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- [00:00]
Capital One Bank Announcer
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Dr. Tamiko Katsumoto
before
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AT&T Business Wireless Advertiser
we had AT&T business Wireless coverage, our delivery GPS wasn't the most reliable. Once our driver had to do a 14 point turn to get back on route. A 14 point turn. An influencer even livestream the whole thing. Not good for business. Now with AT&T business Wireless, routes are updating on the fly and deliveries are on time. And the influencer did get us 53 new followers though.
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Capital One Bank Announcer
AT&T business wireless connecting changes everything.
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Dr. Tamiko Katsumoto
48 million people in the United States are adolescents between the ages of 14 and 24. They're working, parenting, leading, sometimes all at once.
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Raj Panjabi Johnson
I'm balancing work and being a mom
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Dr. Tamiko Katsumoto
at the same time, and I'm still
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Raj Panjabi Johnson
on track to graduate with my bachelor's next year.
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Dr. Tamiko Katsumoto
So what do today's young people need to truly thrive? Tune in to good things from Lemonada Media to hear the six part Thrive series.
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Raj Panjabi Johnson
Hi, I'm Raj Panjabi Johnson, Head of identity content at HuffPost.
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Noah Michelson
And I'm Noah Michelson, head of HuffPost Personal.
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Raj Panjabi Johnson
Welcome to Am I Doing It Wrong?
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The show that explores the all too
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human anxieties we have about trying to get our lives right.
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Noah Michelson
Raj, we got a fun email the other day from a listener named Valerie. Hi Valerie. She was talking about the Forever Chemicals episode that we just did and how much I love a scented candle and how sad I am that I probably shouldn't be burning them because they do tend to, you know, emit a lot of chemicals. And she said a good idea was to make a simmer pot. Have you ever done that? My mom would always do this, like at Christmas. So you put orange peel and cinnamon and clove and some water on the stove and let that heat up. And that's a great natural way to like scent your apartment or your house. And I didn't even think of that.
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Raj Panjabi Johnson
I love Valerie and all our listeners who are trying to make our lives better because that is really fun and beautiful.
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Noah Michelson
Yeah. And it's stuff that we don't think of. So keep sending us emails. It's amidoing it wronguffpost.com and we would love to hear from you if you have ideas or show questions. But today I have a question for you.
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Raj Panjabi Johnson
Okay.
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Noah Michelson
Do you think that you're doing inflammation wrong?
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Raj Panjabi Johnson
Oh, my God. You know what? That's exhausting to even think about because I'm sure I'm doing it wrong. Like every time I feel a little bit of pain or fatigue, I'm like, oh, something's inflamed. Do I totally understand what that means? No. What about you?
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Noah Michelson
Yeah, I don't even know what it means. I just. Everyone's on TikTok or on reels and just being like, oh, this is anti inflammatory. You need to do this. Take the supplement. But I'm, I'm like, I don't even know how I know if I am inflamed, what that would look like or feel like. I am clueless. So I feel like this is an episode where I'm like, I just have
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Raj Panjabi Johnson
to be schooled same. Thank goodness. We have with us today Dr. Tamiko Katsumoto.
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She's a clinical associate professor in the division of immunology and Rheumatology at Stanford University.
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Noah Michelson
Let's do it.
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Raj Panjabi Johnson
Tamiko, thank you so much for being here with us. We're so happy to have you.
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Dr. Tamiko Katsumoto
Well, thank you so much for inviting me. I love your show. You guys are amazing.
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Noah Michelson
Thank you.
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Raj Panjabi Johnson
Good to hear that. Okay, now on to more serious things. When we hear the word inflammation, and we hear it a lot on social media, it's to mostly sell us some kind of product or supplement or whatever. What does it technically mean? Because I like to think I know stuff and I'm not sure what inflammation means.
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Dr. Tamiko Katsumoto
So you are asking a big question. So I'll tell you just a little bit about my background. So I'm a rheumatologist, so that means that I deal with autoimmune inflammatory conditions. You know, I also actually see a lot of patients with cancer, which also, believe it or not, is an inflammatory condition. You know, probably one of the most common things that I see is arthritis, which is kind of a representation of systemic inflammation. I get to help patients who have systemic inflammation who feel it in their joints. There's a lot of other causes of inflammation that may not be so, you know, painful or palpable. So I literally get to experience people dealing with inflammation and then doing things that help that inflammation in my daily practice. So to sort of simply define what is inflammation, I think the best way to define it is it Represents the body's response to a danger signal or to a damaging signal. And then it's followed by a repair process. Right. So when you think about it, we get an infection, you know, we get like some sort of bacteria or virus attacks us and we need our body to trigger the immune system leading to inflammation so that we can actually heal ourselves from that infection. You know, similarly, if we, we get some injury, we get a cut, we know that that wound, it will bleed and then it gets inflamed, sometimes it gets swollen and red and then we need inflammation to come in that then leads to a sort of healing response. So I see inflammation as like sort of this whole process by which our immune system is helping to defend us and it helps then to resolve that insult that we are faced with. So that's kind of the quick and dirty explanation for inflammation.
