Dr. Peter Brukner - 'Inflammation'

Thank You rod and think thank you for hanging around I really drawn the short straw haven't I I mean you know I'm the last cab off the rank and I'm following Steve Finney I mean that's it you know you can sort of look when you're scheduled for Lassiter at a conference you can look at it two ways can't you you can say well you know I clear you think I'm gonna be the person who keeps everyone there for the whole two days or most people have gotten in and you know that doesn't really matter if people don't hear him so I'm gonna go with the the first theory but anyway you're right you're all here which is great I'm gonna talk about this is a straight talk okay the last conference I gave rod rang me up and said we want someone to provide some humor and and I felt like you know I wasn't sure they'd be flattered or insulted that the only reason they wanted me there was because I could make a fool of myself but anyway this is a this is serious stuff and I want to take you through information now we could talk for hour for eight hours instead of the two hours I'm good at all for and about inflammation it's that incredibly broad broad topic but what I want to do is just sort of take you through a a quick sort of overview of the various aspects of have inflammation and leave you hungry for more so to speak okay so what to talk about is what is information what is a croak disease the role of inflammation in crow disease measuring inflammation what effects inflammation the role of diet and some final thoughts so you can see we've got a lot to get through someone to keep moving okay all right what is inflammation inflammation is a response of the immune system to injury irritation or infection caused by invading pathogens radiation exposure etc etc so it's basically a mechanism for removing damaged cells irritants or pathogens okay now we're all familiar with acute inflammation I used to see it a lot in my sports medicine career you know tendonitis bursitis and so on it's usually associated with infection or injury it results in increased blood flow and capillary permit it's a good thing it's a healing thing it's a response to injury or illness it saves our lives that's acute inflammation all right we don't wanna talk about that anymore we want to talk about chronic inflammation okay and this is where there's a prolonged inflammatory response where the original assault has not been resolved so that that acute inflammation is been resolved and their results a chronic inflammation you get a progressive change and the type of cells present and then you associated with with the generation and destruction of tissue so chronic inflammation is what what I want to focus on on now and so I like this nice quote from Maher from an Minahan from from Norwich inflammation access both a friend and foe being essential in metabolic regulation with unresolved low-grade chronic inflammation being a pathological feature for wide range of chronic conditions so it's good and bad so what are the factors that induce chronic inflammatory responses that also cause new causes chronic diseases so these factors are infections it or they may bacterial viral parasitic and so on chemical irritants and non-digestible particles information also recruits leukocytes and those lugar those white blood cells and they secrete inflammatory cytokines and angiogenic factors to their site of the tissue insult now these cytokines are required for proper wound healing and to simulate epithelial cell proliferation and however if they're uncontrolled they then lead to chronic inflammation or inflammatory disorders now there is a strong association between chronic inflammatory conditions and chronic diseases okay chronic inflammation damages the cells of various tissues for instance type 2 diabetes as an inflammatory disease been known for some time but not something that we talked about a thorough sclerosis is an inflammatory disease 1999 New England Journal of Medicine nothing new and yet it's never talked about as an inflammatory disease I like this comment 2018 so nineteen years later the concept that inflammation participates pivotally in the pathogenesis of atherosclerosis it's complications has gained considerable attention but it's not yet entered clinical practice we're pretty bloody slow only us doctors 19 years something was shown and it still hasn't entered clinical practice we never hear about a thorough arthrosclerosis B being described as a chronic inflammatory condition we just hear about cholesterol you know all the sort of stuff that we that we know and other conditions that you know not necessarily associate min fibromyalgia and chronic and chronic fatigue we heard about chronic fatigue this morning both been shown to be basically chronic inflammatory conditions mental illness we have an epidemic of mental illness depression anxiety and so on and there's a lot of thought now that mental illness is a chronic inflammatory disease fascinating book the inflamed mind came out a couple of months ago Edward bull more as a consultant psychiatrist in London