The Mediterranean Zone (19 page)

The 1982 Nobel Prize in Medicine was awarded for linking eicosanoids to inflammation. Depending on the fats you eat, you either make
pro-inflammatory or anti-inflammatory eicosanoids. If those fats are rich in omega-6 fatty acids coupled with a diet consisting of high-glycemic load carbohydrates that increases insulin levels, then you will rapidly escalate diet-induced inflammation. On the other hand, a diet rich in omega-3 fatty acids and polyphenols coupled with low-glycemic load carbohydrates to prevent excess insulin levels will reduce diet-induced inflammation.

The higher the glycemic load of a meal, the more insulin you produce. That’s okay as long as insulin is doing its job correctly, because if you don’t have insulin resistance, those elevated levels of insulin after a meal will quickly return to normal. However, all bets are off once you develop insulin resistance because the target cells (fat, liver, and muscle) dependent on insulin’s ability to remove glucose and fat from the bloodstream become less efficient. Because of this disruption in insulin’s action in targeted cells, the pancreas secretes more insulin to reduce the elevated levels of glucose and fats in the bloodstream. As a consequence, the levels of insulin in the blood will remain elevated all the time. If you also are consuming high levels of omega-6 fatty acids in your diet, then the combination of these two factors will increase the levels of arachidonic acid, which further increases cellular inflammation. The combination of these two dietary factors (elevated insulin and increased omega-6 fatty acids) speeds up the development of chronic disease and accelerates the aging process.

The resolution of inflammation is a totally distinct process from the initiation of inflammation. Without the consumption of adequate levels of both omega-3 fatty acids in the diet, the resolution phase of inflammation is weak, and this allows the inflammation to continue at chronic low levels in every organ in your body. Eventually, if there is enough organ damage, we call it chronic disease.

Our diet is one of the primary environmental factors that control gene expression, especially inflammatory genes. The more inflammation you create by your diet, the more inflammatory genes are activated to continue to produce a continuing stream of inflammatory proteins that maintains chronic cellular inflammation. The end result is that you become fatter and sicker and accelerate the aging process. As long as we maintain our pro-inflammatory diets, epidemics of obesity and diabetes (and Alzheimer’s) are all but assured in our future.

This last possibility is truly frightening as our quest for cheaper and more convenient industrialized food may be causing genetic manipulations of the human genome for the worse.

Just as I believe that nutrition is more complex than we are told, I equally believe that the practice of medicine is not as complex as we think. In essence, if you control diet-induced inflammation in your body, you will lead a longer and healthier life. That’s why I believe that the future practice of medicine should be composed of three distinct steps:

This may seem low-tech in comparison to today’s high-tech medicine. However, I am certain that anything less than this three-step model of health care will be unsustainable in terms of future health-care costs. This plan does not require new breakthroughs in biotechnology but does require a new model of medicine that recognizes the power of diet as its primary “drug” and the need for the patient to be part of the solution. This is not new thinking, as it is essentially what Hippocrates proposed 2,500 years ago when he said, “Let food be your medicine, and let medicine be your food.”

There is one country that is using this approach on a society-wide basis: Japan. Although the Japanese are the longest-lived population in the world with the greatest health span (total lifespan minus years of disability), they realize they too have growing problems with diabetes and Alzheimer’s. Rather than throwing their hands up in despair, they took a rather unique approach to proactively treat what could one day become an epidemic that could destroy their entire economy. In 2007 all employers in Japan were given notice that they had five years to start reducing the number of their employees with metabolic syndrome (pre-diabetes) by 15 percent, and by 25 percent by the year 2015. If those requirements were not met, then the
employers (not the employees) would be subject to a substantial tax to help pay for the projected future health-care expenses of their employees. Since Japan has a national health-care system that includes yearly checkups, the Japanese government had excellent insight into employee compliance. You can imagine the uproar if such a mandate were to be proposed in the United States or Europe. Yet the Japanese know this is a matter of national economic security, and they are willing to pay the price.

We either solve this problem of diet-induced inflammation in every socioeconomic sector of our society, or we will all fall together into a black hole of unimaginable health-care expenses in the future, as the incidence of obesity, diabetes, and Alzheimer’s continues to increase. It may be through following the Mediterranean Zone as described in this book, or taxing the production of omega-6 fatty acids, or making vegetables essentially free by the use of vouchers (basically vegetable food stamps) for every segment of the population, or by following the Japanese example of taxation on employers to slow down the growth of diabetes and Alzheimer’s. These may appear to be radical approaches, but each one provides the potential to help us retake control of our genetic future. We must realize that unless changes come quickly, we will all sink under the increasing weight of health-care expenses as diabetes and Alzheimer’s continue to take their considerable health-care tolls. Furthermore, we need to have a solution that affects every economic sector of society, not just the economically elite that shop at Whole Foods. It will take significant capital to undertake such wide-scale changes, but unless those changes are implemented our future national security is at significant risk thanks to the extraordinary drain of future health-care costs on our financial resources.