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Noah Michelson
Yeah, I was gonna say, I think that's really use because I think when we hear inflammation so often, it's like that's a bad thing, like you don't want inflammation, you want to take an anti inflammatory diet, all of these, like to get rid of it. But basically what you're saying is that it's an umbrella term and there are times when inflammation is good. So if we have a cut, we want inflammation to help heal that cut.
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Dr. Tamiko Katsumoto
Yeah, that's absolutely right. So I think the key point to make is without inflammation, we would be dead. It keeps us alive, so it's really important. And I think the other thing I'll just point out, which is like I mentioned to you, I deal with a lot of patients suffering from autoimmune disease. So I think one thing that's complicated is we have to always figure out what is ourself and what is not ourself. Right. And so the immune system is really important in guiding us in understanding sort of acutely, like, is this part of our body or not? Is this something we want in our body or not? And so there are two different types of ways of splitting up the immune system. There's what's called the innate immune system, which is sort of the quick and dirty, you know, quick response to an infection, that's kind of a common thing, versus the adaptive immune system, which is a more finessed response, a more targeted response. So I'll give you an example of this. So I mentioned that our immune system protects us from infections. Right. So there's a lot of kind of knee jerk immune responses that help us, kind of early stages. But let's talk about vaccines. Vaccines are a really Good example of something that activates the immune system in a very, very specific way so that we can develop very targeted responses that are driven by our special cells like T cells or B cells that you may have heard about. And these have kind of more of a programmed immune response. So we are able to know that's the flu. We're going to have a response against the flu or Covid or measles. And so vaccines are super important to stimulate our immune system and educate our immune system to respond appropriately. I'll give another example where immunity is important. Believe it or not, our immune system protects us from cancer. So every second, well, maybe not every second, but a lot of times our cells are dividing. Our cells may undergo some sort of funny mutation or insult. They may end up becoming almost cancerous. But believe it or not, our immune system is. Can often detect that and then wipe out that cancer cell before it becomes a problem. So this is a term that's called immune surveillance, where our immune system is constantly kind of looking around our bodies and making sure nothing's gone awry. So I think, as you mentioned, the inflammation can be bad. We'll talk about that. But it can also be very good and very protective.
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Raj Panjabi Johnson
Okay. I actually wanted to ask about the two types I've been reading about, acute versus chronic, and I think I know what that means, but we also hear chronic inflammat a lot, so I'm not sure. Can you break that down for us?
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Dr. Tamiko Katsumoto
Awesome, Raj. So you are ahead of the curve. I think that acute inflammation is literally, like I said, the sort of the knee jerk response. You get this very robust kind of activation of the immune system. Inflammation occurs. We can talk about sort of the classic characteristics of inflammation, but basically, acute is really that abrupt response versus chronic inflammation can be a little more subtle. And it turns out we're learning that chronic inflammation is what's driving a lot of our diseases. A lot of the diseases that we're dealing with in the western world are really under. Are driven by inflammation. So what are some of those drivers? We're gonna talk about this in more depth and do a deep dive. This is something that I'm really keen on understanding better. Believe it or not, a lot of inflammation chronically is driven by exposures that we have. Our environment, our diets. That's huge. A lot of lifestyle related factors. You know, stress is a big stimulus for inflammation. Smoking, sleep disturbances, chronic infections, these are all things that can drive chronic inflammation. It's a little bit more insidious. It's not as Obvious. You know, it's not like when you have the flu, but it's like some people kind of get more of a chronic, ongoing, low level of inflammation that can then lead to the development of a lot of these diseases. And I'll just name a few. Heart disease, that represents chronic inflammation. Diabetes, same thing. Even Alzheimer's is chronic inflammation. Even depression and mental illness can, believe it or not, be driven by underlying inflammation. And then of course, what I deal with in my clinic is, you know, maybe a higher level of that inflammation. But things like rheumatoid arthritis, things like lupus, these are autoimmune conditions. You know, there's a really dramatic one called gout that's also an immune reaction that's inappropriate response to one of our body's byproducts called uric acid. So there's a lot of different types of inflammation, a lot of different flavors of it. I think that, believe it or not, probably the vast majority of our diseases are driven by inflammation, maybe like 80% or so. And a lot of those, in fact 80% are thought to be driven by lifestyle related factors that we can have some control over, which is really what I want to focus on. We can't control everything about what we're exposed to, but we can control lifestyle factors that can be very, very protective of this inflammation and really can dampen it so that we don't end up with a lot of these chronic diseases.