very interesting book I recommend you've read it the sad thing is while he acknowledges that depression is a chronic inflammatory disease he doesn't talk about the role of diet in its management the last chapter is just about what drugs might be able to treat this chronic inflammatory disease so I intend to go and see him next time I'm in London and I'm sure I'll have a massive effect on his own I'll be right there he'll rewrite the book I'm sure but again that's that's our mentality you know we're drug oriented okay so non communicable diseases in CDs I mean we hear a lot about them these days and they're really all in epidemic proportions you know obesity diabetes hard to see stroke cancer chronic respiratory neurological the inflammatory you probably add mental illness to that now as well they are the big killers chronic diseases 63 percent of all deaths worldwide these diseases inflammation is at the heart of all those diseases so we should really be focusing on chronic inflammation it's the one key factor that seems to be consistent with all these different diseases so surely it's probably the most important factor in medicine now these are the examples of the markers of inflammation in so there are a whole bunch of market the problem with this chronic inflammation thing is there's no one blood test there's no one marker that can say oh they got chronic inflammation so the whole bunch of of markers of inflammation there's that the blood cellular markers they say the white cell count that we had that we talked about earlier sites there's the cytokines and there's a whole bunch of them ten and il-1 il-6 well eight there's a whole old group of those there's the things called adhesion molecules there are a depends and a cytokine secreted by a fat tissue we'll talk about the more about that later there's the acute phase protein CRP you've probably heard about to that c-reactive protein there's things that transcription factors and inflammatory enzymes so there's all these different markers of inflammation so it makes it incredibly complicated and when you when you look at it you think you see all these in caves and CC's and now I ELLs and you know my god you know I can't keep track of all this so there are a number of issues with these with these markers and that it's not as simple and as nice as we'd like to think firstly there are a number of nonspecific acute phase responses so they with acute inflammation they get very high and then they come down a bit in in in chronic inflammation and then even in healthy individuals there's a wide variety in the measurements made so normal values there's a huge variation so it's a writ they're very challenging as to work out how and which of these inflammatory markers and there's no consensus as to which markers are the best the best represent this chronic low-grade inflammation the two that are most commonly used are a high sensitivity CRP c-reactive protein which is a sort of a fairly nonspecific protein and the other one is interleukin 6 ILO l6 and just briefly to describe these high sensitive CRPS acute phase protein that so dean it increases several hundred fold in an acute injury or acute infection but there's chronically elevated to a much much lesser degree in in disease states that the with chronic inflammation generally speaking it's regarded that a concentration of greater than three is an indicator of low-grade inflammation some people including the good dr. Mason tell me that anything above 1.5 is probably pathological as well and who would argue with with poor so this fellow sports physician of course so you know there we are again we can't even agree on what to what the normal sort of levels are of CRP but it's very widely used as a marker of chronic inflammation interleukin 6 is is also a very complex sort of a molecule like many of the other cytokines you can see here it's involved through these processes in chronic inflammation in in various sorts so there are other markers as I said the a depor kind such as leptin and adiponectin which are derived cytokines produced by white adipose tissue and there they're also reliable markers and then they say things like the at the endothelium of hisham molecules so but let's not worry too much about about those but there's plenty of evidence for inflammation in these chronic diseases and you can see here there's a whole bunch of diseases from irritable bowel syndrome cancer cardiovascular autoimmune rheumatoid Muslim cirrhosis neurodegenerative diseases diabetes the problem is that there's different markers that seem to be right elevated in all these different conditions and there's no one it'd be very nice if they all had Heist you know HS high sensitive CRP are all in interleukin 6 unfortunately it's not that simple and so we we need to understand a lot more about the sort of role of these markers or information the diagnosis of chronic disease okay so that's sort of that's the background if you like if what I'm talking about how do I get interested in in inflammation well this goes back as rod said my previous job was to be a doctor of the