking away the fuel source and it's the inflammation is still going because it's trying to reduce the infection, but it can't go overboard and actually physically damage your body. So that's why they do think there's some truth in that. So perhaps in the term, in the frame of chronic inflammation, perhaps there could be something in it too, like withholding food. It kind of pulls the immune system back. But we just don't have a sound protocol that we know works. And I think experimenting at home can be quite dangerous because ultimately, inflammation is protecting us. So if you withdraw too much, then you get a lot of problems. And if you have a long-term low carbohydrate diet, you can see that and it's it can start eating the mucus in your gut, you know, your own bugs because there's no fuel source, they need the carbohydrates. So I think it doesn't need to be all or nothing, but it'd be really good to have some clinical protocols for different diseases.
Dr Rupy: I totally see that. And you know, even people in the research looking at fasting protocols are still waiting on the long-term research to figure out what sort of different protocols are relevant for different people. What a protocol looks like. Is that, you know, a water fast for two or three days or is it just a shorter term fast like 16/8 or whatever. I always recommend people just have a rough eating window of anywhere between 10 and 12 hours. So in reality, that is having your breakfast at 8:00 in the morning and then finishing your dinner by like 7:00 or 8:00 p.m.
Jenna: Yeah, I think this is like a sensible framework. It's something that you could sort of implement into your life. And going back to the leaky gut thing, it's it's reducing the time that you're eating. So you're having less time where you have this postprandial endotoxemia.
Dr Rupy: Yeah, yeah. Postprandial endotoxemia. It gets me every time. Yeah. The leaky gut. The leaky gut. Yeah. I know. I think I think it's very important for people to be a lot more medically sound in terms of their understanding of these terms because leaky gut, you know, if you type in leaky gut into Google, you'll just get everything. If you type in leaky gut into PubMed, you probably won't get much. So using that kind of terminology is is great.
Jenna: Cool.
Dr Rupy: Okay, let's do the rapid question round.
Jenna: Let's do it.
Dr Rupy: Right. These are, I mean, we've actually covered quite a few of these already. Sugar and inflammation is the first one. So, yeah, I think we've we've definitely talked about that about how, you know, it can stoke the inflammatory fire. Sugar is very important as a fuel for mechanisms. So it's not about removing all sugar, it's about making sure that you're choosing quality sugars in your diet and limiting the ones from refined sources. Anti-inflammatory diets, are they worth it?
Jenna: Well, the studies, I think, that have shown they work in people with chronic diseases. So you only get a kind of shift in the disease when it's already somebody who's quite sick from what we know from the clinical studies. I think that it's sensible for most of us to have an anti-inflammatory diet using something like the Med diet as a guideline because it's it's not really excluding things. It's bringing in the fibre, we've talked about how important that is. Omega-3s, which is part of the switch to resolving inflammation. You need to start pooling omega-3s instead of omega-6 to have this pro-resolution response, which is rich in the Med diet. And it has all the colourful phytonutrients from, you know, fresh produce and all of that. So, yeah, I'd say it's worth it. I think if you have a chronic disease, then definitely it's could be an adjunct that would maybe make your day more bearable, make your disease symptoms more manageable.
Dr Rupy: Do you see a future for anti-inflammatory diets and inflammatory disorders like rheumatoid arthritis, osteoarthritis, psoriatic arthritis?
Jenna: Yes, and I think the data is coming through. There's some conflicts and some things that don't add up. But again, I think a lot of that pertains to when you do human intervention studies, you know, we're biologically very different, but also our microbiomes are really different. They even recently, I think it was Tim Spector's group did a nice study on omega-3s and showing that if you didn't have certain gut bacteria, you the omega-3, you couldn't utilise it in a certain way. So when you see these huge trials with saying, oh, omega-3s don't actually do anything in the body, you know, you have to put it in the context of how the research was done and remember that, you know, the microbiome is like our fingerprint. We're all so unique and that's the interface between diet and disease and health.
Dr Rupy: Absolutely. And you know, I think there's so much nuance to our inter-intervariability. Like I know my genomics is going to be distinct from a lot of other people's, yours for example. And my microbiome is going to be different as well. So how I respond to a dietary intervention, a pharmaceutical, a supplement like omega-3 is going to be vastly different. And unfortunately, we just don't have the power to do this in studies.
Jenna: It would be amazing if we could. And I know they've done those studies with people wearing continuous glucose monitors and they showed like really cool data like two different people, one, both eating a bowl of rice. And one, you know, the insulin's gone through the roof and the other person that's like flatlined. And so we how we respond on a metabolic level to different foods varies. So when people are shouting about how low carb is amazing or, you know, high carb is amazing, it might not work for another person because, you know, where your starting point is, what your microbiome's like, what your metabolism's like, it's going to be so different.
Dr Rupy: I've actually used some of those CGMs, continuous glucose monitors, for some patients that I suspect.
Jenna: I thought you were going to say for yourself.
Dr Rupy: No, no, but I probably will actually because they're, I mean, they're relatively cheap. They actually ran out, the producers of it ran out because I think so many people were self-experimenting. But I've actually done it with some patients who are pre-diabetic or I suspect are pre-diabetic from some of their blood results. And honestly, what I would consider something that's like relatively good for someone might not actually be, or wasn't actually relevant for, wasn't suitable for them. So oats, for example, a lot of people find oats, I love oats, you know, I recommend it and still. But for this particular person, it wasn't suitable at all. And you could just see the spike as soon as they had it and like, you know, one, two hours afterwards, you just like see this maintained glucose response. And when we mixed it around a bit and we actually still had some oats actually, but then we added different nuts and seeds to it, we changed the milk around, we we took the banana, you know, took away the banana and actually added some other low sugar fruits, massive difference.
