When Should I Worry About...

PODCAST: Is Low-Grade Inflammation the Hidden Culprit Behind Chronic Disease?

Oct. 3, 2023


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Most everyone knows acute inflammation, that short-lived redness and swelling that characterizes the healing process in response to injury or infection. But you may not be so familiar with chronic inflammation, a low-grade, insidious condition linked to the biggest killers of the Western world, including heart disease, stroke, cancer and Alzheimer's disease. A constant state of immune system overactivity, chronic inflammation is all but invisible, meaning people typically don't know they have it until disease has developed. Are there telltale signs? And what can you do to prevent it? In this episode, we learn about the condition the World Health Organization ranks as the greatest threat to human health.

Expert: Dr. Joshua Septimus, Primary Care Physician

Interviewer: Todd Ackerman 

Notable topics covered:

  • What we know about how chronic inflammation causes disease
  • Why it took so long for low-grade inflammation to come into the chronic disease spotlight
  • Do the "-itises" (sinusitis, colitis, tendonitis) have anything to do with chronic inflammation?
  • The link between processed food and the risk of low-grade inflammation
  • The best test to determine if you have chronic inflammation
  • Are there pharmaceutical treatments targeted at chronic inflammation?
  • It's not just what you eat — the other factors that can promote low-grade inflammation
  • Does being significantly overweight always predispose a person to chronic inflammation?
  • The best dietary approach to prevent chronic inflammation


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Episode Transcript

 ZACH MOORE: Welcome to On Health with Houston Methodist. I’m Zach Moore, I’m a photographer and editor here, and I’m also a long-time podcaster.

KATIE MCCALLUM: I’m Katie McCallum, former researcher, turned health writer, mostly writing for our blogs.

TODD ACKERMAN: I’m Todd Ackerman, I’m an editor here and I’m a former medical reporter.

KIM RIVERA HOUSTON-WEBER: I’m Kim Rivera Houston-Weber and I’m a copywriter here at Houston Methodist.

ZACH: And Todd, we’re talking about inflammation today.

TODD: That’s right.

ZACH: Do you have it?

TODD: That’s the $64,000 question, Zach.

ZACH: That’s an old TV show, by the way.

KATIE: Okay, I was about to ask, how did you pick 64,000 so, what’s the reference I’m missing here?

TODD: It’s of --


I think the derivation is a TV show, but it is a very common phrase.

ZACH: Yes.

KATIE: Alright, you learn something every day.

TODD: For something that is hard to know what the answer is.

ZACH: It’s the equivalent of “Is that your final answer?” just for an older generation.

KATIE: Is it because 64 is like that magic number thing? Is that what this is coming from?

ZACH: That was -- well, that was a lot of money in the 70s, right?

TODD: Yeah, I think it was before the 70s.

ZACH: Okay, well. I was giving you some credit. Anyway, it’s a very important question. We went into it today. Now, chronic inflammation, right? Is more what we’re talking about today?

TODD: Yes, I think everyone’s familiar with acute inflammation when you have an infection, or you suffered trauma to a  part of your body, and you can see it swell up and become red. But we’re talking about low grade chronic inflammation which is really a sort of silent thing, like high blood pressure or cholesterol, only there is no test for it. Or there’s no commonly, commonly ordered up test. There’s also not a lot of medication out there for it, but it’s increasingly seen as the culprit behind a lot of our deadliest diseases.

ZACH: Does anyone have chronic inflammation here? Not to put you on the spot.

KATIE: I mean, it kinda sounds like you can’t -- almost can’t know until it’s too late. I don’t know. You tell me, Todd.

TODD: There’s one test that has to do with the heart, but I don’t think it’s very commonly known. So yeah, I think generally you’re not really gonna know. The best thing is to be proactive about it, which we’ll talk about. But the odds are that somebody here might, because there was a --

KIM: It’s probably me.

KATIE: One of us has it. Who is it?

TODD: There was a recent study that 60% of people have some sort of inflammatory condition and 40% have two.

KATIE: Okay, well, so, it sounds like one of us maybe has two and at least two of us have one.

ZACH: Yeah. Look to your left, look to your right, one of those people has --

TODD: You guys are probably -- you have a better chance than me ‘cause I think it’s probably something that increases as you get older.

ZACH: So age is a factor, you think?

KATIE: Yeah.

