Читать книгу Health Revolution - Maria Borelius - Страница 14
ОглавлениеIt’s a spring night in Lund, Sweden, 2013.
It’s just the kind of fresh spring evening that creates such expectations of life, love and all the other wonderful things that belong to the light time of year. Students are riding their bikes towards the city centre. Trees are budding in the Lundagård park next to the cathedral’s sandstone walls. The magnolia by the cream-coloured university building will soon begin to bloom, just in time for May Day, when student singers will once again sing a welcome to spring and the beautiful month of May.
Together with the other members of the advisory committee that meets regularly in order to support the university’s big 350-year jubilee, I’m sitting in the old Biskopsgården, just below the library. At the last minute, I’ve decided to attend this meeting, even though my calendar is full. It will turn out to be a significant event.
Every time the group gets together, we have the privilege of meeting one of the most innovative researchers at the biggest university in the Nordic region. Today we’re going to meet a specialist in nutrition research. Professor Inger Björck is introduced and steps forward to talk about her brand-new research. Only a few minutes into her presentation, I realise that her findings are very important, even somewhat sensational.
She gives us a brief background.
Professor Björck leads the Center for Preventive Nutrition Research at Lund University. Scientists there are conducting interdisciplinary research about how a variety of diseases can be counteracted with a proper diet, as well as research into what is known as the metabolic syndrome.
The metabolic syndrome, a medical term that has become more and more common, includes three conditions: diabetes, obesity and high blood pressure. Each of these conditions carries risks. But together, they form a type of super risk for serious heart disease, stroke and other cardiovascular diseases. It is also suspected that this metabolic condition is connected to certain forms of cancer and even to an increased risk of dementia.
Researchers haven’t quite been able to explain the metabolic syndrome. One theory is that it has to do with insulin, the hormone released by the pancreatic gland when you eat sugar-containing foods and whose function it is to move the broken-down sugar into the cells. People with diabetes 1, which often begins to manifest in the teenage years or even earlier, lack the ability to produce enough insulin.
But there is also an acquired form that sneaks up on people later in life, diabetes 2. (Today there are researchers looking into whether there may also be a number of intermediate forms between diabetes 1 and 2, but we’ll leave that aside here for the sake of simplicity.)
To sketch out a simple explanatory diagram for this process, when you eat sugar and your blood sugar level rises, a signal is sent to the pancreatic gland, which releases insulin. The insulin is sluiced out and ‘opens up’ the cells in order to sluice in the broken-down sugar, along with proteins and fat.
When the body constantly takes in large amounts of sugar and insulin levels have to stay elevated in order to shuttle the sugar out of the bloodstream and into the cells, it creates a so-called insulin resistance. In other words, there is insulin in the blood that’s supposed to deal with the sugar, and that makes the insulin attach to the cells, but something goes wrong in the communication between the insulin and the cells. The cells simply lose their ability to react to the presence of insulin. The number of people who have metabolic syndrome is growing rapidly, because more and more people eat the wrong kind of food, have a sedentary lifestyle, and/or suffer from stress and other psychosocial problems.
The above-mentioned triple combination, with diabetes/belly fat/high blood pressure, used to be a medical condition that affected mainly older people. But now it’s increasing even among younger men and women. Altogether it’s estimated that one quarter of the adult population in the United States, Canada and Europe have metabolic syndrome. In short, we are talking about an epidemic that is increasing like an avalanche in the Western world, an enormous threat to public health.
In the past, each of these diseases was studied separately. But Inger Björck and many other researchers worldwide are now beginning to realise that the diseases are in fact connected.
‘Then you have to wonder, how can suffering be prevented?’ she says.
Inger Björck is carrying out innovative research in this area. For example, she’s studied mice that have been fed either a high-fat or a low-fat diet. In addition to that diet, the mice were given different berries and fruits like lingonberries, raspberries, prunes and currants. It turned out that the mice who ate berries – especially lingonberries – maintained the same weight regardless of whether they ate a high-fat or low-fat diet. The lingonberry group actually lost some weight, even with a high-fat diet.
Björck believes that the risk of diabetes 2 and coronary artery disease can be decreased by means of an entirely new method, a new category of food in which berries are part of a larger food group.
‘These foods are called anti-inflammatory,’ she says.
I make a note of the name. It calls to mind what I read about in Dr Perricone’s books ten years earlier.
Then Professor Björck begins to explain how these new foods can affect the whole person, not only blood pressure and cholesterol levels but also cognitive ability, or the brain function that includes a person’s intelligence, in the broad sense of the word – our capacity to think, remember, solve problems and learn new things. This research sounds both creative and worthwhile, and so far I’m following her presentation with interest. This is worth supporting, my professional self acknowledges in an observant yet slightly distant fashion.