Jenna: That's fascinating. I think that's really, that to me that just screams like the meal is the sum of its parts, you know, we don't want to look at nutrients in isolation anymore because it's not actually not very useful. And like dietary patterns are much more helpful, like what you were saying about sort of a time window of eating, like patterns of eating.
Dr Rupy: Yeah, and there's so many different things that will that will predict what that person's glucose response is going to be, right? Like whether they were stressed at the time of eating or whether they'd actually had a full night's sleep the night before or what they actually ate the night before because that's going to have affected, you know, what's in their gut and everything. So, yeah. And you know what, we've covered a lot of the other questions about weight loss, inflammation, intermittent fasting. Vampire blood. Have you heard about this? Young blood being, yeah, transfused, yeah, and how that's having an anti-aging effect.
Jenna: Hmm, I don't know. I'd have to look into the mechanisms actually.
Dr Rupy: Yeah, I think there was something that came out in Cell. I'll have to forward it to you about the potential mechanisms of this. But people are already seeing the monetary value and they're spinning out companies where they're charging exorbitant amounts for young blood to be transfused and stuff. And I don't think they have the data to prove that it works, but certainly in mice they do. So when you transfuse an old aging mice, mouse, with young blood from a young healthy mice, the health effects are actually.
Jenna: And how long does it last?
Dr Rupy: That's another good question because I think in mice it will be very different. So I know I think they were looking at the end point of lifespan and it significantly improved their lifespan.
Jenna: It's really hard to do that in humans, isn't it?
Dr Rupy: Really hard to do that. Yeah.
Jenna: But I'm I'm a bit sceptical. I'd rather have a a microbiome from somebody who's young and fit.
Dr Rupy: That's super interesting.
Jenna: Because there's actually a lot of studies doing swaps with old and young microbiomes. And as you mentioned earlier, like the microbiome changes as we age. And I was wondering if that could be upstream of the blood because lots of metabolites from the microbiome is going into the blood and that's like our own personalized pharmacy of stuff. And maybe that's something that's in the young blood.
Dr Rupy: Maybe you can get two for one.
Jenna: Exactly. Yeah, I know we should set up our own clinic doing blood and poop transfusions from young victims. Anyone wants to volunteer.
Dr Rupy: There you have it, another podcast with the wonderful Dr Jenna. You can catch her on socials at Dr J Mac on Twitter and Dr_Jenna_Macciochi, all these are going to be on the show notes, on Instagram as well. And check out her website which has got some fantastic articles looking at everything from the perspective of immune health. It's drjennamacciochi.com. Again, that's going to be on the show notes. If I was to summarise our conversation in a dietary way of life, it would be the Mediterranean diet. As we alluded to in our conversation, it is known to be anti-inflammatory. And now you have an understanding of what we mean by anti-inflammation. Inflammation isn't something that we need to radically remove. It is something that should be welcomed, but in the context of our modern lifestyles, we are usually out of balance. If you have a copy of my book, make sure you check out the page where I actually have a diagram looking at what is pro and what is anti-inflammatory in our modern world. Vegetables are key. Citrus have flavanones, grapes have anthocyanins, apples have procyanidins. There are all lots of different types of chemicals that are anti-inflammatory. They work on multitude of different pathways including NF-kappa B and a whole bunch of other confusing long chemical names that you don't need to know about. The easiest way to have an anti-inflammatory diet is getting a variety of different coloured fruits and vegetables. Having quality fats, things from nuts, seeds, and fish oils if you do eat fish is absolutely key to getting that nice balance of fats that have anti-inflammatory properties. Fibre, fibre, fibre. As I've always talked about before, fibre is super important from the perspective of inflammation as well as lots of different perspectives when we're looking at different medical specialities. So having fibre from legumes, nuts again, different sorts of bran and whole grains is a great way of improving your microbiota that have natural anti-inflammatory ability. Looking at your stress levels. Now, we talked about this with Dr Rangan on the previous podcast. Make sure you check that out again on the podcast page on the website. But looking at resetting your stress levels, particularly in the morning, I think is a very interesting thing to do from the perspective of inflammation. Whether it's using an alarm clock instead of your phone, whether it's a mantra in the morning, whether it's just simple deep breathing that you do for three minutes before you start your day, I do recommend a stress-relieving, therefore anti-inflammatory activity in the morning to help start your day on the right note. Exposing yourself to nature, walking through pine trees, there's lots of different Japanese research looking at forest bathing, getting yourself, if it is at the weekends or even if you're walking through parks during the week, it's a fantastic way of again, resetting your stress levels, but also exposing yourself to those natural anti-inflammatory chemicals that you find in Greenland. You can find all this information in my new book, The Doctor's Kitchen: Eat to Beat Illness. It's out to pre-order now on Amazon and check out the show notes where I've summarised our conversation and you have all the show notes there as well. Make sure you subscribe to the podcast, give it a five-star review and share it with your friends. It really does help get the message out there. And see you next time.
