Wednesday, October 10, 2007

Blog 016 - an inflammatory response

In medical school a professor once told me that I would forget half of what I was being taught, and the other half would ultimately be discovered to be untrue. It was a bleak and discouraging perspective. Hopefully, it was an exaggeration.

But, since I started medical school in 1981 there have been some big changes in the way we think about a lot of important issues. One of these is heart disease.

Back in the day, we believed that coronary heart disease was a consequence of eating too much cholesterol with all of the excess cholesterol being deposited onto or into the inner lining of the arteries to our heart. The metaphor often used to describe the process was “corrosion accumulating inside a pipe.” It was an overly simplistic point-of-view that led to the “obvious” mechanical solution of coronary artery bypass surgery – “putting in new plumbing” as a heart surgeon once joked to me and my peers while on rounds one day.

Coronary artery bypass surgery has extended the lives of many patients, but bypassing the clogged blood vessels does absolutely nothing to change the underlying disease process that got the patient into trouble in the first place.

We used to think that a heart attack was a consequence of a coronary artery getting progressively more narrow because of cholesterol accumulating in the artery wall until it was finally swollen shut, thereby obstructing blood flow to the heart muscle. Now we think that a non-obstructing plaque inside the lining of a coronary artery breaks open and causes a blood clot to form inside the coronary artery, thus acutely obstructing blood flow and causing a heart attack.

We are beginning to recognize that our fundamental understanding of what causes coronary artery disease was not exactly right. It is more complicated than corroding pipes and globs of fat accumulating inside blood vessels. Now we are talking about “oxidative stress” and “chronic systemic inflammation” as the underlying causes of heart disease.

The phenomenon of oxidative stress and chronic systemic inflammation are consequences of our modern, unhealthy lifestyle. And, these phenomena cause more than just heart disease. It’s beginning to look like oxidative stress and chronic systemic inflammation play a role in most of the chronic diseases that afflict us today.

Here’s the good news – oxidative stress and chronic systemic inflammation can be largely prevented or reversed with a healthy lifestyle.

I’m not even going to pretend that I understand the nuances of oxidative stress and chronic systemic inflammation. The more I read about them, the more confused I become. But, I am fascinated by the cellular biology involved. Over the next few weeks on the Fitness Rocks Podcast I will be sharing my efforts to understand these complex processes that are at the origin of so much sickness.

While you’re waiting for me to get a handle on this stuff you should be eating your fruits and vegetables and exercising every day. And, if you smoke – quit.

Have a great workout.
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Monte Ladner, M.D.


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