Australian cricket team and I want to preface this by saying I finished with Australian cricket team twelve months ago well well before sandpaper gate and Steve I'll explain what sandpaper caters to you later so clearly they've been missing my moral guidance and and and they're you know I suspect the real problem is as they've gone off the ketogenic diet and you know it affected their brain and they thought they could cheat and get away with it anyway but even let's that's there's a paper in that I'm sure anyway getting back to the Creighton cricket team 2012 were on tour in in India my first talk with the with the test team I'd been on one previous two of the one-day team and what about players will remain nameless but he when I first met him he'd had an interesting history he'd had knee pain for two years prior to this prior to this tour and quite debilitating and got to the point we'd had to stop playing cricket and he had been around every doctor and and had you know scans and arthroscopy is and no one could work out he was in Sydney so clearly if he'd been in Melbourne would have sought him out much quicker but he was in Sydney and they couldn't work here what was what was wrong with him and eventually you know he was unable to play eventually he was given a diagnosis by a Rheumatologist of seronegative arthritis so basically it's really a lack of rheumatoid that's not rheumatoid so it's very similar to a rheumatoid arthritis very debilitating and he was started on some some pretty serious drugs he was started on methotrexate and prednisolone initially had very minimal effects and then he went on to a drug called in Braille which is an D and E tumor necrosis factor drug used in autoimmune disease that's very expensive costs about $15,000 a year thank you taxpayer and he was on that when I when I first met him so well I when I met him he was taking this in Braille in it as an injection once a fortnight so every fortnight he would inject this in Braille and this kept his knee pain under control and he told me that at about day 10 or 11 of the fortnight he would start to get an ache in his knee and he'd know that was a reminder to him oh yeah it's time for my injection of Enbrel and so he was he was coping all right he wasn't able to train fully the coaches had labeled him as lazy and because he really struggled to do the full training light but he was able to playin and so on anyway he was a little bit overweight and I just lost a whole lot of hold on weight and he sort of said you know why don't you do I'd really like to hear I'd like to try what you what you're doing so he decided was gonna try a low carb high fat diet now India is not the easiest place to do that you know because every meal there's rice and naan and all those lovely breads and things anyway but he did it to it to be fair to him he was very very good at it and he stopped all sugar processed foods he really went a very low carb for this period in India and I was you know I was very impressed three weeks after he started he came to me and said doc I forgot to take my enbrel last week that's what do you mean he said well I didn't get any knee pain so I sort of didn't get that reminder and it's now three weeks instead of the normal two weeks now what should i do should I take my end belt I said well yeah why won't you just you know wait I pretended you know that I'd expected that of course you know you're up there yeah absolutely I've never even heard of in Braille anyway that's all right just a sports medicine doctor I mean yeah anyway he said you know what do you think I saw yeah well just keep going and see how you go anyway a year later no drugs no pain increased his training and improved his performance went from being not at the Australian tuned to being one of the top 10 batsmen in the world and no drugs so by simply changing his diet he had got himself off a $15,000 a year drug habit and improved his his knee enormous Lee and I must admit that blew me away I mean I had thought well you know opportunity him than I expected it but I really had no you know no idea and so I guess that got me I already sort of got involved in low carb and that really sort of pointed out to me wow this is a bit very potent anti-inflammatory okay so what causes inflammation now there's a whole bunch of things that cause inflammation now we know about that poor died particular sugar processed foods vegetable oils visceral obesity we'll come back to those but you know that's not the only thing there's a sedentary lifestyle poor sleep stress alcohol smoking lack of Sun all of these things contribute to inflammation as I said if I had a week to go through everything would go through well who would go through all of this but I'm just going to focus on now on these things over here poor diet and visceral obesity okay so that's we're gonna start with there we've done that and solving the inflammation and diet puzzle because it's not as simple as it as it seems now Mary Ann mentioned yesterday that challenges it and the inadequacies if you like of nutritional research and this is exemplified again