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Noah Michelson
Yeah, I wanna get into that, but first I wanna know, how do we know if we have inflammation? I guess there are things that are symptomatic. So if we have arthritis, we might have pain, or if we, you know, we have different diseases, we might know. But in general, what does it look or feel like to have inflammation?
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Dr. Tamiko Katsumoto
So that's a great question. I'm going to give you the four words that we were taught in med school. I don't know if you've heard these. They're, I think based on Italian or Latin or Spanish, they're all kind of similar. Dolor, rhubor, calor and tumor. So dolor, or dolor, if you want to pronounce it correctly, is pain. Right. Pain is one of the cardinal symptoms of inflammation. I see this every day in my practice with joint pain. Right. So that represents inflammation. Rhubar is redness. So a lot of times when there's substantial inflammation, things turn red. You know, you get a cut and it turns red. It means there's more blood flow. Right. So there's more vascular infiltration of that area, color is heat. So a lot of times this is. You get, you know, increased warmth of that area. So my patients have these really red hot swollen joints. And then tumor. Tumor represents either. It can mean cancer, but it also means swelling. And so I think that that's an important one of the cardinal signs of inflammation that we know we're experiencing. You know, that tells us we're experiencing inflammation. But the problem is there's a lot of situations where that's really more of an example of acute inflammation. And so when we start talking about chronic inflammation, sometimes that flies a little bit below the radar and we may not fully be aware that it's happening. Right. So some examples of chronic inflammation, believe it or not, the number one thing that I hear in my clinic besides joint pain, I hear fatigue. People that say, oh, I'm just so tired, I have no energy, I have brain fog, I have headaches, I have joint pain, I have abdominal pain and bloating, I have rashes. These are all manifestations of chronic inflammation driven by different things. But I think that those are some examples. They may be a little bit more subtle, little bit less obvious than the dolor, rubor, calor and tumor that I just told you about, but they are likely inflammation driven. So I think that's important to note.
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Raj Panjabi Johnson
So what I'm hearing is with acute inflammation, it shows up, does its job, and then it kind of goes right. It's there for a purpose, and it's one part of a healing component. But with chronic, it's like a little bit sneakier and it sticks around. Is that kind of what you're saying?
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Dr. Tamiko Katsumoto
I think that's exactly right. So acute inflammation typically has sort of a very rapid onset and a rapid decline. But chronic can basically be like sort of a slow burn. Like a slow burn. There are people that are prone to autoimmune diseases, and I think one of the problems they may have is, is their immune system is not as good at turning off the inflammation. So they're just more prone to these sort of ongoing inflammatory cascades. And then, of course, in the setting of a lot of other sort of exposures, lifestyle and otherwise, you know, we are constantly being exposed to a lot of inflammatory stimuli, or I call them insults. We're surrounded by stuff. Right. So our body needs to figure out how to adapt. And we can talk about some of those things that. That are problematic.
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Raj Panjabi Johnson
Yeah, I would love to know.
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Noah Michelson
Yeah. One of the first ones I think that people talk about a lot is ultra processed foods.
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Raj Panjabi Johnson
Oh, yeah.
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Noah Michelson
And they say that ultra processed Foods causes inflammation. Is that true? And if so, why does that happen?
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Dr. Tamiko Katsumoto
Such a great question. So let's take a step back because I think the term ultra processed foods gets thrown around a lot.
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Noah Michelson
Absolutely.
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Dr. Tamiko Katsumoto
And so what exactly is an ultra processed food? I mean, I'll be honest with you, it's like, it's a little bit unclear. There are at least eight different systems that have been used to define what constitutes an ultra processed food. And it turns out you've probably heard statistics that our standard American diets, which we're just going to call S.A.D. s a d S.A.D. standard American diets are comprised of anywhere between 60 to 70% ultra processed foods. So we've got a problem. And some of the key characteristics of ultra processed foods include that they have these industrial ingredients. So high fructose corn syrup is probably something you've heard about, can be very inflammatory, a lot of hydrogenated oils. There's a lot of other stuff that gets broken down from food. So instead of the whole food, where you've got all the nutrients, you've got all the fiber, all the good stuff, a lot of times those ingredients get broken down and taken away. There's additives, so there's flavors, there's colors, red dye, there's emulsifiers. Emulsifiers are, are ingredients that help mix things better. So you know, they put them in like let's say mayonnaise, right? You've got fat, you've got oil, and you've got more water stuff. And it helps to kind of mix things together. There's sweeteners, there's things that make the ultra processed foods hyper palatable. And by hyper palatable, I mean that they are addictive. They make you want more and more. So you keep eating more, which is a huge problem. And so I think that ultra processed foods are problematic for multiple reasons. Number one, we're eating too much of them. Number two, they lack a lot of the really key wonderful protective anti inflammatory ingredients that whole foods have. You know, plants have some of the best ingredients, polyphenols, antioxidants, and a lot of times those get stripped out of ultra processed foods. There are things we talked about, the emulsifiers, right, to kind of mix oil and water together. You know, a lot of our salad dressings have these. And those, believe it or not, can distract, disrupt the gut microbiome. And I do want to take a little time to talk about gut microbiome because I think that's really important. So I think that ultrapassive foods certainly have been found to be Highly inflammatory for various different reasons. I think the gut is really fundamental and foundational. It turns out, I think that we have learned so much about the gut in its core role of driving inflammation that I think it's really important for us to highlight it here. It turns out that probably about 70% of our immune system resides in the gut. Right? And so you can imagine that it's a huge factor in driving inflammation. You've probably heard about leaky gut. Does that ring a bell?
