Dale True, editor of the Inflammation Wellness website, interviewed Julius Torelli, M.D. on a broad scope of topics related to the prevention and treatment of chronic inflammation. The interview took place in Dr. Torelli’s office in the Integrative Cardiology Center in High Point, North Carolina.
DT: Why should readers of the Inflammation Wellness web site be aware of chronic inflammation, and specifically, what do they need to know?
JT: When I look at the Stedman’s Medical Dictionary definition of inflammation, I find: “a localized protective reaction of tissue to irritation, injury or infection, characterized by pain, redness or swelling”. A protective reaction!
I knew it was a protective reaction, but clearly something has happened to change the normal protective state of inflammation. While it is still protective in the case of a sore throat, pneumonia or any infection and you need that, something has gone haywire, causing this protective mechanism to become destructive.
Most chronic diseases appear to be inflammatory in nature. Inflammation can be very severe, especially in the form of autoimmune diseases, such as lupus, multiple sclerosis, rheumatoid arthritis and certain forms of cancer. These are the type of health issues that cause CRP levels go to 50 or 100 or more.
Then there are other more moderate inflammation states that are indicative of heart disease, diabetes, insulin resistance and types of cancers and arthritis. There are also some diseases that are caused by mild inflammation, such as gingivitis, skin disease (psoriasis and eczema) and allergies.
All of these diseases and many others appear to have excessive inflammation as the root cause.
Rheumatoid arthritis, as an example, is caused by severe chronic inflammation. Your body is making antibodies that continually attack and damage the synovial membrane of the joints. Traditional allopathic medicine focuses on developing and prescribing drugs to stop the inflammation process. Aspirin, steroids and other compounds have made great progress. We now have some very powerful anti-inflammatory drugs, immunosuppressants and chemotherapy treatments for cancers.
Yet with all of the pharmaceutical agents available, we see very poor effectiveness in stopping the inflammation associated with rheumatoid arthritis. So those who have this severe chronic disease face a powerful immune response. But in allopathic medicine, we never stop to ask why this condition occurs in the first place. We just keep exploring for more drugs to treat it.
DT: Are you saying we don’t know the cause of chronic inflammation?
JT: There is very little research as to why chronic inflammation is happening. From my standpoint, you’ve got three major lifestyle issues. One is the emotional component that Western medicine never talks about. Another is the nutritional component, which we almost never talk about. There’s also an activity component—or lack of it—to which we only give lip service.
So I think it’s important to know inflammation is a root cause of chronic disease and we must address those three areas of our lives if we wish to prevent or fight excessive inflammation.
DT: In your practice, have you successfully treated patients utilizing a nutrition, exercise and stress management plan?
JT: Good question. I certainly have not compiled enough data to provide scientific evidence. I don’t have the money or the time to do that. But I can tell you that there are only two choices for people who are pre-diabetic, meaning their lab tests show signs of insulin-resistance, they are inactive physically, plus 60 pounds or so overweight and making poor food choices.
One, which is the one most people choose, is to maintain their current unhealthy lifestyle and in the future—could be six months or six years—you will be diagnosed with diabetes and require medicines that you’ll need to take the rest of your life. By the way, these medicines may only manage the disease until it eventually ends your life.
But, here’s the second choice. You can choose to alter the way you eat and increase your activity level. It’s not easy and I can’t do it for you. I struggle with this myself. I try to eat the right foods and make time for exercise, but it is a struggle in our busy and complex society.
When you educate people on the seriousness of the situation and the benefit of adopting a healthy lifestyle, they begin to take on some responsibility for their own health care. They also respond to someone working with them instead of just telling them to take these three medicines and then walk out.
DT: To what degree have you seen changes in these patients with chronic illnesses using natural methods?
JT: When people commit to the health strategies I recommend, they do get better. That is very clear to me. For example, I had one 42 year old patient who was about 60 pounds overweight, although fairly active at his job. I diagnosed him as having heart disease. His insulin level was at 137—the highest I’ve ever seen. Normal is less than 15. His CRP was also high at 8. I prefer to see CRP below 3, for sure, and ideally less than 1.
We treated the problem through changes in his normal diet and exercise. He walked daily and followed an inflammation-free diet. He also cut out sodas, which was a big deal! Three months later, when he came in for his follow-up exam, he had lost 12 pounds, which was a modest weight loss for that amount of time. We re-checked the lab tests at four months and his insulin level was 12! (Down from 137) His CRP was 1.5! (Down from 8.) I didn’t believe it and asked the lab to confirm the tests. I was shocked!