when we're looking at diet in inflammation there are that many papers out there every one of them seems to contradict everything else for every nutrient for every food for every diet I can show you a paper that says yes and I can show you a paper that says no so I've tried I've spent the last couple of months sort of wading through an incredible number of incredibly boring papers on on diet and inflammation and trying to sort out you know the weight from the char fear if you excuse the opponent um I think I've concentrated mainly on the level 1 evidence so the systematic reviews and meta-analyses but as we know you know you can have a systematic review but if the systematic review is of some pretty crappy papers it's a pretty crappy systematic review so that's the problem with there with a lot of the literature in this area but I'll do my best to sort of summarize some of the findings that we've had over the last day a little long so sort of things I'm going to talk about we're going to talk briefly about macronutrients different food groups individual foods diets etc alright let's let's get going let's start with carbs and sugar because as we know sugar is is everywhere so it's been pretty consistently reported that the dietary sugar intake is a stimulus of subclinical inflammation and it's CRP it causes CRP to to go up quite quite nicely and particularly it's been shown that sugar sweetened beverages raise the level of CRP so there's a that's pretty clear and I think that's you know that's probably the easiest one that we will cover in this whole session this paper showed a dietary pattern with high consumption of sugar-sweetened beverages sweets and white bread again associated with increasing CRP levels once again another review paper that oh this is a trial that showed loads of moderate soda consumption soft drink consumption so it doesn't have to be a massive amount but even quite low soft drink consumption increases CR P so what about intervention so that's all the observations so that what you'll see now is that there are two types of studies really that have been done in all this area there's the observation trials and then there's the intervention trials so the observation trials show that sugar is very clearly a effector intervention trials actually are pretty similar to the observation studies so as a diet low in sugar and starch and tends to lower CRP what about fructose versus of glucose well that's that's a nightmare there have said that much debate about about that this is a systematic review that shows no significant difference between fructose and glucose and here's another one that that shows that there is a there is a difference so I'm totally confused what about carbs in general that was sugar what about carbs in general and again it seems that there is in observational studies that there are there's plenty of evidence of increased markers of inflammation with there with carbohydrate and persistent hyperglycemia due to two KUB carb intake and and then what about the interventions well it does seem reducing carbohydrate will reduce the amount of pro-inflammatory cytokines chemokines and adhesion molecules so that's what we've got from from sugars and carbs here's another another study that I quite like from from biking and her colleagues and they looked at two things they looked at high low and high GI glycemic index low semuc load on the markets of inflammation and then high fibrin and whole grain intake and what did they they find that high glycemic carbohydrates had a high had more of an impact on inflammatory markers than then low low GI and again a number of studies showing a positive association between high GI and low-grade inflammation but interestingly here intervention trials did not support that so into intervening reducing the the glycemic index didn't seem to make a big difference which is interesting what about grains and and fibers observational studies addressing fibrin and whole grain intake almost unanimously agree that it it lower they lower inflammation so that's from your observational studies however intervention studies not so obvious a different picture it's mostly intervention studies do not report a benefit of increasing fiber so why this difference between observation studies and intervention studies and it's probably a lot to do with the quality of the researchers we know observation is not very strong their research we know there's a lot of talk out there about the evils of grain and and fiber and and and wheat and most of you would have read both these these books Wheat Belly by William Davis and and grain brain by it by David Perlmutter and certainly if you if you believe what those guys say that that grains are the biggest evil in the world so what about fiber and whole grains there's as far as fiber goes the data generally supports that dietary fiber intake is associated with reduced inflammation and here's another another study that shows both the presence of body weight related and body weight unrelated anti-inflammatory activities of fiber now what about lecture and some of you may have