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Noah Michelson
Yeah.
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Dr. Tamiko Katsumoto
So, okay, so let's. Let's sort of. I'm going to paint a little picture here. So the gut essentially is a nice long tube. It's probably the main way that we are exposed to our external world. Right through our lungs, we're breathing and stuff, and through our gut while we're eating stuff. And so the gut, it's super important. And again, for years, this was not well understood. Like, how do we define what's ourself and what's not ourself? What's good, what's bad? It turns out that we need a strong gut barrier to really protect us from a lot of these toxic insults and bad things that come our way. And the key thing is, if you imagine the gut, essentially, it's a tube. It's got a single epithelial lining. So these are sort of cells that kind of line the gut. Then those gut lining, there's basically these cells produce something called mucus, which we know mucus comes out of our nose, but it's also important to line our gut. And that mucus barrier is very protective. And the way the mucus barrier is fed is by these happy, healthy, diverse bugs. This is called the microbiome. And so to keep the microbiome happy, we gotta feed it fiber. And fiber, guess what? It's only found in plants. Animal products do not have fiber. So we need to have plants to feed that gut mucus layer as well as create a very happy, healthy, diverse group of bugs that are gonna keep sort of what's called immune homeostasis. And so what's been found with the American Gut project is that there's sort of a magic number. The idea is the people that were eating 30 or more different plants every week had healthier, happier guts. And fiber is really key, right? So fiber is. And it gets fermented by these microbes in our gut, and they produce these molecules that are called short chain fatty acids. And these short chain fatty acids are really important in keeping our immune system in check, dampening it so it doesn't Overreact, right? We have problems like inflammatory bowel disease or irritable bowel syndrome, where you've got a very unhappy gut microbiome. You've got more of the bad bugs, less of the good bugs. And so you need the good bugs that are going to produce these short chain fatty acids to keep your gut kind of homeostatically happy, healthy and calm. And if you don't guess what, you end up getting what's called leaky gut. And so what happens is a lot of these bugs that are normally hanging out peacefully can end up actually getting either into your immune system, coming into your gut, getting into your bloodstream. We see endotoxin, which is one of the products made by bacteria that goes up in our bloodstream, driving inflammation when we have leaky gut. So having a very strong intact gut is so critical to keeping inflammation at bay. And so I mentioned to you the 30 different plants a week, I think at least that's one thing that's super important. But so emulsifiers can actually mess up your gut mucus barrier. And so that's another reason why a lot of these types of chemicals can be very problematic for the gut microbiome. A lot of these other additives can be toxic to the good bugs in the microbiome as well. You know, some of the dyes, there's titanium dioxide, there's different compounds that are in food that can be toxic to the gut. And then I do want to mention to you that there are also a bunch of environmental toxins that we need to be thinking about that may not be top of mind. This is a concept that I think may not be as well highlighted, but we are exposed to a lot of different toxins in our environment. We're breathing stuff in, we're eating stuff, and there's things getting into our food that can be problematic. And I think one of the key points I want to drive home is that probably about 90% of these environmental toxins are fat soluble. So I think that's important to note. Fat tends to go to fat, right? So if something is what's called lipophilic, meaning fat loving, it tends to go into fat. I love you guys. And I heard that you guys did an awesome episode on pfas. So you're thinking about some of these toxins, like forever chemicals. There's other chemicals like in plastics, so things that are called phthalates or bisphenols, these are things that are additives in plastic that make plastic either softer or harder. And these are also fat soluble.
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Paige Desorbo
Right.