But when she shows us the list of the foods the researchers have been using to achieve these results in people, I get a shock. A slow-motion lightning bolt strikes my brain, and I sit at the very edge of my chair, suddenly wide awake.
First, there are things like decreasing sugar, doing away with white flour, increasing the intake of all kinds of berries, increasing the amount of vegetables and fatty fish, and adding vinegar and probiotic supplements. But then comes a concrete list of foods, and it looks like . . . Rita’s food list?
My heart does a quiet leap of recognition and time stands still. I gaze around me at the old meeting room, with its view of the university library’s stepped gable in brick. The great linden trees shimmer with fresh new leaves in the spring evening.
What is this? Have I unknowingly been eating anti-inflammatory foods and thus affected my body much more deeply than I had realised?
The effects I’ve felt are exactly the ones that Inger Björck describes in her test subjects. They grew stronger, reduced their waistlines, expanded their mental capacity and developed more of a zest for life.
Or is it just an amazing coincidence?
After the talk, we are served an anti-inflammatory buffet that the researchers have designed themselves. They’ve even baked their own bread, similar to Danish rye bread, using whole barley. There are salads, fatty fish and nuts, and everything is delicious. Over one of the salads, I share my insight with another woman. I lean forward confidentially, almost a little embarrassed.
‘I’ve actually been eating like this for a few months. Or at least trying to.’
‘I thought you looked energetic, somehow,’ she says, looking at me appraisingly.
I go up to Professor Björck and tell her that there are in fact people who live like this every day but who haven’t quite made the scientific connection to anti-inflammation that Björck’s team has. They just do it because they’ve discovered that it works.
‘Who are they?’ she wonders.
‘Well . . . fitness people in the United States and Canada,’ I say.
She looks surprised. We agree to stay in touch. And that’s where my own journey of knowledge begins.
Inflammation and anti-inflammation. What is this all about? I have to learn more.
I begin racking my brain for long-ago facts from my university studies in immunology. I think I took that course in the red building at the old Veterinary College in Frescati in Stockholm, if I remember correctly, and we learned something about the two forms of inflammation – because inflammation is not always a bad thing.
The first type of inflammation is purely positive, a helping process. Imagine a cut from a kitchen knife, a finger squeezed in the car door, a urinary tract infection or a sore throat. When you’re injured or infected, your immune system starts producing inflammation as a defence mechanism. A teacher I once had used this image to describe it: imagine a land that is being attacked by an external enemy and wants to defend itself. That’s how the immune system works. The outer injury is the external enemy, the immune response is the country’s government and defence, and the inflammation is part of what you have to do to defend yourself. There are a number of different foot soldiers who help. These soldiers in turn have many different specialist functions, just like in a regular army, with bridge builders, telegraph operators, explosives experts and intelligence agents.
In human blood, the blood platelets constantly wander around looking for problems in the blood. The blood platelets gather around the problem – the cut, the bruise or the infected body part – and then send a chemical signal to the immune system.
‘Problem at g, come here right away,’ say the blood platelets.
The signal is intercepted by the white blood cells, who answer, ‘On our way.’
An advanced line of defence is set up, with many different types of foot soldiers. They’re called cytokines, leukotrienes, prostaglandins, chemokines, thromboxanes and so forth, and they function like support troops, where each one sets out with its own task. They expand the blood vessels at the site of the affected tissue and make the area around it more ‘transparent’. This means that more cells from the immune system can reach the injury, attack enemy bacteria, clean out old junk and then repair and build up new and fresh tissue.
In medical training around the world and through the centuries, students have had to learn to recognise an inflammation the traditional way, which originates with the ancient Roman Celsus, who wrote great reference books about the body. Celsus’s favourite treatment was to simply open the veins and empty out the ‘extra blood’, a procedure he recommended for many types of health problems, as well as for people ‘with big heads’. Celsus also described the signs of inflammation in Latin: rubor, tumor, caldor, dolor. Redness, swelling, warmth, pain. Which is exactly what you feel in your throat when you have a sore throat. These signs of inflammation can in turn be counteracted by RICE, or rest, ice, compression, elevation. (Exactly what you do with a sprained ankle.)
The whole point, in short, is that inflammation works like a kind of fire department. It rushes out, attacks the enemies, cleans out and repairs. Then the system goes back to resting status.
This acute type of inflammation has a rhythm. There’s an ebb and flow, a clear beginning and an end, and the rhythm signals a healthy and active immune defence. It isn’t this type of inflammation that’s problematic but rather another one, which seems to be affected by food and contributes to illness. I wondered who might be able to tell me more about it.