read this book to plant paradox by by serving Gundry it's been very popular came out last year I think and had quite an impact and he talks about lectins that's not something we sort of hear a lot about lectins but lectins are proteins found pretty much everywhere you know they're found in high qualities in grains beans certain fruits and vegetables and their their proteins that the plants make really to defend themselves against predators and lectins have been shown to create an inflammatory response in the predator that eats them so in the in the insect world that's fine but that's not so good when when we're the predator that that eats them so what what foodstuffs contain lectins well there's a whole bunch of them and and there's this there's the grains they're starches there's oats there's legumes seeds and a number of the vegetable family fruit and vegetable family there so electrons are very common in our array in our food in our food chain one of the most common of course is wheat and you know it's a very controversial thing you know that most of the world thinks that that weight and you know whole grain wheat and so on is is very good for your health obviously as low carb as we have we have a different philosophy on this but as you know modern wheat is is very different to the week that previous generations had to have eaten and as a result we can't assume that just because we've eaten wheat for hundreds of years that it's okay because it's very different from what it was now that the two parts of wheat that that we want to focus on our gluten of course would you hear a lot about and also wheat germ agglutinin which we don't hear nearly so much about so let's talk about gluten to start with it's the main structural protein of wheat contains gluten ins and and gliadin xand that's it's the that's what makes them the the flour nice and doughy and it so it's very good for for making into various various foods and the protein content of wheat gluten consists of comprises most of most of that so gliadin which is obviously one of the proteins induced an inflammatory immune response to Bo in both celiac patients who are you know gluten deficient MC and and healthy controls although the the level of inflammation was higher in the celiac patients that it was in in other patients so it seems that glute it's inflammation to most people but obviously particularly in those with celiac disease so as we probably would have that would have expected what about wheat germ agglutinin well that's its money founded in wheat germ but also in wholemeal wheat products wholemeal flour on your pasture as well as breakfast cereals so it's around quite a bit and initially in quite small doses wheat germ agglutinin stimulates pro-inflammatory chemicals so while everyone focuses on gluten it may well be that wga is just as important if not more important as a pro-inflammatory agent than gluten itself now enough about that let's get on to fruit and fruits and vegetables and the the technical term for these are flavonoids which contain most of the flavonoid group contains most of the most of the fruits and vegetables also contains green and black tea and and so on so let's look at flavonoids and what what's happened happened with inflammation and you can see here in this in this study the dietary flavonoids inversely associated with serum CRP so the higher the intake of flavonoids the lower the inflammation so it's an anti-inflammatory product and you can see also in the intervention trials intake may reduce inflammation mediated diseases polyphenols I'm a short-term basis intake of strawberries oranges and wine and mixed fruit drinks provide a protection against mule induced increases via reduction of inflammatory and adhesion molecules so just confirming what Steve said before that that wine is probably probably okay and it's another study here that's showing moderate wine consumption approximately 200 to 300 I think by Australian standards that's low consumption rather moderate but that's alright Louis both inflammatory and adhesion molecule so it's not quite one o'clock yet but not far around not far often but it's okay I've given you permission to have some wine tonight what about berries as we know we love berries as low-carb people and it showed a favorable response for for berries so other fruits grapes pomegranates red oranges also showed Marcus introduced markers so generally speaking it seems that this poly phenyl group is has a positive response on on inflammation so you can see see that the fruit polyphenols mr. did receive study that looked at the flavonoids and the immune response and initially no response in healthy people but in those with disease they had quite a marked marked response so it may well be that it's particularly people with with chronic disease that do well get benefit from from fruits and vegetables as an anti-inflammatory and that's what they concluded that the role of flavonoid is not substantiated by intervention studies but the TNF factor may may be those with set inflammatory stress rather than help normal healthy people so if