ZACH: Okay.

KATIE: And I think I -- I mean, I was probably a little doom and gloom with how I answered. But like, what we’re gonna get into today is how -- maybe, the tests aren’t quite caught up to detecting it. But there are obvious, sort of, lifestyle factors I think you would say. That sort of if you, you know, if you’re doing a certain number of things that we’re gonna talk about today, your chances of maybe having chronic inflammation a little bit higher. Right Todd?

TODD: Yeah.

KATIE: So, we’ll all be really excited to hear about those, ‘cause I’m sure it’s all the things we love to do.

TODD: Yes.

KIM: It’s something that you really can’t know if you have it, but it seems like there is a lot that you can do to potentially prevent it. Because if you’re eating well and if you’re exercising, if you’re doing the things that you probably you should do to just take care of yourself it can kind of help lower that risk. And you know, it’s crazy how so much of these sort of ac -- lifestyle actions that you can do are preventative for all sorts of disease states.

ZACH: You know, that’s a good point and that’s something that we’ve learned throughout the podcast here on On Health is how interconnected all these things are. Right? We compartmentalize like heart health, or -- or food, or exercise, all these things. And they all work together to improve your quality of life. Now, they’re not necessarily gonna keep you from getting ailments. Like you can be as healthy, you can do all the right things and still suffer certain ailments. But it really can’t hurt if you’re doing all the right things, so to speak, right Todd?

TODD: Well, in the case of inflammation that not only it couldn’t hurt, it’s sort of the prescribed thing to do to prevent it.

KATIE: Yeah, and you know Zach, I think it’s kinda perfect that you brought up the interconnectedness of everything. We’ve -- we talked about it several times on this podcast, and I don’t think there’s probably a better example of how interconnected everything is than chronic inflammation. I don’t -- Do you agree Todd?

TODD: Oh yeah.

KATIE: Yeah. I mean, the -- and it’s -- so many of these things we talk about, you know, like -- like Kim said: Diet, lifestyle, be healthy. But I think this is actually probably the best example of -- of how basic and why it matters because it -- it’s gonna kind of be the foundation of things.

TODD: Right.

ZACH: Well, who would we talk to today about this Todd?

TODD: We talked to Dr. Joshua Septimus, who’s an associate professor of clinical medicine at Houston Methodist and something of an authority on the subject.

[Sound effect signaling beginning of interview]

TODD: So, we’re here with Dr. Joshua Septimus, associate professor of clinical medicine at Houston Methodist. Greetings Dr. Septimus.

DR. SEPTIMUS: Greetings. How are you, Todd?

TODD: I’m good. Good to have you hear for this conversation on inflammation.

DR. SEPTIMUS: Thanks for having me back.

TODD: Just reading up a little bit on this today I saw the World Health Organization rank chronic inflammatory disease as the greatest threat to human health. Do you agree with that?

DR. SEPTIMUS: Woo. That’s a -- That’s a bold statement. I have not read that yet.

TODD: It’s that really the culprit behind our -- our deadliest diseases?

DR. SEPTIMUS: I think it is part of the equation. I think it would be hard to say that one particular trigger is the single unifying theory. I know people are always looking for that single underlying reason for everything under the sun. But I certainly think that if you look at the biggest killers, particularly in the western world, you’re talking about heart disease, strokes, cancer, Alzheimer’s disease. All of those things have chronic inflammation as at least a -- a participant in the disease process.

TODD: I think everyone’s familiar with acute inflammation, the redness and swelling that result after a wound or infection or injury. Not so much chronic inflammation that‘s a cause of disease. Can you give us a quick explanation and example of that?