How much did this lower his risk of a heart attack or other chronic disease? That’s nearly impossible to state absolutely. But without question, the lower insulin and CRP levels suggest that this man would have much better health, if he maintained the rather simple steps he took.
So, have I successfully treated patients using natural methods? Yes, people feel better and their critical lab data gets better, as well as their tolerance to do more physical activity. In the world of preventative medicine, this is unquestionable success. Success in traditional medicine is opening up a blocked artery to stop a heart attack. I prefer to prevent the need for open heart surgery!
DT: In your book, Beyond Cholesterol, you detailed diagnostic tests, such as CRP, that reflect inflammation levels in the body. Would you like for people to know their CRP levels regardless of their health condition?
JT: It’s a very important level to know. Why wouldn’t you ask your doctor to order a CRP test, especially once you realize the benefits of early detection of excessive inflammation in your body?
CRP is a non-specific marker of inflammation, meaning it can tell you whether or not you have excessive inflammation, but it cannot tell you where in the body it is. Still, CRP is a much better diagnostic test than the traditional sedimentation rate, or sed rate, as it is often called.
DT: You also wrote in your book about the importance of the fasting insulin test. Why is it so vital to know our fasting insulin level?
JT: I order a lot of fasting insulin tests, although it is not a direct marker of inflammation. But it is important in detecting insulin resistance. Insulin resistance often leads to metabolic syndrome, which is linked to the development of arterial inflammation and other aspects of heart disease.
High insulin levels do not cause the inflammation that leads to diabetes, atherosclerosis or other diseases related to diabetes. But high insulin levels are an indicator that things are out of balance within the body. If this can be detected early enough, there are natural methods that can be adopted to prevent chronic disease from becoming firmly established. We know with certainty that weight loss and exercise improve insulin resistance.
DT: Increasing physical activity is a major part of your Inflammation Wellness Program. How does exercise improve our health?
JT: Maintaining enough physical activity to have a greater metabolic rate will prevent weight gain. Ironically, exercise causes a small amount of inflammation. But the body quickly recovers from normal physical activity.
When you are sitting, doing nothing, you are burning fat for energy. That’s what I call your idle speed—your basal metabolic rate. If you go walking, you will burn even more fat for energy. You have to take in oxygen to burn fat. If you can’t get enough oxygen to burn the fat that you need for that level of exertion, your body will switch from burning fat to burning sugar. The level of that switch from burning fat to burning sugar is called the anaerobic threshold.
Getting out and moving is very important. I like to think of it less as exercise and more as adopting an active lifestyle. Instead of sitting home watching TV, go out hiking or canoeing. Let’s face it; spending 45 minutes on the tread mill is not the most exciting thing in the world. It’s boring and somewhat unnatural. But hiking is really fun; most people tell me they really like that. It’s a completely different experience—you’re outside enjoying the sights. There’s a different sense of vigor and good feelings with natural activity as opposed to using exercise equipment. On a treadmill, most people only feel good when they’re finally done.
DT: Earlier you mentioned lifestyle issues as a reason we’re seeing more and more chronic inflammation in our society. How can people alter their lifestyle to achieve better health?
JT: With any of this, but especially the physical activity, there’s an optimal level and a practical level. What we would ultimately like to do is come up with a lifestyle program with recommendations for physical activity, nutrition and stress management that is practical for people to do.
The reason we don’t do these things today, for most of us, is that it is not practical—it does not fit into our lifestyle or time limitations. People eat fast food, not necessarily because it tastes good, but because dad works, mom works, they don’t get off work until 5:30 or 6:00, she’s got to go home and prepare food—clean it, cut it, cook it—clean up everything, help the kids with homework, bake cupcakes for the school bake sale—no! She stops by McDonald’s or the fried chicken place in order to cut out a big part of that time commitment.
DT: How does stress management lower inflammation?
JT: I believe that our overly-stressed lives play a major role in chronic inflammation and definitely contribute to diseases such as heart attacks, cancer, arthritis and other maladies. Many people live an “inflammatory lifestyle”. Inflammatory disease does not derive exclusively from being overweight, lack of exercise or the foods we eat. It also comes from a lack of stress management, which causes a release of harmful hormones.
How people express their emotions are important with regards to chronic inflammation. There are studies that have looked at the personalities of people with rheumatoid arthritis. It’s fascinating.
