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Inflammation as we all know it, in its most rudimentary and reductionist parlance, represents a visual phenomenon that is putting it mildly, discomforting. Redness accompanied by swelling and carrying a common label that invariably has “itis” at its end – tonsilitis, appendicitis etc. However, as transplant gastroenterologist and Assistant Professor of Medicine at Columbia University, Dr. Shilpa Ravella, exquisitely reveals, there is yet another kind of silent and insidious inflammation lurking behind the shadows while wreaking havoc with our bodies in a sustained yet stealthy, and incremental yet impactful manner.
Silent inflammation in contrast to “acute inflammation” can be tricky to detect. Acute inflammation has been examined, analysed, and written upon in copious terms from time immemorial. In 25CE, Aulus Cornelius Celsus in Rome held forth on inflammation. Believing that a noxious build up of one of the four ‘humors’ in the body resulted in the four cardinal symptoms of inflammation, he identified the typical symptoms as rubor (redness), tumor (swelling), calor (heat) and dolor (pain).
Silent or simmering inflammation, on the other hand, can remain unnoticed and often there will be no symptoms until disease occurs. Only recourse to several tests, such as those included in the Inflammation Panel, can help an individual identify the amount of inflammation prowling within their body.
The beauty of Dr. Ravella’s book lies in its astounding simplicity. Elucidating seemingly convoluted and complex physiological workings into simple layman terms, Dr. Ravella unravels the perniciousness that is silent inflammation. The book draws extensively on pioneering research in immunology conducted by Russian zoologist Ilya Ilyich Mechnikov. Now recognised as “father of innate immunity,” Metchnikoff was responsible for discovering a process of immunity called phagocytosis and the cell responsible for it, called phagocyte, specifically macrophage, in 1882. This discovery turned out to be the foundation of the concept of cell-mediated immunity.
Beginning her utterly compelling book with a poignant personal experience, Dr. Ravella illustrates the deleterious effects of silent inflammation that can render an otherwise healthy person utterly helpless and debilitated. Silent inflammation plays a vital role in exacerbating and even triggering chronic and dangerous conditions such as heart disease, cancer, Type 2 diabetes, depression, and dementia. It is fascinating to read how a human being’s adaptive and innate immune systems – trusted sentinels and gatekeepers engaged in a perpetual vigil to ward off predatory germs – can transform into wrathful renegades that destroy the very stuff they are invested with a responsibility to protect, with a frightening degree of rapaciousness and precision.
So, is there no means of protecting oneself against the workings of this silent inflammation? Dr. Ravella identifies diet as a powerful means to combat this unseen peril. Including a diverse array of plants for a start is a good beginning. According to her our diet ought to include “foods we have been conditioned to avoid: whole grains – even beans and those containing gluten – are anti-inflammatory foods.”
Cruciferous vegetables, such as broccoli, cauliflower, and kale, are especially healthy because they contain molecules called isothiocyanates, which remove toxins, prevent DNA damage, and kill cancer cells. Dr. Ravella also urges her readers to look favourably towards the soluble fibre found in bananas, oatmeal, and beans. “Gut bacteria love these foods. They ferment soluble fibre to make short-chain fatty acids which lower inflammation in the intestines and throughout the body.”
Of especial interest to me personally, is the Chapter highlighting the famous Ancel Keys “Seven Countries” study. This study was the vision of Ancel Keys, a Minnesota physiologist, who aimed to evaluate questions about heart and vascular diseases among countries having varied traditional eating patterns and lifestyles. The countries identified for the study were Italy, Spain, South Africa, Japan, Finland, Greece, and the United States of America. The findings of this humongous study exhibited with startling clarity the fact that dietary patterns in the Mediterranean and in Japan in the 1960s were associated with low rates of coronary heart disease and all-cause mortality. A healthy diet and lifestyle (sufficient physical activity, non-smoking, and moderate alcohol consumption) according to the study was also associated with a minimal risk of cardiovascular disease and all-cause mortality. A healthy diet and sufficient physical activity, the study postulated, may also postpone cognitive decline, and decrease the risk of depression.
Dr. Ravella has rendered yeoman service to the lay and the learned alike with A Silent Fire. This book has all the makings of a breakthrough work in its genre. Dr. Shilpa Ravella has undoubtedly put herself on par with the arresting writings of Dr. Siddhartha Mukherjee and the alluring persuasions of Dr. Atul Gawande with this wonderful book. She has this enviable gift of the pen in addition to her core accomplishments in the field of medicine. This is indeed a boon for her readers as it would undoubtedly be the case for her patients.
A Silent Fire – a magical journey into the invisible world of pain, protection, and prophylaxis.