DR. SEPTIMUS: So, we have -- since at least the 90s when I was in medical school started to think about chronic low-grade inflammation as a cause for chronic disease. The biggest example being heart disease where there was a, contrarian at the time, theory that people who had underlying atherosclerotic heart disease had an inflammatory component to that plaque, that cholesterol plaque that would rupture and cause heart attacks. And there was actually some pioneering work done here in Houston on that. So, when I was in training that theory was becoming more and more prevalent. There was an investigator named Paul Ridker at Harvard, who started measuring a special type of inflammatory marker called a High-sensitivity C-reactive protein. And correlating it with active cardiovascular disease using a new risk equation that he and his team developed. And so, from that cascade of events has come this theory that inflammation is playing more of a role that we -- than we think. And there have been a number of clinical trials now evaluating that. The -- you know, using pharmaceuticals to even help modify that risk. There was a big trail using Rosuvastatin, which is a very commonly used statin drug now, name brand Crestor. Where they took patients with heart disease who had good, like well controlled cholesterol and put those patients on Rosuvastatin if they had an elevated high-sensitivity C-reactive protein and showed a huge reduction in cardiovascular disease. So, proof of concept. And since then there have been some investigative drugs that they’ve attempted to study in reducing cardiovascular events. And just recently there was drug approval for the use of an old, old, old, drug previously used for gout called Colchicine to reduce the risk of recurrent cardiovascular disease events. So, now if you’re on statin therapy and all the other standard of care modalities for treating your heart disease, now cardiologists are starting to put you on an anti-inflammatory to reduce the risk of heart attack and stroke. And that’s one of these game changing chronic inflammation, pharmaceutical modification of your risk that we’re seeing with this low-grade inflammation that you can only find with this special test the high-sensitivity C-reactive protein. And there are examples all over the place of chronic inflammation leading to disease that spans from really poor data to excellent data, like the cardiovascular disease. So, it infiltrates many, many, many aspects of medicine.

TODD: And this started in the 90s by medicine standards that constitutes kind of a new field, right?

DR. SEPTIMUS: Yes. And by the way, I don’t know if that’s the first time anyone thought about inflammation, but I know in terms of cardiovascular disease at the time it was considered to be a relatively revolutionary idea.

TODD: An -- But it’s still sort of early in the field that they’re still learning about it. It’s still something of a mystery.

DR. SEPTIMUS: Absolutely. And if you think about it, we have one FDA approved medication to treat that inflammation. And that tells you, you know, whenever there’s something that’s as common as cardiovascular disease that only has one medicine, you know it’s in its infancy. And I would be shocked if there were not a dozen other medicines in development that are going to follow the Colchicine story.

TODD: So, why did it take so long though? It seems like inflammation is well known to doctors and so much of disease.

DR. SEPTIMUS: Well, I think you’re looking at it from the lens of 2023. If you look back to the 90s when I first got into medicine, inflammation was really associated with autoimmune disease when you’re talking about chronic inflammation. Things like rheumatoid arthritis, things like systemic lupus erythematosus, things like Sjogren’s disease, you know all of those chronic autoimmune diseases. And it’s been in my career, in my medical lifetime that we now tightly associate all of these chronic inflammatory conditions with cardiovascular disease. Why? Again, this inflammation. I think it’s that we’ve been focused on what our technology could evaluate. So, in the 80s I believe is when they came up with, for example cardiac stents and what are called PCIs where you just opened it up with a balloon. And at the time I think it was more of a plumbing hypothesis. So, they just got slow accumulation of plaque, there wasn’t as much of an -- there wasn’t as much of an elucidation of this being more complex than that because these were the tools that we had. We didn’t have statin therapy. We didn’t have so many of these other non-mechanical therapeutics. And similarly with cancer, think of how much more we know about cancer now than we did in the 1980s. And how much has been published in that time on the relationship between metabolic syndrome, which is central obesity and insulin resistance, which by the way, is another chronic inflammatory condition, and the risk of cancer. Why? In my opinion, because it’s a chronic inflammatory condition and that high insulin level and metabolic syndrome, it’s all tied in with this inflammation. But all of these things are relatively new in terms of what’s being researched, and what people’s thought processes are.

TODD: So, I guess I’m thinking of all the itises: sinusitis, colitis, tendonitis. I mean, I was told I had chronic sinusitis back in the 80s. That is -- is that what we’re talking about or is that a different animal?

DR. SEPTIMUS: No, those -- so even chronic sinusitis could we considered more of an acute phrase response. Even if you have chronic sinusitis that goes on for months. And it’s a much more -- You can measure that C-reactive protein that I was mentioning earlier, you can see in someone who has sinusitis that that’s elevated even without that more sophisticated high sensitivity test that I was talking about. We are talking about very low levels of inflammation and even localized levels of inflammation that are in only particular areas. So, it takes a much more nuanced approach to inflammation than the diverticulitises of the world and the gastroenteritises and the sinusitises and those types of things that are clinically in front of your face. You can see someone that has an acute infection or abdominal pain, or acute you know, gastrointestinal infection. You can’t see those chronic low-grade inflammations that lead to vague symptoms or no symptoms at all.