I investigate some more, and after a while I find a new trail. There’s a researcher in the United States, Barry Sears, who has been on this track for a long time and founded an organisation for research in that area, the Inflammation Research Foundation. I’m not able to travel to meet him, but I don’t want to just send him an email, since there’s so much that I don’t understand. We need to actually talk.
I’m able to reach him by phone, and he gets right to the point.
‘This is a new area for most doctors. I’ve been working in the field for a while, but in general way too little research has been done.’
He mentions how many different kinds of diseases the low-grade systemic type of inflammation is linked to. We’re talking about heart disease, high cholesterol values, diabetes, joint problems and neurodegenerative disease, but also certain forms of cancer.
‘But what exactly does this low-grade systemic type of inflammation do?’ I wonder.
He begins to explain very fast, and it’s hard to follow him since the connection breaks several times during our call.
‘Okay, how about this: I’ll send you a scientific article,’ Dr Sears says.
He soon emails me an article from European Review of Medical and Pharmacological Sciences. I click it open.
‘The inflammatory response was developed over millions of years and allowed us to coexist with a number of microbes. The same inflammatory response also made it possible to repair physical damage . . .’
Okay, I think, acute inflammation is an ancient mechanism with benefits, millions of years old . . .
‘But there are also equally important anti-inflammatory mechanisms in the inflammation cycle that allow cell repair and renewal. Only when these two phases are continually balanced can the cells effectively repair the small damages that arise with inflammation.’
This is new to me. Does this mean there’s a need for balance inside the system itself – perhaps that just as there’s an inflammation yin, there also needs to be an inflammation yang?
‘But if the proinflammatory phase continues in a low but chronic level under the pain threshold, it can drive many chronic illnesses. In the end it can result in organ damage, loss of organ function and lead to severe illness, in spite of the fact that the initiating illness-causing events may have taken place decades earlier, triggered by an underlying and ongoing chronic inflammation process.’
So, low-grade inflammation arises from imbalance – from a steadily ongoing inflammation that doesn’t cause a ‘fire department’ type of acute inflammatory response but in the long run can act as a catalyst for small seeds of illness that have been germinating in the body for a long time.
Is this the type of inflammation that we bring about through an unhealthy lifestyle? In other words, might bad nutrition, stress, environmental toxins and other lifestyle factors give us inflammation, which in turn makes us sick? Perhaps that’s why the wrong food can lead to illness and not just to us ingesting too many calories.
And is it true that long before we actually become ill, the low-grade inflammation affects us so that we start to ‘lose steam’? When I went to the doctor complaining about my back pain, depression and listlessness and looked for explanations based on external things (‘the kids are moving away from home’), maybe it was actually a low-grade inflammation, an imbalance in my immune defence caused by a number of lifestyle choices, leading to my bad back, blue mood and bloated stomach. And maybe this is what I’ve ‘cured’ with my new lifestyle choices?
I go on looking to see if my symptoms, like back pain, fatigue and a ‘low’ feeling, could have been signs of low-grade inflammation. I find the following symptom list:
• The skin looks older, is drier, and has more wrinkles
• Lower energy
• Less stamina when exercising
• Swelling in the face
• Swelling around the belly
• Increased risk of either constipation or loose bowels
• Less ability to concentrate
• Fluctuating appetite
• Fluctuating blood sugar levels
• Weaker immune defence
• Joint pain
• More depressed mood
I can tick off several of the points but not all. So far, we’re just talking about what a doctor would call ‘everyday troubles’. But how does inflammation work in relation to serious illnesses?
I realise that I’ll have to become a detective in order to get to the bottom of this riddle. No single researcher seems to have the whole picture. I will have to solve a jigsaw puzzle.
A few years earlier, an editor in a publishing house gave me a book called Anticancer. I didn’t read it then, but one day it falls off the bookshelf as if some friendly soul in there wants to help me on my way. It turns out to be a good lead.
The book is by the French neurologist and Médecins Sans Frontières activist David Servan-Schreiber, who developed a brain tumour at the age of thirty and set out on a journey of knowledge to save himself. In the book, which became a bestseller in many countries, he reported on some of the leading research about the essence of cancer, as well as strategies for keeping up resistance. Servan-Schreiber eloquently describes how cancer and inflammation are intertwined and drive each other on in a kind of evil witch dance.
‘I realise that I’ll have to become a detective in order to get to the bottom of this riddle. No single researcher seems to have the whole picture. I will have to solve a jigsaw puzzle.’
A tumour is a number of cells that begin to grow wildly and unchecked. In the beginning, there’s enough nourishment for the tumour in its immediate surroundings, but after a while it outgrows its small neighbourhood. The tumour now begins to operate with a devilish intelligence, causing an inflammation around itself. Why? Fascinated, I continue reading. The tumour uses the inflammation to manipulate the immune defence and make it ‘attack’ the tumour from inside.