you're healthy you don't need lots of fruit and veg maybe if you're a you're sick maybe yeah maybe you do so what about some others Tomatoes again you can see here that there's a there's a reasonable you know small but definite sort of improvement reduction in in inflammation with with tomatoes legumes not so much these are all the different obviously legumes and beans and and so on pretty marginal effect on on c-reactive protein olive oil we all you know in favor of olive oil and this the evidence supports the fact that two olive oil exerts beneficial effects on markers of inflammation so a lot of this is you know what we would have expected i guess but there is some evidence the evidence again i repeat is not really strong but it's there what about fats now we get into the interesting stuff okay unfortunately you know people have to think about you know fats whereas really we should be thinking about foods and as we know most foods or foods that contain fat don't just contain saturated fat or Pollione cetera they're they contain it a combination of these things but nevertheless there the research tends to focus on one or other type of fat let's start with saturated fat and that's you know complicated there's a lot of studies out there some of them show positive associations between saturated fat and il-6 which is one of our favorites and and the the adhesion molecule one likewise no significant associations with all these always things what about c-reactive protein well two studies showed significant positive through studies show no significant associations so as with most things to do with saturated fat we're just confused so it's very I don't think there's clear evidence to say that saturated fat is or is not that in favourable promoter of of inflammation what about the polyunsaturated as you know polyunsaturated fats are divided into Omega 6 and Omega 3 Omega 6 is largely linoleic acid and Omega 3 is largely alpha linolenic acid why they make these names so similar I've got no idea just to confuse us but the Omega 6 is metabolized to 2a a 2 arachidonic acid and Omega 3 to EPA and DHA and there as far as information is concerned and it's I think it's generally accepted there are papers that still refute this but I think the overwhelming majority of papers would say that Omega 6 pro 8 prothrombotic and more importantly pro-inflammatory leading into production of these interleukins and the Omega 3 is anti-inflammatory if you like it blocks the metabolites of the a a from from omega-6 and prevents inflammation so we're fairly generalized but fairly clear that omega-6 is pro-inflammatory and omega-3 around here Kalama tree so we know that the omega-3 act on adipose tissue to relieve that adipose tissue inflammation they secrete and adiponectin which is anti-inflammatory and and so we'll talk more about visceral obesity in in a minute alright so this is an interesting study looking at lung inflammation and it showed that diets rich in omega-6 would provoke airway inflammation in in asthma so that's you know that's an interesting study because again I'm sure not too many of our spirit repositions advised their their patients to reduce their omega-6 intake so omega-6 and omega-3 as as most people are aware historically there's been a relatively even balance between omega-6 and omega-3 during evolution you know Amiga 3 was found that all the foods consumed but unfortunately modern agriculture by changing animal feeds and then so on has decreased the omega-3 fatty acid content in many foods animal meats eggs and and fish and you can see here that when you get a food from an edible wild plant it contains a good balance of omega-6 and omega-3 but so post land which is a wild plant in comparison to the plants that we eat spinach and lettuce and so on has eight times more ala more on Iger three than then cultivated plants it's likewise with fish modern agriculture produces fish that contain less omega-3 acids tender fish grown naturally and then similarly with eggs the fatty composition of egg yolk from free ranging chicken has an omega-6 to omega-3 ratio of 1.3 where's the the USDA egg what you didn't know they produce eggs but anyway as a ratio of 20-odd so you know there's a huge difference in in sort of naturally growing wild sort of produce compared to processed processed foods now we said before that you know the jury was out on unsaturated food as fats and was we know the only food that has a majority of its fat as saturated fat is dairy so it's interesting that when you review the evidence between between dairy products and inflammation you're actually systematic review of 52 trials showed that there was a strong anti-inflammatory activity in subject with metabolic disorders and not surprisingly a pro-inflammatory activity of those allergic to milk so it sort of makes sense but it certainly seems that there is enough evidence I believe that dairy is actually an anti-inflammatory food what about - you hear a lot about - green tea in particular as being anti-inflammatory yet there's not a lot of evidence to support that and and the only systematic