TODD: And there’s not an obvious trigger.

DR. SEPTIMUS: I think in a lot of cases there is. I think a lot of times we don’t want to see those triggers. I personally think that processed foods and just our American lifestyle in general are enormous triggers for chronic inflammation. You’re never gonna be able to prove that in a randomized controlled trial. But clearly people who eat a lot of processed food, a lot of processed sugar, have high levels of inflammation and therefore high risk for all of these other diseases that we’ve talked about already. But again, these are all subtle very, very, low-grade as opposed to the person who has an attack of diverticulitis and has to go to the hospital because they’re in abdominal pain.

TODD: So, the thing is that people usually don’t know about this until it’s progressed to the point that it’s caused disease. It’s insidious.

DR. SEPTIMUS: Correct. Insidious is a great way of describing these chronic inflammation conditions. And in fact, I think that most people don’t even associate chronic inflammation with the diseases that are self-evident. I don’t think if you were to ask the average heart disease patient, “Do you have an inflammatory condition?” I think the vast majority of them would say, “No.” Whereas I would say, “Absolutely, if you have heart disease that’s an inflammatory condition.”

TODD:  Is there any way to know if you have inflammation, if you don’t have obvious symptoms. Are there more subtle symptoms to be on the lookout for?

DR. SEPTIMUS: Well, I think you have to start by looking at it by -- on a disease-by-disease basis. There are some diseases, for example, cardiovascular disease that I keep going back to where we have that high sensitivity C-reactive protein. And if you have a high sensitivity C-reactive protein of less than one, your risk is very, very low. It doesn’t exclude that you could have a really low-grade inflammation, but it -- but it’s -- it helps, I don’t know of lab tests for chronic low-grade inflammation in any other disease state. Doesn’t mean they don’t exist, but I don’t know of them. I think that when you say what are the symptoms of chronic inflammation you get a little bit off the rails of what I would call traditional allopathic medicines, so allopathic physicians are doctors like me, who practice kind of traditional medicine. Osteopathic medicine is very tightly related to allopathic medicine. And so, I think when you talk about allopathic and osteopathic physicians, we would say that there’s no hard science behind symptoms of chronic inflammation. But going slightly off of what we know with hardcore science I think people who are struggling with chronic fatigue, people who are struggling with sleep, people who are struggling with chronic pain. One, as a physician, should at least think about inflammation in those cases and what you can do to reduce their inflammation even if you can’t measure it. I’ll give you an example. You have a patient who is struggling with fatigue and generalized aches and pains, and you see them and they’re not living a very healthy lifestyle. Well, I would go back to that person and talk to them about what we can do, not necessarily explicitly saying, “These are things to reduce your inflammation.” But that is what I’m thinking in the back of my mind and say, “Okay, let’s talk about your sleep. Because if you don’t sleep well, your stress hormone levels are gonna be high. Let’s talk about your stress. Do you need to practice mindfulness? Because if you practice mindfulness and you reduce stress, you’re gonna reduce inflammation. Let’s talk about your diet. Let’s get the processed foods out of your diet. Let’s get you exercising, because if you’re exercising, you’re gonna reduce inflammation.” If you can get patients to buy into that, you’re gonna have a high success rate in getting them to feel better. You may not get them to feel perfect, but I think you can get them feeling better.

TODD: Is there a genetic component to this at all or it is -- is it mostly kind of in your mind is probably a diet/lifestyle thing?

DR. SEPTIMUS: There’s no, that I know of, hardcore scientific data, but I think look at families. There are some families where everyone in the family struggles with obesity, everyone in the family struggles with their gut, and there’s other families where family members don’t necessarily take great care of themselves and yet they have longevity. They are not severely overweight. They have good energy levels. So, I do think there’s a genetic component to it and there are some people who are really lucky. Who -- man, if you’ve got that genetic lottery and you also take really good care of yourself, those are those people who are in their 90s who are still working and productive and feel good ‘cause you gotta have both. You gotta hit the generic lottery and you have to take care of yourself to make it that far.

TODD: Do you talk about this with your patients a lot? Is it hard to get their attention about something that seems -- that’s kinda silent and amorphous?