Once the immune defence has got into the tumour, it faithfully begins to work according to its usual procedure when it encounters inflammation, which involves, among other things, producing certain substances that are going to help repair the tissue. It’s just that the tissue being repaired this time is an enemy – the tumour itself. The immune defence is literally fooled by the tumour. Instead of protecting the body against the tumour, it begins to fuel its further growth out into the body. New blood vessels are built to bring new nourishment to the tumour, and little supporting structures help to anchor the tumour even further.
To sum up, the tumour creates an inflammation that in turn feeds the tumour, which in turn creates even more inflammation in its surroundings, spreading the disease further. The effect of the inflammation is like pouring petrol on the cancer fire. That’s why cancer is such a diabolical disease and so hard to fight.
Professor Björck has also explained that inflammation is linked to coronary artery disease, obesity, diabetes 2 and joint problems. Is it true then that inflammation is either the basic cause, or least the promoter, of our main public health diseases – the diseases that cause so much human suffering – as well as ageing and human breakdown?
And how does inflammation work, generally? Is it like a wildfire that burns down the healthy parts of a human being? Or more like a flood wave that beats and beats against a barricade until it finally falls apart? Or is it more like a low-level conflict between two people that distracts and weakens them so they are no longer able to defend themselves against an external threat?
Which one is the most reasonable scenario? I must keep searching.
But right now, I can state one thing that seems obvious: low-grade systemic inflammation is harmful and either triggers or speeds up disease. At this stage it’s also apparent that there are foods that counteract the broad negative effects of inflammation and that these foods to some extent are similar to the Rita Diet, which is like the Inger Björck Diet – and also like the David Servan-Schreiber Diet, which kept him alive for almost twenty years after his brain tumour diagnosis, even though he was supposed to survive for only a few months.
I have found a lot to think about, and I’m encouraged about my new lifestyle. In general, I’ve started to like the ‘Rita programme,’ as I still call it. And I’ve begun to feel results. They are modest results, but noticeable. My body is stronger, my belly flatter and I’m sturdier both in my psyche and across my shoulders.
‘You seem stronger, Mum,’ says my older daughter, unexpectedly.
That’s good. I want to feel strong, and my new lifestyle grounds me with a new feeling of security. I’m slowly gaining more insights into this lifestyle, about what it is and what it’s like to live it and not just talk about it. It’s both surprisingly simple and complex, since it demands a new kind of awareness.
To have an anti-inflammatory lifestyle was never a goal in itself for me. I hadn’t even heard of this as a lifestyle until that fresh spring evening in Lund, when I was already a few months into my new lifestyle. I just thought I would get a training programme via the internet.
The fact is that I don’t have time to spend dealing with food and exercise, I don’t feel like losing weight and I can’t spend all my energy on it since I have a life to live too. You have to live your life in the human village, as Mowgli says in The Jungle Book. You can’t live a life that’s too different, because that’s like settling down on a dry little patch of grass by yourself outside the village, surrounded by your pills, protein powders and strange food. As a mother of four, I neither can nor want to live like that. After all, I live in a very loud and lively human village that consists of family, job and friends, a context that’s much bigger than just me.
But still I’m driven onwards by this new feelgood sensation. The biggest change is that I have to start planning for eating well, to go from a lifestyle where I eat whatever I happen to find, or what tastes good, to strategically planning my food intake for health.
People say that if you fail at planning, you plan to fail. Everyone who has children learns to plan food at home to some degree. It doesn’t work to come home from work tired and have hungry kids digging through the fridge. (Those evenings always end with fries, fish sticks and ice cream . . .) You just have to learn to be a few steps ahead. It’s easy when it’s about the children, but to think like that about my own nutritional needs is something I’ve never done.
The first thing I need to learn is how to eat in a more conscious and planned way, and that also includes thinking about my specific needs. It sounds pretentious and, above all, time-consuming. Let me explain.
We humans have a limited window from the time a feeling arises to when we want to act on it. The more we’re aware of that window, the more impulse control we have and the smarter we get. But when it comes to food, hunger and eating, this control is being disabled by the miraculous innovations of the modern food industry.
Today we can get hungry one minute and theoretically find food within the hour, as long as we don’t find ourselves in a kayak on an expedition along the northeastern coast of Greenland, or looking for hidden treasure in inner Amazonia. There are little biscuits in the pantry and fig marmalade in the fridge. At work, there are some leftover biscuits by the coffeemaker. At the counter at the 7-Eleven are ready-made sandwiches. Our ability to plan food and think strategically about food doesn’t bother trying anymore. It simply isn’t needed.