review I could find you know basically sat on the fence in with this but that's not going to stop me continuing my my green tea similarly with that with coffee again in lots of health benefits supposedly purported forever coffee but not a lot of evidence about its effect on inflammation and finally cocoa ironically a little bit more inflammation or evidence about the benefits of cocoa but those three that's still I think the jury is out on on all three of those alcohol not just why am I just generally speaking the regular consumption is reported to be inversely associated with a number of markers of inflammation so again that's that's encouraging news all right okay so enough about sort of individual foods and nutrients what about sort of diets in general as we know there's a million diets out there and and everyone sort of claims that their diet is the one and only diet but I think if you if you're looking at some of the reviews of this that and this is a study that a review that looked at both paleo and Mediterranean diets and looking at inflammation and basically they they agree that both these all these two diet types are associated with lower levels of systemic inflammation and you can see here positive effects of the Palio's and the Mediterranean diets on on HS high sensitivity CRP so that's the diet as a whole rather than the individual and again here the this paper looked at consumption of what they call a healthy dietary pattern which is sort of basically that the diets that we would all consider a healthy was related to significant reduction in c-reactive protein and the diets they looked at with a Mediterranean diet the Nordic died Tibetan and and the DASH diet and all of these had were associated with significant reductions in CRP again is another review that says the Mediterranean and - diets associated with several low-fat diets anderson we were associated with lower inflammatory markers and here's one more that shows a diet high and minimally processed high-fiber plant-based foods will blunt the post-meal increase in glucose triglycerides and inflammation so when you are when you eat you have a postprandial glucose surge obviously and that's often associated with a surge in inflammatory inflammatory markers so you can see here that lean protein vinegar fish oil tea and cinnamon as well as those other things positively impacted that that postprandial and metabolism again Mediterranean diet coming out as anti-inflammatory and again more studies here that show a number of studies showing a decrease in inflammatory markers after weight loss a significant 24 percent decrease in CRP after three months replacement of high-fat foods with reduced fat alternatives interesting and another studies showing a carbohydrate restrictive diet with daily intake of eggs decreased CRP so pretty confusing all the studies out there what about the classic low-carb high-fat we're all familiar with and what we promote plenty of those sort of things what about the low-carb high-fat studies and there are some studies out there this is looking at a high low-carb high-fat diet for 12 weeks lowering c-reactive protein and raising serum adiponectin which is actually an anti-inflammatory factor so some positive effects from a low-carb diet there you can see there this is the results from that study that you can see quite a marked reduction in NH CRP from comparing a low-fat to a low-carb diet and similarly with adiponectin as well so some pretty pretty significant results there and they came to the conclusion that there was a significant effect on inflammation now what about ketosis and it's there's a fair amount of evidence to show that beta-hydroxybutyrate which is obviously one of the ketone bodies that we rely on in a ketogenic diet there's a fair amount of evidence that shows an anti-inflammatory effect from lead to a beta hydroxy butyrate mediated inhibition of the nlrp3 inflammasome so it may well be that that's the factor beta hydroxy butyrate that really will result will result in reduced inflammation here's another another factor we're looking at being stress induced behavior inflammatory responses and this papers show to be two hydroxy butyrate exerting an antidepressant like effect on on gyro inflammation so again the ketogenic diets only been looked at relatively recently and now in these here's looking at Alzheimer's disease but what they found in that study was that it had an anti-inflammatory activity what about plant-based diets diets vegan and vegetarian and so on and there is some evidence that plant-based diets are associated with improvement in obesity related inflammatory profiles you can see here is a summary of the plant-based diets and the majority of them coming on the on the side of improvement in in inflammation however you know this again it's always contradictory papers the significant one that shows no difference in CRP between vegetarian and omnivores except when it was greater than two years so up to two years no difference great than two years of vegetarianism then is associated with lowered a lowered CRP okay so in summary