DR. SEPTIMUS: So, those are two very different questions. Yes, I do talk about this with my primary care patients. The problem is, as you can tell from this discussion it’s incredibly nuanced and it’s incredibly time consuming. And it involves asking people to make enormous changes to their lifestyle. There’s a physician name Peter Attia who -- he’s a become a little bit of a cult hero to the longevity community, fascinating guy. He lives in Austin. Who calls our American diet, the SAD diet, the Standard American Diet. And that’s what the vast majority of my patients follow. It’s a diet heavy in processed foods. It’s a diet that is very high in calorically heavy and nutrient poor foods. And what we should be eating is a diet that is real food that is nutrient dense and calorie poor. But that’s not what’s easily available. It’s not what’s cheap. It’s not what stays good in your refrigerator or on your counter for long periods of time. So, it’s hard. And when I asked patients who for their entire lives have been following that SAD diet to make changes, it’s incredibly difficult to break through. It doesn’t mean I don’t try, and it doesn’t mean that anyone listening to this podcast shouldn’t try because even small changes can make enormous differences, but it’s hard.

[Music plays to signal a brief interjection in the interview]

ZACH: Dr. Septimus mentioned the type of foods that lead to inflammation, the so called Standard American Diet, processed foods and foods high in calories and low in nutrients. Here are the leading specific ones to avoid: Red meat, bacon, hot dogs, lunch meats and cured meats. Refined grains including: white bread, white rice, pasta and breakfast cereals. Snack foods such as: chips, cookies, crackers and pastries, sodas and other sweetened drinks, and fried foods. What should you eat instead? You may have heard it touted before, but the Mediterranean diet is considered a model anti-inflammatory diet. It’s heavy on plants, whole grains, and fresh unprocessed food. Handy prioritized protein options contain less saturated fat and more omega three fats such as: salmon, mackerel, sardines, and certain tunas.

[Sound effect signals return to the interview]

TODD: These conditions tend to be degenerative conditions?

DR. SEPTIMUS: Not necessarily, I wouldn’t call heart disease degenerative. I wouldn’t call cancer degenerative, but chronic inflammation can lead to degenerative conditions. I don’t have a randomized clinical trial where I can tell you that Alzheimer’s disease is clearly a, you know, inflammatory linked condition but I do believe that. And so that would be considered degenerative from chronic inflammation and obviously, if someone has rheumatoid arthritis, they’d slowly if they don’t treat their rheumatoid arthritis will develop joint degeneration. But I wouldn’t call chronic inflammation a degenerative condition all in one ‘cause I think it’s more subtle than that.

TODD: Okay. You mentioned autoimmune diseases, are those considered an example of this?

DR. SEPTIMUS: Autoimmune diseases are absolutely chronic inflammatory conditions.

TODD: But the biggest mystery of all, right? How they develop and what’s going on, why the immune system is going so haywire.

DR. SEPTIMUS: What I would say is we know a lot about autoimmune conditions. We know that there is a genetic component. And we know that there’s something environmental that probably contributes to trigger the immune system to go haywire. But we usually can’t identify that one particular thing.

TODD: So, what do we know about the process by which inflammation causes disease? What happens as it continues over time?

DR. SEPTIMUS: Well, I would take you back to heart disease where we know the most. When you get atherosclerotic plaque what’s happening is you are getting cholesterol deposited underneath your endothelium. Your endothelial layer of your heart is the lining of your blood vessel walls and cholesterol gets deposited there. And once it gets deposited it triggers an inflammatory response, and that inflammatory response grows the clot, damages the blood vessel wall, and makes that blood vessel wall more prone to further damage and eventually leads to plaque rupture which is what causes a heart attack. I don’t have a good feel for what the underlying pathology is of chronic inflammation leading to cancer for example. I’m sure somebody else knows that answer but.


TODD: Is obesity always predispose you to inflammation?

DR. SEPTIMUS: I believe it does, yes.

TODD: But you can also have inflammation going on if you aren’t overweight?