I begin to think about how I in particular, and human beings in general, have ended up here.
Just imagine if we were as spontaneous about getting ourselves to work. We would get up and get ready, and just as we were leaving the house, we would begin to think about how to get there and what address we’re going to. But of course we don’t do that.
Most people check the calendar in advance to see what time the meeting is, Google addresses, check that the car has petrol, look up the tube lines, and see how far we have to go between the station and the meeting place. Not many of us would get to our jobs or our meetings on time if we didn’t do all this. We need an inner map. A road plan.
We need this for food as well.
This is what I have to learn – that in the pause between feeling and action, there’s a rainbow leading to a pot of gold, and it’s easier to find that pot if I’m well prepared.
My basic plan becomes this: I plan how I’m going to eat as soon as I wake up in the morning. I plan for a good day. Many people do that anyway when it comes to work, family and leisure activities. Why not do it for your own health as well?
In Rita’s plan I wasn’t given calories, quantities or forbidden foods. Instead, I have a number of guidelines. The most important thing is to eat food that is as unprocessed as possible – food that you could pick, fish or hunt. ‘Made by nature, not by man,’ as someone I met said.
Rita doesn’t just want me to reduce sugar – something that I’ve known I should be doing for a long time – but also to avoid bread and pasta, which get broken down into glucose, or sugar. She wants me to replace these with sweet potato, quinoa and brown rice. She wants me to eat protein-rich foods, often and in large quantities. Four or five times every day, I’m supposed to eat eggs, turkey, mussels, prawns, fish, meat or vegetarian protein. Can I even eat that much protein? I’m supposed to eat lots of leafy greens and vegetables, preferably four times a day. And good fats like olive oil, coconut oil and nuts. All this advice goes into planning four or five meals per day.
Now this advice needs to be transformed into habits that will work in my everyday life. Then I have to have time for work and also exercise four times a week. It’s stressful. How is that supposed to happen?
I can be undisciplined and lazy, with a tendency to overeat. Even worse, I tend to eat for emotional reasons: when I’m anxious, bored or exhausted; or when I just have a craving for something good and make the usual mistake of satisfying this craving with food that ends up giving me only momentary relief.
How am I supposed to manage to eat in such a disciplined way?
I face several big challenges, which begin as soon as I wake up. I continue to look for a new standard breakfast. I don’t want to have to think in the morning, when I’m a little sleepy and everything’s spinning around in my head. What can I come up with?
Most of what goes into a typical Swedish or British breakfast is wrong, according to the new thinking. Juice, bread, yogurt, cheese, rolls, cereal – none of that works anymore. So I look for something that can become the new breakfast.
I test different things and arrive at smoothies for breakfast. Almond milk, berries, nuts and protein powder. It breaks up our family’s mornings, since my habits are so different.
Snacks are simple: a couple of hardboiled eggs and a tomato; nuts and fruit. But dinner demands more thought.
I was no cook before I became a mother, but once I had children I became interested in cooking to nourish the family and create a happy mealtime. In my old life, it was easy to make food taste good and dress things up with extra butter, sugar, cheese and breading, or by frying, adding good bread toasted with garlic butter, and so on. There were soup and pancakes on Thursdays. My husband cooks just as often, usually with extra everything.
ANTI-INFLAMMATORY VEGETABLES AND MUSHROOMS
Think of the rainbow – purple, blue, green, yellow, orange and red. The more colours you eat every day, the prettier your plate and the more beautiful you will be, inside and out, since each colour represents a certain kind of active polyphenol.
• Asparagus
• Aubergine
• Beetroots
• Pak choi
• Broccoli
• Brussels sprouts
• Cabbage – white, red, cauliflower, green cabbage
• Celery – celery root and stalks
• Courgettes
• Cucumber
• Dandelion leaves
• Endive
• Fennel
• Kohlrabi
• Mushrooms – white mushrooms, ceps, oyster mushrooms, chanterelles
• Nasturtium
• Nettles
• Onion – red, yellow, garlic, leeks, spring onions
• Parsnips
• Peppers – red, orange, yellow and green
• Radishes
• Salad – rocket, iceberg, mâche – go wild!
• Spinach
• Sprouts – alfalfa and all others
• Tomatoes
• Watercress
Certain vegetables, like beetroots, parsnips and celery root, have a higher glycaemic index (GI) value than others. Mix them with vegetables that have a lower GI value, for example beetroots on a bed of rocket with a dressing of vinaigrette and nuts. Perfect!
I still want to eat good food, feel satisfied and enjoy food together with my family, by myself or with friends or colleagues, so I have to become more creative. But I don’t have all the time in the world.