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Dr. Tamiko Katsumoto
See these are fat soluble compounds that tend to kind of migrate more towards fat. Similarly, there's a whole class of what are called persistent organic pollution pollutants. And PFAS is but one of them. Right? These forever chemicals are in our environment. PFAS are fat soluble. They're also water soluble. They're kind of both. But it turns out they are higher in animal products than they are in plant based products. So that's something to keep in mind. And then there's other pops. These are persistent organic pollutants, we're going to call them pops. There's things like polychlorobifenols, there's things like dioxins, there's things like brominated flame retardants. These are also environmental toxins that are out there that even though some of them have been banned since 2001, they're still in our environment, they're still in our soil, they can still be accumulating in the environment. The problem is, and there's also pesticides, right? So there's pesticides that get sprayed on our plants and then they end up getting eaten by the animals. And there's a whole concept that's called bioaccumulation, which, where these fat soluble toxins end up getting into the fat of animals. When we eat the animals, they accumulate in us and they accumulate in our fat. And by the way, fat can actually be an inflammatory organ. So fat releases inflammatory cytokines as well. So I guess my point is these environmental toxins that we may, you know, we're eating, that we may not even be fully aware we're eating can be driving inflammation, can be disrupting the gut microbiome in ways that we're not aware of. And I think important to note we want to try to minimize our consumption of a lot of these toxins. And so as I mentioned to you, plants are really a great solution to building a very strong, robust gut microbiome. Plants are the answer to that. And by eating more plants you also are not getting, you're not eating as many of these fat soluble toxins. And in addition, when you have a healthy, happy gut microbiome that can actually help also detoxify your body from a lot of these more toxic pollutants and these compounds that are concerning. So it's really a win win on multiple levels. That was a long winded answer.
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Raj Panjabi Johnson
No, I have to stop you because I'm going to walk into the water because I'm so scared and never come back. Listen, I really appreciate being informed about this I just, I have, like, a couple of things I want to clarify. Because this is about harm reduction, right. So I'm not gonna, like, just go into a bunker and like, eat fruits that I've grown myself. In fact, this conversation is making me want a martini in a plastic jug. But here's what I would ask first. So when you say 30 plants, because I'm working on this, my partner and I are working on this in our house. You mean beans, legumes, fruits, like just things that grow, right? Like not spicy Cheetos is what you're saying,
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Dr. Tamiko Katsumoto
so. Correct. It's really focusing on the whole food plant as much as possible. You know, it doesn't mean you have to be a saint. Like I just mentioned to you, like, it's difficult, right, to like, our diets are full of ultra processed foods. So you want to just do, you know, and I'll be honest with you, not all ultra processed foods are terrible. There are some that are good. There are some. You know, part of them is think about it from a. I also think about from like, you know, environmental justice perspective and social determinants of health perspective. Right. A lot of ultra processed foods can be cheaper. They can last longer.
- [26:18]
Raj Panjabi Johnson
I was gonna say this is a privilege thing too, you know.
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Dr. Tamiko Katsumoto
Yes, yes. And so I think that this is where we do need to not draw. I never draw lines in the sand. I think that's not helpful. I think it's all about, you know, trying to be moderate in moderation. We don't demonize anything. Yes. We all will eat some of those ultra processed foods sometimes, and that's okay. I think the bottom line is if we can really try to keep our gut as happy as possible by really kind of loading up with a lot of diverse plants. Right. And you know, occasionally some animal foods are okay, but I just want to say, really, the plants are where the money is and the plants are what are anti inflammatory. And they're going to keep you. You know, they're going to really. There's been so much data suggesting that plants are super important for health.
- [27:07]
Raj Panjabi Johnson
Hi, this is Raj from HuffPost's Am I Doing It Wrong Podcast. Noah and I have discovered so much from hosting this podcast, and we really believe that learning is a lifelong journey. That's why I'm so excited to share that. This episode is sponsored by Study.com Study.com offers over 220 online college courses that help students make progress toward finishing a college degree in a flexible and more affordable way. This includes general education courses such as English math and history. Study.com is fully online and self paced, and courses transfer to over 2000 colleges and universities.
- [27:42]
Dr. Tamiko Katsumoto
The best part?
- [27:43]
Raj Panjabi Johnson
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- [28:09]
Capital One Bank Announcer
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- [28:39]
Paige Desorbo
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- [29:23]
Noah Michelson
Okay Tamiko, though, I'm going to throw you a curveball. I have heard that some plants actually promote inflammation. Like people say potatoes are inflammatory or other nightshades are inflammatory. What are your thoughts on that? Is that true or is that a myth?