DR. SEPTIMUS: Absolutely. And there is an interesting concept in endocrinology and in bariatrics now of the “healthy obese” meaning people who are technically body mass index over 30 but they are metabolically heathy, and those patients are not gonna have a whole lot of inflammation. And then people who are the non-obese but metabolically obese, and those are the metabolic syndrome patients. Those patients, even if they’re not struggling with obesity, they are metabolically obesity. Meaning they have insulin resistance, they have a low HDL, they have a high triglyceride. If you did a fasting insulin on them it would be high. Those are the patients that you see who are much less healthy than they appear. Much more common in people from the Indian subcontinent we see a huge risk of diabetes in those patients, even though their body mass index would not indicate obesity. And in fact, the guidelines for metabolic syndrome are different depending on your race, as a result of that. So, people from the Indian subcontinent do not need a waist circumference of 40 inches the way that Caucasians do to get that tick, or that checkbox for metabolic syndrome.

TODD: In your mind are weight issue the primary risk factor for inflammatory disease?

DR. SEPTIMUS: I wouldn’t call it the primary. I would call it a significant because I think it’s just much more complex than that. And I think obesity is very prevalent in the United States for example, but there are other places where it’s not as prevalent where you still see a lot of chronic inflammation. So, I think certainly it’s a contributing factor, but I don’t know that I would pick any one thing and label it as the primary.

TODD: But what other risk factors are there?

DR. SEPTIMUS: There’s risks we talked about, there’s genetics, there’s diet, there's stress, there’s sleep disorders, any number of environmental factors, toxins, that you know, like if you live in a city for example where the air is heavily polluted, that’s gonna promote inflammation. You know, there’s any number of things that you could point to.

TODD: And so, what can you do to prevent it?

DR. SEPTIMUS: My take home is really -- it’s one of those things where it sounds so simple but it’s incredibly hard to implement. When I start talking about this with patients, I tell patients the easiest way to think about inflammation is actually to think about insulin. So, we always think about insulin as being this life saving hormone that diabetics need to survive. But in fact, most diabetics are type two diabetics, and type two diabetics are resistant to insulin. So, when patients become insulin resistant, which that’s the majority of the inflammation that I see, is people who have chronic insulin resistance. Everything you can do to reduce your insulin level is gonna be good for inflammation. The reason I like this way to discuss it is it’s simple. What am I doing with my body and what am I putting in my body that will reduce my insulin levels. So, if I’m eating processed food, I’m increasing my insulin levels substantially as opposed to even it’s the -- if it’s the same number of grams of carbohydrate, if I’m eating vegetables. The difference between my insulin response to those two carbohydrate loads is gonna be markedly different. Everything you do with your body, so if you are sedentary your insulin response is gonna be terrible. But if you are physically fit, you are gonna have a much more healthy insulin response, and even one up from that if you build healthy muscle mass, which our muscle mass naturally decreases with age. So, if you fight that and you do resistant -- you participate in resistance training regularly and for the rest of your life that will reduce your insulin resistance. Weight management reduces insulin resistance. Stress management with mindfulness or changing jobs if you need to or, you know, seeing a therapist reduces insulin resistance. And then sleep, if you sleep better your insulin resistance will go down. So, tho -- it’s -- I know it’s a little overly simplistic, but I like using that model of discussing inflammation because it enables patients to tackle it without getting overwhelmed.

TODD: So, in terms of diet are there any specific foods that would be good to, you know, the so called superfoods, foods rich -- high in omega threes.

DR. SEPTIMUS: So, I don’t buy into the super food hypothesis. I think that it’s one of those things that patients like because it’s the easy answer. But I honestly feel there are no easy answers here. Michael Paul, and I, I have to give credit. I give out a list of his recommendations to a lot of my patients really, I think summarizes it best. He las a list of three basis things about food and a list of seven. I put the seven in my after-visit summaries for patients a lot, but the three basic are to eat real food, mostly plants, and not too much. That literally sums up everything you need to know about nutrition. Now, that’s really complicated actually if you think about what undermine -- what under -- what’s underneath those three statements. Eat real food. What is real food? Real food is food that will rot. Real food is food that your great, great grandmother would recognize. Real food is food that you can pronounce every ingredient on a list of ingredients on a package. Real food is generally found on the outsides of the grocery store, not the packaged foods in the middle, mostly plants. Okay, well we’re not talking about being a vegetarian and in fact, I actually strongly recommend against vegan diets but if you fill you plate with 50.01% vegetables and fruits, you’re gonna get a lot of nutrient dense and calorie poor foods and that’s gonna be good for you.

TODD: Other prevention agents? I know in our supplements podcast you mentioned turmeric curcumin. Is that something to take proactively?