I decide to compromise. I plan meals with food that is natural but with a little glamorous twist. A little more taste, a little more spice, good sauces and dips made of tomatoes, avocado, grilled vegetables, spices, oils and garlic.
The trick is to achieve good proportions. A plate divided into four parts, where 25 per cent is protein, 25 per cent salad, 25 per cent other vegetables and 25 per cent rice or quinoa – more or less.
But there are many challenges.
‘Where’s dessert?’ asks my son, with his big brown eyes. ‘You used to make that good chocolate cake.’
It’s true. Since I started cooking with my new method, I’ve increasingly lost interest in baking big, fluffy cakes. It’s not about body weight but just the feeling that I want to serve my family something other than 2 cups of sugar, which my former prize cake contained.
So I experiment, with mixed results.
‘Sorry, Mum, but this is a failure,’ my blue-eyed son laughs when I serve his best friend some courgette cake.
The friend is too polite to say anything, but he stares listlessly at his piece of cake. A few strips of courgette are swimming around like threads in the dry almond flour.
My brown-eyed son brings his new girlfriend home, and I serve them some protein muffins. I’ve found a recipe with protein powder, sweet potato and almond flour. The new girlfriend smiles but doesn’t take seconds.
My son grunts.
‘What is this?’
It sounds like I have spoiled children, but I don’t. They’re just used to a different kind of food. It’s said that Chinese children don’t like cinnamon buns. Why? Because they never eat cinnamon buns. You like what you are used to. This way of eating is the opposite of how we used to eat, and the change takes time. But I don’t really care; I have patience. I feel happy in some way. It’s not just the spring light. It’s something more – that’s hard to put into words.
Then I find the explanation. Again, by chance.
I’m working on a book that I’ve been thinking about for a long time.
I once had a brother who died. My handsome, mischievous, idolised brother got sick in his twenties and was diagnosed with schizophrenia, a grim psychiatric diagnosis. In 1986, I lost him in a fire in a Stockholm apartment. Through a contractor project I’ve done for Karolinska Institutet, I’ve begun to think a lot about the stigmatisation of mental illness.
Now I’ve decided to write a book that illuminates and looks into the taboo around mental health problems. This also involves dealing with the taboo within myself, the shame that I’ve felt – because mental health problems are looked at differently than physical disease. Aside from the sorrow, there’s this damned feeling of shame that rests over both the afflicted and their loved ones. And that makes us doubly ashamed. We’re ashamed because people we love have a shameful illness, and then we’re ashamed because we’re ashamed.
I root around eagerly in everything that’s connected to this issue. I talk to researchers, read and interview lots of people with different illnesses, as well as doctors and nurses.
While I’m looking through the latest research, a new branch emerges. It has a very long name: psychoneuroimmunology. It’s the study of how mental illness can arise in the brain, and how it’s linked to– here it is again – inflammation. Hmm . . .
In other words, on the one hand there’s a connection between immune defence and inflammation, and on the other hand, a connection to brain health? Fascinated, I look more closely into this connection.
We’ve already mentioned all the foot soldiers that are sent out by the immune system. Among them are the cytokines, triggered by inflammation to show up in huge numbers – something called a cytokine storm. This storm, like a swarm of bees, starts up the body’s defence system in the form of the so-called B and T lymphocytes. But the cytokines also talk directly to the brain.
Let’s say that again. The immune system and the brain talk to each other.
This is a new piece of knowledge, a new puzzle piece. I investigate further.
The American researcher Robert Dantzer did the pioneering work that showed that the cytokines triggered by inflammation also affect the brain’s signalling substances: dopamine, serotonin and noradrenaline. Since these substances directly affect how we feel, physically and mentally, cytokines can change how we feel in emotional terms.
When you have a high inflammation level, the cytokines decrease the levels of dopamine, noradrenaline and serotonin. You get a feeling of illness, like when you’re coming down with something. You feel low, tired, withdrawn. And when the inflammation decreases, the number of cytokines also decreases, and the signalling substances can flow again at a normal level in the synapses of the brain.
I add this to what we now know about signalling substances, highly simplified. Balanced dopamine levels provide more energy and self-confidence. Balanced serotonin levels lead to more calm and less anxiety. Balanced noradrenaline levels lead to increased alertness.
That’s exactly the change that I’ve felt in myself. This is interesting . . .
Not only does this train of thought offer new possibilities for understanding how mental illness begins, but perhaps it might also account for my new, brighter mood. A signal sent directly from my decreased inflammation level up to my brain might actually be affecting my mood. Has the new diet rearranged my brain chemistry?
I have to keep digging.
Researchers can demonstrate a connection between the degree of inflammation and depression, as well as between the degree of inflammation and the risk of suicide.