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Dr. Tamiko Katsumoto
Such a good question. And it's actually funny because I actually hear that a lot in my clinic because I think the associations that have come up with those these are nightshades, right? The nightshade class of these are potatoes, eggplants. A lot of them have something called solanine in them which some people think may cause problems for some people. That being said, one thing I'm going to say is that everyone is different. Not everyone reacts the same way. So you can try to do a really large study and I'll tell you the large studies that have looked at this question have not found these types of plants, eggplants, potatoes, tomatoes, to be problematic. In fact, the opposite. The majority of people do not experience inflammation in response to these. But this is where personalized medicine comes in, because it may very well be that your microbiome is not primed right? It may not have the right composite bugs that are important to properly digest and metabolize some of these plants or some of these foods. So we'll talk about gluten in a second. But I think that these are examples where everyone is different. There are a lot of people that have food sensitivities. I feel like this number is growing. I'm sure you guys have also heard this right? And whether that's because our food supply has a lot of additives and things like that versus if there's. Who knows what else is going on, it's complicated. We want to distinguish between a true food allergy, where people end up getting hives. They get the swollen lips, the swollen eyes, and then they get dramatic. They may have constriction of their airways. So food allergy is a big problem that we want to really distinguish because those are people that need EpiPens. They need medical attention. If they get exposed to the peanut, that's going to set off an anaphylactic reaction. But food sensitivities are very different. And I think what's interesting about food sensitivities is that they may be mitigatable. People may be able to overcome their sensitivity as they start to build up their tolerance via adding more of these foods gradually, maybe doing a little bit of a dose response, response, little, tiny, tiny bit that builds up the microbiome. They add more, a little more. There are digestive enzymes that can be super helpful. People may have heard about some of these elimination diets. There's one called the low fodmap diet, and that's a fancy term for just foods that tend to cause gassiness and bloating. And the idea is to eliminate those and then to gradually reintroduce them. But there's also an enzyme called fodzyme, which has a lot of the enzymes that can help break down some of these problematic foods. And so I think sometimes I'll recommend to my patients, you know, maybe you have an intolerance related to a deficiency in one of these enzymes. And so I think that's something that we try, right, to try to overcome these food sensitivities.
- [32:41]
Raj Panjabi Johnson
I think that's really important to say because I feel like think because more people have a gluten sensitivity now or a dairy sensitivity. It's like, maligned across the board. Like, you know, people will be like, dairy's so bad and dairy's not bad. It just makes you a bunch. And that's not my life. So, like, I don't know what to tell you. We all have our own bodies. I think it's important to go to your physician and talk about this stuff. We can't just be on TikTok being like, I cut dairy. Like, let's figure it out, Right? But can you tell us just a little bit about gluten in particular? You know, how that causes inflammation for people who have celiac or an insensitivity?
- [33:15]
Dr. Tamiko Katsumoto
Let's go back to wheat, going back to the basics. So wheat is actually not intrinsically a bad thing, right? Whole wheat has a lot of health benefits. And the problem is a lot of what we're eating in our diets now is refined, right? So it's the wheat that's been stripped of the husk, you know, the bran as well as the germ. These are the parts of the wheat that are super rich in fiber, in B vitamins and minerals, and a lot of the good stuff. So essentially, a lot of the wheat in our country is really the white bread, the white, you know, the baked goods. Right. That have been. Have refined grains. And so I want to say, generally speaking, whole grain's not a bad thing. However, so we are seeing celiac disease at a higher rate. And celiac disease is genetically mediated. So people have to have a certain genetic, what's called genotype. The Alphabet Soup here is HLA DQ2, HLA DQ8. These are some of the genotypes that are associated with celiac disease. And if you are not one of those two genotypes, you probably don't have celiac disease. But there's a blood test that we do called the tissue transglutaminase antibody. It's a blood test that has pretty good sensitivity for picking up celiac disease. But to really define it, you do need to get what's called an endoscopy, an upper endoscopy, where they go down your throat, and then they take a little biopsy and they look right. So celiac disease is, unfortunately, it is on the rise, and it is a situation where you do need to really avoid gluten, which is really sad. A lot of our foods have gluten. But, Raj, I think what you're probably referring to is this rise also in what's called non celiac gluten. Sensitivity. And we're seeing more and more of this.
- [34:59]
Raj Panjabi Johnson
Yeah, no, I was gonna say that sucks for people too. It's like, like whatever makes you bloated and uncomfortable. It's terrible. So, you know, not for me to be like, oh, if you have celiac, you know, you're legit. And the insensitivities are insensitivities. I'm just, like, curious as to how it affects our bodies.