When I was in training, we had to go through different rotations. One was rheumatology rotation. I remember seeing all these patients with rheumatoid arthritis and I said, “We shouldn’t call this the rheumatoid arthritis syndrome, we should call it the ‘nice guy syndrome’.” The attending physician asked why I would say that. “Well, every time I go into a room, I come out and think to myself, “Geez, that’s a nice guy, but the rheumatoid arthritis is awful’”. I have never seen many jerks that had rheumatoid arthritis. Rheumatoid arthritis has been referred to as “anger turned inward”. Angry is also an apt description of a joint inflicted with severe rheumatoid arthritis.
A study of personality and rheumatoid arthritis indicates that 70% of those that develop this disease have the martyr syndrome, or as I call it, the nice guy syndrome. This personality type usually goes along with what everyone else wants to do and rarely do what they want. They favor conflict avoidance, preferring to not “rock the boat”, and rarely speak up if they feel wronged.
Is anger responsible in some part in the development of rheumatoid arthritis? The evidence suggests it may be.
DT: Is it possible for people to change how they react to external events?
JT: I read in the Seven Habits of Effective People that people say they are stressed by what’s going on, because they don’t want to take responsibility for their own actions.
If you go into a rage when another driver cuts you off in traffic, your body secrets fight or flight hormones, such as adrenaline, noradrenaline and others which cause your vessels to constrict, your heart rate goes up, your blood pressure goes up, your sugar level actually goes up and your cholesterol level goes up—all of these negative things flood your system when you react this way. You are allowing a perfect stranger to negatively affect your health.
Instead, act out of the role of appreciation. “Wow! That was close and he almost hit me. I’m so appreciative he didn’t hit me. Thank God he didn’t hit me.” Or “maybe he was on his way to the emergency room because his wife was taken there. I hope he gets there safely.” If you give him the benefit of the doubt, you’re not even mad at him anymore. Reacting that way causes little or no reaction in blood pressure or heart rate and you didn’t secret all those bad hormones.
So it wasn’t the situation that caused the bad physical reaction, but rather our reaction to the situation. We always have a choice to react calmly or react angrily. Repeated calm reactions lead to managed stress and help us maintain good health; repeated angry reactions lead to unmanaged stress and contribute to poor health.
Managing stress through appreciation is a learned behavior. But it becomes natural as we practice the management of stress this way.
DT: In your book, Beyond Cholesterol, you make the case that heart disease is more a function of excessive inflammation than high cholesterol. Is the medical community in agreement with your view?
JT: When comes to cardiovascular health, most doctors consider cholesterol to be the primary indicator. If you have a heart attack and your LDL is 90 (the recommendation is less than 100), most physicians will put you on a statin drug in order to lower your cholesterol further.
“But my LDL was 90, which is lower than recommended.”
“Yes, but you had a heart attack, so your LDL was too high for you.”
In a cardiologist’s mind there’s no “too low” from an LDL standpoint. If they can get it to zero, that’s what they would do.
But here’s the issue, although doctors mean well and they want to practice evidence-based medicine, the studies required to get the evidence is very expensive. The cost for these studies can run from 10 to 100 million dollars. Some of the big cholesterol mortality trials with a lot of patients cost 100 million dollars!
So doctors can say that they only pay attention to peer-reviewed studies in the journals, those that are randomized, double blind and placebo-controlled. But there is bias in these studies, because it is the pharmaceutical companies that are paying for them. More importantly, all of the really large studies are from the pharmaceutical industry. Who is going to pay for a 50 million dollar study on the effects of exercise or a low-inflammatory diet on cardiovascular health? Certainly not the pharmaceutical industry!
So when it comes to natural wellness for chronic disease, we’re left with antidotal evidence, common sense approaches, and a lot of small studies, mostly from outside the U.S. I have no problem with the foreign studies, but in this country, we seem to have a bias against studies performed in Europe or Japan. We have studies from Europe on the health benefits of fish oil dating back well over a decade, but we never paid attention to them.
DT: Still, there seems to be a lot more public interest in natural health, especially in fish oil to lower the risk of heart disease.
JT: When Lovaza, the first prescription fish oil drug, became available in the United States, suddenly lots of primary care physicians were putting their patients on fish oil. Five years ago these physicians would rarely, if ever, even mention fish oil to their patients. But the new drug put drug company reps into doctor’s offices talking about fish oil, which confirmed what I already knew—doctors receive 90 percent of their information from drug company representatives.
Now I do not have a problem with reps providing information on the drugs they sell, but it does concern me when that seems to be where physicians get the majority of their research information. This is why most physicians are either unaware of the evidence concerning how nutrition and exercise can be used to treat chronic inflammation or they have little confidence in such evidence because it’s not coming from their traditional sources.
DT: Thank you, Dr. Torelli. I hope our readers will benefit from your insight and experience in treating chronic inflammation with natural methods.