Suicide is today the most common cause of death among young men. One of the explanations is that there are too few resources available in the scandalously downsized psychiatric acute care centres. The doctors are forced to make a brutal selection among all the people who are seeking help, asking themselves terrible questions like ‘Who is actively likely to commit suicide? Who can we consider to be managing adequately at home, in spite of their depression?’ They are forced to look for those patients who have the highest risk for suicide and send home the rest even if they are feeling unwell.
Since the price of making the wrong judgement call is so incredibly high, people have looked for more objective markers, something that can be measured, instead of simply asking the patient questions. As most people who have known someone who committed suicide realise, a person who really wants to commit suicide will hide it.
At Lund University, the researcher Lena Brundin found that in people with depression, the will to commit suicide was directly linked to the degree of inflammatory markers in the blood. Not only that, but the degree of violence used in the suicide could also be correlated with the degree of inflammation.
In autumn 2017, new research was presented in London, where scientists from the University of Cambridge argued that there is a ‘very robust link between inflammation and depressive symptoms.’ Professor Ed Bullmore, chief of psychiatric staff, pointed to the fact that people who have just received vaccinations and people who take inflammatory medicines get depressed more often. The teams are now thinking of depression as a physical illness that might be treatable with anti-inflammatory measures.
It turns out that 30 per cent of people who suffer from inflammatory diseases like rheumatism are also depressed, making that group four times more likely to develop depression than the general population.
Schizophrenia has also turned out to have connections to inflammation, in research carried out at the Karolinska University Hospital by the psychoneuroimmunologist Sophie Erhardt, a pioneering scientist I had the privilege of meeting when we both became involved in the Swedish Psychiatry Foundation’s work. The same goes for bipolar illness.
It’s clear that cytokines are linked to poorer mental health for people, and cytokines are produced when there is inflammation.
I’m now hearing more and more researchers say that there’s a real connection between immune defence and the mind. Might these mental illnesses actually be immunological diseases? Which one is the chicken and which is the egg?
More and more doctors are coming to radical conclusions.
‘Our old model of care, where we make a distinction between body and mind, is completely outdated, where psychiatric care is provided by psychiatric specialists and physical care by doctors and nurses who specialise in the body. We have to begin to educate people within healthcare who can bridge this gap – between immune defence and the nervous system,’ thunders Professor Robert Lechler, chairman of the British Academy of Medical Sciences, in an interview in the Daily Telegraph.
Everything is connected, and the link is inflammation.
This is the very front line of research. I’m standing right at this front line and probing it as I’m writing this book, and I see the inflammation trail grow red hot again. I have to dig deeper, even though it’s sometimes tough going – very tough.
I have the twenty-five-year-old grief of a big sister simmering away inside. It’s been shut up in a closet with the door bolted shut and marked with a sign saying ‘Open at your own risk!’ In that closet lives the grief I feel for not being able to save my brother. It sometimes feels like I’ve gone straight down into a black hole while I’m working on this book. I also encounter the sorrow and anxiety of the people I interview, people who have been stricken with serious illnesses and sometimes met with little understanding from the outside world; who feel alone and vulnerable even though they’re fighting with such courage. It touches me at my very core, since I understand them all too well.
But then I notice something. The afflicted and their families say almost exactly the same thing: when they eat junk food, or bad food, their symptoms get worse. When they choose better food, the symptoms decrease.
The new lifestyle that I’m learning about shines so brightly in the midst of all this darkness, and it’s signalling from all directions. It turns into a kind of lift that leads me up towards joy, out of my grey mine shaft.
Up in the daylight again, a journey to completely ordinary things – things that might be trivial but that absolutely need to work, things that used to be self-evident before, in my old life, but that I now have to relearn.
Like how to shop for food, for example.
I used to wander around fairly randomly and pick out things that looked interesting when I wasn’t shopping for a recipe or based on sale prices. I bought things mainly based on what my family likes to eat every day. Crisps, bread, jam, cereal, milk, chicken, pasta, muffins and vegetables. Nothing strange. That’s what a regular shopping list might look like.
Now I’m starting to see the supermarket in a whole new way. It has its agenda, I have mine. That’s why it’s important to examine the supermarket’s setup. You are often met by freshly baked bread that’s meant to tempt you with its warm aroma, and then you’re supposed to walk all the way inside the shop to find the milk, a product that almost everyone buys. The vegetables are often hidden far inside, along some wall.
I decide to outsmart the shop’s selling agenda and my own old reflexes. I’ll get a maximum amount of good and nutritious foods while minimising gluten, lactose and sugar, and I’ll shop economically.