Throughout this book, I have discussed how the industrialization of our food supply has set in motion an unprecedented change in the expression of inflammatory genes, presenting a very bleak health future for America. It will take the equivalent of a multi-generational “wartime effort” to reverse the epigenetic changes of the last fifty years. It remains to be seen whether or not we have the will to win that war to reclaim our genetic future, but I know this: A diet rich in omega-3 fatty acids and polyphenols and low in omega-6 fatty acids and refined carbohydrates is the most important part of medicine we have in reclaiming our health now and for future generations to come.

T
he world of nutrition is constantly evolving, and we are now able to explore with growing scientific sophistication how our diet can affect the expression of our genes. To stay on top of that world, I can offer several resources. For the rapid acceleration of the science of nutrition,
www.DrSears.com
compiles breaking research news on nutrition and medicine on a daily basis. For advice and products that help support the Mediterranean Zone, I can recommend
www.ZoneDiet.com
. Likewise, one of the best markers of being in the Zone is the AA/EPA ratio. Used primarily in research studies, it is not a standard blood test, but it is available at the lowest possible cost at
www.ZoneDiagnostics.com
.

The Mediterranean Zone meals in this book are taken from the menu at the Saturnia Spa in Tuscany, Italy, considered one of the top spas in the world. The meals were developed by Dr. Daniela Morandi and Chef Claudio Colombo Severini. These Mediterranean Zone meals represent the foundation of Dr. Morandi’s Nutritional Reset program at the Saturnia Spa.

U
nderstanding the concept of the Zone means understanding the link between diet and inflammation. We often think of inflammation as harmful, whereas, in fact, it keeps us alive. Without a strong inflammatory response to fight off microbial invasion and help heal physical injuries, our future would be bleak. On the other hand, if those same inflammatory responses are not brought back to normal, then that resulting chronic low-level inflammation continues to attack our own tissue, leading to obesity, development of chronic disease, and acceleration of the aging process. In other words, you need a balance of inflammatory soldiers that can be called into action when needed and then returned to their barracks when the action is over.

The primary soldiers in your inflammation army are a group of hormones known as eicosanoids. Little is known by the medical profession about these hormones, even though the 1982 Nobel Prize in Medicine was awarded for understanding their role in the inflammatory process, and more than 125,000 scientific papers have been published about them.

My interest in eicosanoids began more than thirty years ago when I began to consider the impact of diet on eicosanoid formation and on
inflammation. It is a complex story that I have told many times in my previous books, so here is a short summary.

Essential fatty acids are fats that the human body cannot make and therefore must be supplied by the diet. The two key essential fatty acids that play a critical role in the body’s inflammatory responses are the omega-6 fatty acid arachidonic acid (AA) and the omega-3 fatty acid eicosapentaenoic acid (EPA). It is the balance of AA and EPA that ultimately controls the degree of cellular inflammation in the body because these two fatty acids can be converted directly into the eicosanoids that ultimately control inflammation. The eicosanoids derived from omega-6 fatty acids (AA) are pro-inflammatory and accelerate inflammation; the eicosanoids derived from EPA are anti-inflammatory and are critical for the resolution of inflammation. The AA/EPA ratio in the blood provides a unique insight into the balance of these two fatty acids in every one of the 10 trillion cells in the body and describes how well you are able to maintain a healthy inflammatory response and, as a result, live a longer and better life. It was obvious to me decades ago as I was developing the Zone Diet that it could be used as a powerful “drug” to be taken at the right dose and at the right time to change the balance of these fatty acids and thus control the levels of inflammation in the body.

That part was easy to come up with. The more difficult process was to understand how the molecular pathways leading to these two fatty acids could be modified by the diet to optimize the ratio of AA and EPA to control inflammation. You need some AA to mount an inflammatory response to microbial invasions or to heal injuries; however, if the levels of AA are too high, the inflammatory response is constantly turned up, and the end result is that the body attacks itself. If there were too little EPA in the cell, there would be limited competition with AA for the enzymes (cyclo-oxygenase, or COX, and lipo-oxygenase, or LOX) that make inflammatory eicosanoids, thus making it impossible for the body to control inflammatory responses. On the other hand, if you have an excess of EPA in the cell, it might inhibit the inflammatory response too much, making it more difficult to repel microbial invaders.

In addition, from EPA (and the other long-chain omega-3 fatty acid docosahexaenoic acid, or DHA) comes a powerful group of anti-inflammatory eicosanoids known as resolvins that turn off the inflammatory response. It should be noted that the initiation of inflammation is totally different from the resolution of inflammation.
Anti-inflammation
can be thought of inhibition of the initiation phase of inflammation.
Pro-resolution
can be thought of as the acceleration of the termination of the inflammatory response. Both pathways (the initiation of inflammation and its resolution) have to be in balance to maintain inflammatory homeostasis. What was needed to achieve this was a dietary approach to maintain the AA/EPA ratio in a zone that is not too high, but not too low.