In the practice of medicine, the primary task is the diagnosis and treatment of acute disease. This is the main emphasis of most medical schools and the continued focus of medical research. However, the significance of chronic inflammation is becoming more relevant due to its direct relationship with many medical problems. This subject was first brought to my attention in an article published in the May-June 2019 issue of Harvard Magazine titled “Could Inflammation Be the Cause of Myriad Chronic Conditions?”
The article stated that “you can have a brain full of amyloid plaque and tangles, but if you don’t have neuroinflammation, you don’t get the disease.” In other words, you need a “spark to light the fire. It appears that chronic inflammation is absolutely causal to the process, and if you interfere with it, you can reverse the pathology.”
In 2021, Dr. Stephen Kopecky, a Mayo Clinic invasive cardiologist, wrote a book called “Live Younger Longer: 6 Steps to Prevent Heart Disease, Cancer, Alzheimer’s and More.” Kopecky writes, “As we get older, what strips us of our health and eventually our lives are conditions that affect us over the long term—chronic diseases of the heart and blood vessels, diabetes, dementia, and other illnesses that are common today.” This list of chronic diseases also includes Alzheimer’s disease, cancer, arthritis, asthma, gout, psoriasis, multiple sclerosis, depression and Parkinsonism—all indeed triggered by low-grade, long-term inflammation, according to the Harvard Magazine article.
What are the causes of chronic inflammation?
- Oxidative stress: pollution, smoking.
- Poor nutrition, including processed foods.
- Unmanaged stress.
- Excess alcohol consumption, defined as more than one drink per day.
- Inadequate sleep (less than seven hours a night).
- Too much weight (body mass index above 25, which is overweight,
and particularly above 30, which
- Lack of physical activity.
Exercise Reduces Inflammation
Numerous studies have shown an inverse relationship between physical activity and inflammation—in other words, the greater the amount of physical activity, the lower the level of inflammation, according to Kopecky. As a physician who has practiced preventive medicine for 66 years, I concur with this statement—I have seen that the greater the amount of physical activity in my patients, the lower the level of inflammation.
A noteworthy article published by The Cooper Institute was “The Association Between Midlife Cardiorespiratory Fitness Levels and Later Life Dementia,” which was included in the Annals of Internal Medicine 2013. In this study, 19,458 community-dwelling, nonelderly adults (average age 49.8 years and 21% women) were followed for 25 years. Medicare data was evaluated between 65 and 75 years.
The only risk factor considered during this study was fitness level as measured by time on the maximal performance treadmill stress test (modified Balke treadmill protocol). The top 20% of performance on the treadmill was then compared with the bottom 20%. Conclusions: Higher midlife fitness levels seem to be associated with lower hazards of developing all-cause dementia later in life, independent of cerebrovascular disease (a 36% reduction in the top 20% versus the bottom 20%).
I believe the major difference between the two groups was due to the participants’ weight and physical activity. Those in the top 20% were more active and weighed less during the 25 years than the bottom 20%, which was just the reverse.
How do we measure chronic inflammation?
The test we use at Cooper Clinic to measure inflammation is the hsCRP (high-sensitivity C-reactive protein), which is rarely measured in conjunction with most annual examinations. The usual complaint is that it is “too expensive (about $65) and not worth it!” But we have found it is a more sensitive measure of acute inflammation in older people than relying on the elevation of the white blood cell count and sedimentation rate.
My future focus is the importance of measuring chronic inflammation and, if elevated (hsCRP above 3.0), to make a major effort to reduce it, concentrating first on promoting weight loss and increasing physical activity. I recommend at least 30 minutes collective or sustained aerobic activity most days of the week (150 minutes per week is also the recommendation of the American College of Sports Medicine).
Healthy habits to reduce inflammation
There is an epidemic of inactivity and obesity in the United States today, and it is fueling chronic inflammation in many Americans. Remember, what is good for the heart is also good for the brain. These healthy habits can effectively reduce chronic inflammation:
- Exercise 30 minutes a day, collective or sustained, most days of the week.
- Sleep at least seven hours per night.
- Socialize—avoid isolation by joining a club or support group or volunteer at your place of worship or in the community.
- Do not use tobacco of any type.
- Drink alcohol in moderation if at all—I don’t drink, but I recommend both men and women avoid consuming more than one drink a day.
- Supplement properly. Vitamins are extremely important for overall health and immunity as well as dementia prevention. One study has shown having vitamin D blood levels greater than 50 ng/mL offers considerable protection against Alzheimer’s disease and dementia. I recommend taking each day 50 mcg (2,000 IU) of vitamin D3, 400 mcg of vitamin B12 and 1,000 mg of omega-3 (and/or at least two servings of fatty fish per week).
We read in Genesis 6:3 that God graciously limits our years in a fallen world: “Their normal lifespan will be no more than 120 years.” I would hasten to say the reason we do not live to 120 years is not because of design deficiency but because of the way we treat our bodies. Remember, “No drug can replicate the benefits of an active lifestyle.” ©2022 Kenneth H. Cooper
The Scripture quotation is taken from The Holy Bible, New Living Translation.
Kenneth H. Cooper, M.D., MPH, known worldwide as “the father of aerobics,” is the founder and chairman of Cooper Aerobics in Dallas and chairman emeritus of The Cooper Institute.