The first step is to make a plan for the day’s meals every morning. Breakfast, lunch, dinner and snacks. And then shop according to that. Just like an architect, you have to begin with a drawing in order to build a good house.
My plan might look like this:
Breakfast: Smoothie with protein powder, green spirulina powder, chia seeds, raisins, blueberries and spinach.
Snack: Boiled egg, tomato.
Lunch: Chicken, sweet potato, raw grated carrot and cooked broccoli.
Snack: Fruit and nuts.
Dinner: Lentil patties, spinach and tomato salad.
If the kids are eating at home I add things that they like, but only then.
I’m beginning to dig around a lot more in the vegetable bins. I’m starting to pick up onions, tomatoes, carrots, lemons, garlic, broccoli, green beans, cauliflower, Brussels sprouts, squash, aubergine and so on, according to season and price; I inspect them and smell them. I find green cabbage. And white cabbage! This is an unassuming but wonderful, cheap delicacy – especially in the springtime, when the delicate spring cabbage arrives. Here I also find my clumsy, ugly, new best friend – the sweet potato.
I buy blueberries, especially if they’re on sale, since you can freeze them. Strawberries and raspberries according to the season. Lots of frozen berries. Rita doesn’t want me to eat too many bananas since they have a high GI value. Okay, I’ll try.
I’m starting to think about the store in unpoetical terms. Like for example ‘protein shelves’. That’s where there are chicken fillets, meatloaf, pork chops. The egg shelf, and the shelves with canned sardines, mussels and tuna, are also protein shelves. What has good quality and reasonable prices?
I often come home with different kinds of fish, preferably ethically sourced. Chicken thighs have more taste than breast fillets, and you can buy them in bigger packages with six or twelve thighs and then freeze the part you don’t use in smaller bags. I buy according to season, price and quality. Cans of mussels, salmon and sardines, and quick protein solutions with lots of omega-3 fats. And also lots of eggs. They have to be from cage-free, happy chickens. I also buy beans and lentils of all kinds and shapes, since it turns out not everything is a good fit for my stomach.
I buy low-lactose milk, yogurt and sometimes soy yogurt. I often try different kinds of nut milk, like almond, coconut and hazelnut, and soy milk. I use butter once in a while, preferably organic.
The spice shelf expands. New tastes turn up there, and more experiments. At the base are of course salt and pepper of different kinds, and now also turmeric, which I’m beginning to learn is extremely anti-inflammatory. But other spices reduce inflammation as well. I check lists and find cinnamon, oregano, cumin, coriander, thyme, rosemary, basil, different kinds of chilli, garlic, ginger, capers . . .
I buy different kinds of oil and begin flavouring it myself. A sprig of rosemary, some garlic and a few lemon peels quickly add a new taste in a couple of days. I try new kinds of vinegar – there are so many to choose from. I learn more about my trigger points – whipped cream and toasted bread.
ANTI-INFLAMMATORY SPICES
• Basil
• Capers
• Chilli
• Cinnamon
• Cloves
• Coriander
• Cumin
• Garlic
• Ginger
• Lovage
• Oregano
• Rosemary
• Thyme
• Turmeric
• and many more!
I become a seed and nut eater and also buy lots of dried fruit, with favourites like goji berries, dried apricots, dried plums, figs and cranberries. Little delicacies.
I put all these little things in plastic jars in a row at home.
My usually good-natured husband bangs around angrily among all the new jars that are crowding out his tubes of caviar, fig marmalade and cheese, when he’s in his home-economics-teacher mood. We start having new types of arguments. About foods in the cupboards. What goes where? It is not dignified but it is the new reality at home.
I also learn to make more food than I need.
Apparently, this is called ‘food prep’ in bodybuilder language. You’re prepping food when you grill long rows of chicken thighs, for example, and save them in the freezer. Or boil sixteen eggs at once. Or make a big batch of vegetable stew at a time.
Rita thinks I should cook in bulk twice a week so that there’s always something at home that’s easy to serve. I wonder if I have the time, but I soon discover that it doesn’t take more time to make food in advance. It takes exactly the same amount of time, sometimes even less. But the difference is that you eat better when you’ve planned better.
But what if you’re not eating at home? This will be a big challenge for me. With work in several countries and with children who are studying or working abroad as well, the year includes many days of travel. At such times, I’ll set off early, on crowded morning flights where they serve sandwiches packed in plastic and a cup of coffee, and return late on other planes, where they serve even more sandwiches in plastic and more coffee. Food on the go, food in canteens, meals with clients – always on the road to somewhere.
How will I manage this?
It will be especially hard when I’m headed out on a really long trip to a completely different corner of the world, where I might be able to get a few more leads to how all the remarkable things I’m experiencing actually fit together.