DR. SEPTIMUS: I would not recommend using it proactively. There’s really no evidence that it would work as a prophylactic. I do recommend it to people who are actively struggling with joint pain and we’re trying to avoid putting them on NSAIDs which are things like Ibuprofen and Aleve. But I don’t recommend anything as a prophylactic agent. I don’t think there’s any shortcuts.

TODD: Are we getting it in food? In Indian food or spices?

DR. SEPTIMUS: We’ll I love Indian food, so I absolutely recommend that. But, you know, if you think about it these traditional diets that are not the, you know, meat and potatoes diets, they all have a couple of things in common. They utilize a multitude of different spices. That’s good, because a lot of these spices seem have natural anti-inflammatory properties, makes the food taste really great. And a lot of these traditional and ethnic dishes have lots of colors to them. Meaning they’re getting, you know, different phytochemicals, different phytonutrients. And they tend to have a lot of vegetables associated with them, minimizing, you know, the caloric density that you’re experiencing. And by the way, I’m not telling anybody that they should be a vegetarian if they don’t want. And I think that protein intake is incredibly important, especially as you age. And the most efficient way to get protein is generally through animal protein. So, I don’t want anybody to think that I’m saying don’t eat any animal protein, I just think that it’s important to balance.

TODD: Inflammation targeted treatment. You mentioned the gout drug, is there anything else?

DR. SEPTIMUS: So, right now, Colchicine just was approved for people who have already had heart disease at a low dose to reduce cardiac events by about 25, 30%. I don’t know of any other, again prophylactic or preventative agents that have been specifically approved for inflammation. Statins actually have what’s called a pleiotropic effect meaning that beyond the fact that they lower cholesterol they also have some anti-inflammatory effects. So, you could throw statins into that kinda list even though they’re not technically for inflammation. But I really do think for these chronic low-grade inflammatory related conditions the key is lifestyle.

TODD: Lastly, you mentioned this before but -- so this is -- you wouldn’t consider this a unifying theory of disease?

DR. SEPTIMUS: No, I think that diseases in humans are too complicated. I, you know, I had a professor in medical school named Stephen Greenburg. He’s an infectious diseases doctor, who was the chief of medicine at Ben Taub in Houston which is our county hospital. He’s an infectious diseases doctor who said that all disease can be summed up in three categories and that they overlap. And those are trauma, genetics, and infection. So, I have not found something that doesn’t fit in to those categories and I would say that chronic inflammation is a trauma, right? Poor diet and, you know, toxin exposure from bad air, poor lifestyle. That all is trauma. But there’s still almost always a component of at least one other thing that’s contributing, usually genetics when it comes to chronic disease. But you even see for example there’s some cancers now that we know are triggered by infections, like cervical cancer and head and neck cancer with human papillomavirus. So, I think it would be overly simplistic to say it’s a single unifying theory.

TODD: Alright. Very good. Well, I think that’s all I have. I appreciate you taking time to talk with us. It was certainly an educational podcast for me.

DR. SEPTIMUS: Thanks for having me.

TODD: Okay.

[Sound effect signals the end of the interview]


ZACH: Alright, well, take aways guys?

KIM: My first take away is Zach, that list of foods you read to avoid what was little depressing.

ZACH: I feel like that’s what I eat all the time.

KIM: Yeah.

ZACH: I feel like that’s my diet I just described.

KIM: It certainly was my diet in my 20s. So, I hope -- I hope you can reverse chronic inflammation to some extent ‘cause I certainly had it in my 20s, that’s for sure.

ZACH:  That’s the thing like when I’m being healthy, that’s my diet. But I have to actively be he -- like my default what am I gonna eat, is that list. Like, I’m not even kidding. So that could explain some of my health ailments.

KATIE: I think that’s most people’s lists.

ZACH: Yeah.

KATIE: I think -- from blog posts I’ve written, I’ve read that it’s some percentage over 50% of Americans eats mostly processed food.

ZACH: Yeah.

KIM: Yeah, I don’t know, that was probably my biggest take away in the sense of really like staying accountable of how much of those foods I’m eating. I don’t know, Todd when you were -- you were taking to Dr. Septimus what was your kind of like reaction to all of this?