most studies comparing diets are different competitions reported a similar decrease in in CRP so the question is is it the weight loss per se or is it the actual dietary composition that's the factor all right so I just want to spend the last couple of minutes talking about visceral obesity numerous studies indicate that inflammation occurs as a consequence of obesity so we might turn about you that well maybe your inflammation and obesity have the same cause that may be true but on top of that obesity per se essentially visceral obesity so that the adipose tissue that surrounds your your the organs in your in your gut and and heart and so on they are inflammatory so the adipose cells produce abnormal amounts of these cytokines and increased acute phase reactants and they activate inflammatory signaling pathways money through macrophages so they the adipose cell attracts macrophages these macrophages produce abnormal cytokines such as leptin we've heard about that before resistant and an TNF they also produce another cytokine called adiponectin and that's actually an anti inflammatory cytokine so whereas most of the cytokines are pro-inflammatory adiponectin is an anti-inflammatory and and the more the more fat you have the more fat cells adipocytes then the unless the ability to produce an opponent and so the more fat you have the less anti-inflammatory adiponectin if you like and so it sees macrophages that that are the issue they produce all these pro-inflammatory cytokines and then when you reduce the amount of fat you have a dramatic decrease in the number of the macrophages and decreased expression of the inflammatory Jamarcus and here you've got got these are the the macrophages here and so there's the the neutrophils and the macrophages of these little devils here and what happens normally then when you get up become obese these macrophages become more prominent and they're basically the the fat cell dies so you've got from from normal yes you become obese your fat cells are hypertrophy rather than increasing your number then they the macrophages produce these cytokines and and cause the damage here and you can see the different cytokines that are produced by these adipose cells so it's the adipose cells themselves that are producing inflammatory cytokines so as I said a number of pro-inflammatory cytokines leptin resistant number of cytokines and hydrogen peroxide and then some of anti inflammatory cells that the fatter you are the less you produce of AD Anno pectin in in particular so excessive accumulation of surplus body fat initiates a release of all these pro-inflammatory cytokines from both the adipocytes and the macrophages and then you get a rapid retribute of monocytes to the adipose tissue as well and so those cells deteriorate the state of inflammation by presenting an additional source of pro-inflammatory cytokines and there's a visualization of adiponectin is in particular so very interesting that as a result of becoming obese you actually become more inflamed so the question is you know what comes first is that is the content of the diet that's causing inflammation or is it the fact that we get fat and then as a result of that we become we become inflamed so in summary I'll leave that question is I don't think we know the answer that there's probably a bit of both so in some I think there is convincing evidence for these things for a pro-inflammatory effect of sugar refined grains omega-6 polyunsaturated fats and visceral obesity and there are there's good evidence for anti-inflammatory effects of the omega-3s for dairy for the flavonoids and for so-called healthy diets the jury is still out on lower GI carb saturated fats whole grains tea and coffee so we still got a lot - a lot to learn but I still think you know it's definitely worth promoting what we call an anti-inflammatory diet and I often think that if instead of calling the diet that we all think is good a low-carb diet maybe we should have called it an anti-inflammatory diet I reckon the rest of the medical profession would feel a lot less threatened if we call that an anti-inflammatory diet rather than a low-carb diet and it may well be that it's through its effects on inflammation that the low-carb healthy fad diet really has has its effect so thank you that as was mentioned I've just put a book out a fat lot of good I'm sorry it didn't make it here but if any of you want to email me I will gladly gladly post it and I'll go one up on our Kiwi friend and I won't charge you postage so when I was with the trigger team we played New Zealand many many times including the World Cup final and they never beat us so I wouldn't let him beat me again so oh yeah thank you very much [Applause]

Channel: Low Carb Down Under

Views: 192,841

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Gold Coast 2018, #LowCarbGC, Peter Brukner, Inflammation, Low Carb High Fat, Ketogenic, Chronic Inflammation, Acute Inflammation, leukocytes, cytokines, interleukin-6, adipokines, omega 3, omega 6, hs-CRP

Id: pfy4jZLsY_0

Length: 46min 7sec (2767 seconds)

Published: Wed May 22 2019