- [35:14]
Dr. Tamiko Katsumoto
Totally. Totally. So I think that the non celiac gluten sensitivity is a little bit less well defined. It's a bit more of a clinical diagnosis that we basically do sort of a, you know, elimination and a re challenge and, you know, really try to define. Like, are you to trying truly having symptoms related to the gluten or not? And then if that's the case, trying to kind of figure it out. I think one of the issues is that it may not actually be the gluten that's the problem. It may be something called the fructans that are high in wheat products. And so this is where I get back to the enzymes that can be helpful. I mentioned to you Fodzyme is a new supplement that is a bunch of enzymes, including Fructan, which can help people if they are having a fructan sensitivity related to wheat. So I do try this on my patients. I will confess it's not cheap, but Fodzyme has fructan. It has alpha galactosidase, which is the same thing that's in a supplement called Beano. So that helps you digest beans better. Important to know that also has lactase. Right. So we can talk about milk and lactose intolerance, but it has lactate, so it actually helps with a bunch of different food sensitivities. You just literally, it's a powder. You, like, sprinkle it on. Your food can be super helpful. So worth giving that a try. I try that with a lot of my patients, and sometimes it does mitigate the intolerance. The dose makes the poison. So if you load up with a ton of wheat and gluten products, people are like, oh, my God, I'm so bloated. Right? So go slow. Slow and steady wins the race, Right? And build up your microbiome to be able to accommodate that better.
- [36:48]
Noah Michelson
Can sugar cause inflammation? I've heard that as well. People say, you don't want to have sugar because that's going to cause inflammation. What do you think about that?
- [36:57]
Dr. Tamiko Katsumoto
I can tell you this from personal experience. Oh, my gosh. Sugar is probably one of the number one things my arthritis patients say triggers their arthritis. So, you know, I think that that is a well regarded phenomenon. I think there's been associations with sugar and rheumatoid arthritis risk. Processed sugars are more inflammatory than natural sugars. So let's make that distinction. Right? So if you're getting a big sugar bomb, you know, eating your cakes and your cookies and whatever, again, we all have to be naughty occasionally, but those sugars give you a big spike in your glucose. High fructose corn syrup is particularly problematic. That can actually cause liver inflammation. But if you're getting sugar that is packaged in a fruit, for example, it's got the fruit matrix, it's got the fiber, it's got a lot of other good stuff in it. It's got antioxidants. It's got things that mitigate inflammation. It's got the full package, Right? So those tend to not be so problematic. In fact, they tend to be very, very good for you. They're processed more slowly. So people will notice if you're wearing a continuous glucose monitor, your sugar won't go up quite so quickly. I think that that's important to make that distinction between processed and added sugar versus natural sugar.
- [38:12]
Raj Panjabi Johnson
It kind of reminds me of when I was little, and I would be like, I want something sweet. And my mom would be like, here's an apple or mango. I'd be like, I want cake.
- [38:19]
Noah Michelson
Yeah, it's. No, it's not the same.
- [38:21]
Raj Panjabi Johnson
It's not the same.
- [38:24]
Noah Michelson
What about. I always call Raj out on this, but what about drugs and alcohol? I'm assuming that those are inflammatory.
- [38:32]
Dr. Tamiko Katsumoto
Yeah, I don't want to be a Debbie Downer, you guys.
- [38:37]
Noah Michelson
Every doctor. Every doctor we meet is Debbie Downer. So just continue the grand tradition.
- [38:42]
Raj Panjabi Johnson
It also helps us live another year, healthier and longer.
- [38:45]
Dr. Tamiko Katsumoto
So there's that.
- [38:46]
Noah Michelson
Okay.
- [38:48]
Dr. Tamiko Katsumoto
I think as the research is really coming out, I mean, you know, you remember back in the day, right? Oh, red wine's good for you. Like, it's got, you know, resveratrol and all this stuff. So I think there's more and more evidence that is pointing towards alcohol not being a good thing. That being said, again, it's not like a never thing, but I think it's important to. To recognize that it's, you know, we're starting to realize that one of the things it does. Let's talk about the gut. Is that it can lead to a leaky gut. And so it can, you know, lead to, you know, the translocation of bacteria and bacterial products into your bloodstream, which leads to inflammation and then that leads to inflammation of your liver. Right. And this is why we get hepatitis and cirrhosis, which is, you know, when the liver stops functioning. So unfortunately, alcohol, not the best thing for us. So we really want to be moderate in our consumption of it.
- [39:41]
Noah Michelson
What about sleep? If we're not getting enough sleep, is that going to be inflammatory or could it be.
- [39:49]
Dr. Tamiko Katsumoto
So I will tell you, I'm a lifestyle medicine doctor and there are six pillars of lifestyle medicine which are diet, exercise, sleep, stress, social connection, and avoidance of risky substances. And sleep is one of the six pillars. And I'm gonna confess to you guys, I can't believe I'm publicly saying this. This is the pillar I struggle with the most. I'm not always really good. The ideal is seven to nine hours of sleep. There's been a lot of positive associations with long life, but unfortunately it can. Not enough sleep can lead to inflammation. So, you know, I think that it's super important that we try to prioritize sleep. It's a way our body heals. I mean, you've probably heard the term autophagy where it like cleans out our brain of sort of cells that are not as functional. So sleep is really important for sure. And yes, not enough sleep can lead to inflammation.