TODD: You know I, like you in my 20s I ate a lot of that stuff but at some point, I cleaned up my act and especially even reading your blog posts since I’ve been working here, I’ve continued to be educated about this stuff. I find that for me, eating at home it’s pretty easy to follow the advice. It’s more when I’m out with people that I let my…

ZACH: Social life is the biggest detriment to your health.

KIM: Yeah, that really is the best point. But I felt like it was really encouraging that it sounded like he felt like you could really turn the ship around if you just get started with it.

TODD: Yeah, Dr. Septimus spoke about how some patients respond very well and can turn things around.

KATIE: That was exciting for me to hear, and I was really surprised about how he spoke about mental health too and how stress can be -- can cause inflammation.

TODD: Right, stress is considered one of the -- one of the big causes.

ZACH: Stress.

KATIE: Yeah. None of us have any of that.


KATIE: You know, I also got one of my questions answered, you know, that I -- that I’d pose to you Todd, in the sense of, okay if we can’t really know it’s happening, you know, what can you do about it sort of like, you know, what is -- what’s the story there? I was -- I found it intriguing that he mentioned that blood work won’t necessarily show low-grade inflammation early on, right? So like right now, you know, I know that I don’t have high blood pressure, things like that. Some of these things that are linked to chronic inflammation. But if I’m going to my doctor complaining about chronic fatigue they can recommend just these lifestyle factors, ‘cause that is the preventive strategy of all of this. So, I like -- I liked that part that it truly is not such a negative outlook in that, “Oh it’s the silent, like insidious thing that’s gonna like take us all down.” There is still an exit strategy and like a forward path to avoiding it or, you know, like we all said, turning the ship once we get over 20s. We’ve do -- I think a lot of us have done that. But for anybody who kinda hasn’t taken that step yet, it’s -- you know, you can do it.

ZACH: You know, that’s super encouraging ‘cause I’m one of the people who, like if I wanna do something at 3:00 and it’s 3:05, I’m like, “Well, gotta wait ‘til 4:00.” You know, so I, you know, wait if there’s still a chance you can kinda so there's still a chance you can kinda right the ship -- I don't know why we keep using the ship analogy, but righting the ship.

KATIE: We’re using the analogy. Let’s go.

ZACH: No, that’s great. Turn that -- turn that wheel, you know, that steering wheel. Right as we… What’s the thing? Is it a steering wheel? We all know what I’m talking about.

KATIE: Yeah, what is it called?

KIM: The stern.


ZACH: Anyway, turn that thing 360, turn that thing around.

KATIE: 180.

ZACH: Yeah, 360 is not what you want to do in this situation, but yeah, 180. No, but it’s true though because you get your mindset, “We’ll, what’s the point now, right? I mean, there’s no way to undo the damage I’ve done.” But there is and that’s encouraging.

KATIE: And we heard so many of the most common medical conditions got tossed around in this episode diabetes, heart disease. I mean, I think these are things that, you know, are, they’re so common and it’s these early steps to take. And I know they’re hard, like -- yeah, I -- we all know they’re hard. Right? I would love to just have a bag of hot fries for lunch today. Nothing would please me more, but you know, I mean more times than not, it’s making that decision to not have the bag of hot fries, have some, you know, broccoli and a piece of chicken instead.

ZACH: Don’t make it sound so sad to be healthy Katie.

KATIE: I know. And I should say Mediterranean diet too. I think broccoli and chicken -- I think a lot of us and maybe this is the whole podcast topic at some point, because I think the Mediterranean diet, I feel like it’s come up in a couple seasons now talking about like what that really looks like. I know we can rattle off lists of things, but I think a lot of people think it’s like eating and being a vegetarian and it’s not, it’s just getting rid of some of these processed food.


And then eating plants but, you know, I mean, getting rid of the bad stuff is key.

ZACH: No more two hot dogs at the baseballs games as I’ve been known to do.


TODD: I think for the next work gathering where they order in catered food, they should have seafood paella instead of…

ZACH: I’m down.

KIM: I don’t know if I would eat catered paella. I’mma be honest.


KATIE: I have something easier, fish tacos.


ZACH: Alright, well that’s gonna do it for this episode of On Health with Houston Methodist. Share, like and subscribe wherever you get your podcasts. We drop new episodes every Tuesday morning, so until then, stay tuned and stay healthy.

[Music ends signaling end of episode]

Categories: When Should I Worry About...