- [40:42]
Raj Panjabi Johnson
I think it's the only pillar I'm doing right. I'm so sad. I need to work on the other pillars.
- [40:49]
Noah Michelson
You're doing good with the exercise too.
- [40:50]
Raj Panjabi Johnson
Okay, good.
- [40:51]
Noah Michelson
Yeah, I got two out of the six. Are there foods that are actually anti inflammatory? I mean, we've talked about the vegetables.
- [40:58]
Raj Panjabi Johnson
We know, we hear so many promises.
- [41:00]
Noah Michelson
We. But besides the vegetables, why don't we go through a couple of foods that people say are anti inflammatory.
- [41:09]
Dr. Tamiko Katsumoto
So there's good data on turmeric and on ginger. There's actually good clinical based data. CMOs, I think there's no real human data, no clinical trials or clinical data. It's more. And the concerns there, and I think you guys have talked about this, that supplements. The industry is not regulated, so we have to be very cautious. So I'm a big fan of really focusing on our foods and then maybe taking like a well vetted multivitamin. You know, consider B vitamins, things like that, you know, But I really think about, yeah, plant proteins are super important, right? Sort of your lentils, you know, your legumes, those types of things. Nuts and seeds are super important. Fermented foods, did we talk about that? Those are also really good.
- [41:53]
Raj Panjabi Johnson
We didn't But I love everything fermented.
- [41:56]
Noah Michelson
Yeah. So good.
- [41:56]
Raj Panjabi Johnson
I'll eat like a bucket of kimchi and then be like, I'm fixing my gut just.
- [42:00]
Noah Michelson
Well, you kind of are a little. My boyfriend, my husband, Benji. I know I'm not used to saying that, but thank you. Yes. He loves kefir. Kefir.
- [42:12]
Raj Panjabi Johnson
Oh, love.
- [42:13]
Noah Michelson
He calls it his medicine and he drinks like every single day. And his stomach has actually. He feels so much better since he started drinking.
- [42:18]
Raj Panjabi Johnson
It's also delicious to me.
- [42:20]
Noah Michelson
It's so good. Yeah. So fermented for the win.
- [42:23]
Raj Panjabi Johnson
Back to the exercise, which we just did a fitness episode. Me and Noah love to be up in the gym. Can you tell us how exercise affects inflammation in our bodies?
- [42:32]
Dr. Tamiko Katsumoto
So I think it's a little bit of the Goldilocks model. But generally speaking, exercise is anti inflammatory. If you overdo may have a little bit of a pro inflammatory effect. But generally speaking, moderate exercise is considered anti inflammatory, a good thing. So definitely exercise is a, a key point, a key pillar of keeping inflammation at bay.
- [42:58]
Noah Michelson
Tamiko, have you ever seen like on TikTok or online any crazy shit where people are like, this is anti inflammatory? I was, someone was telling me about they had heard that if you consume borax, which is like a cleaning product, but like they had seen someone saying that that was actually good for like anti inflammatory stuff. And I was like, no, that sounds crazy. But what have you seen that you're like, absolutely, don't do that, don't do this.
- [43:27]
Dr. Tamiko Katsumoto
So yeah, the borax thing is super interesting, A little concerning. I think there's maybe more in vitro data that boric acid may be anti inflammatory. We're talking in petri dishes or in animals, but there's been no human studies. And so I would caution people about that. But in terms of the liability factor, again, the dose makes the poison, right? So number one, these supplements are unregulated. Number two, a lot of them have potential interactions with other drugs with other supplements. These have not been well studied or well vetted. There's a natural medicines database that you can sometimes reference. But again, remember, there's like new supplements coming out all the time. And it cracks me up when people say, oh, just ask your doctor, like as if we know all this, right? Like this stuff has not been tested. I always look for like liver liabilities because a lot of these things, you know, if you take too much of it, it can cause liver injury that can very problematic. In addition, I would say, you know, just be sure to look for Interactions and just be buyer beware. Always think about, when you're hearing someone advertising for a supplement, think about what their ulterior motive is. Right? Because like I mentioned to you, I really think the majority of what we need comes from plants. And let me tell you something, I'm not making any money telling you that. Right? Like I'm not, I don't have a business.
- [44:48]
Noah Michelson
You're not a farmer.
- [44:49]
Raj Panjabi Johnson
Yeah, we learned a lot today. But if we had to just do like, if we can only remember one takeaway from this, what's one thing you would advise people to do to avoid that chronic inflammation.
- [45:02]
Dr. Tamiko Katsumoto
I have to say, I think the key point here is let's focus on a healthy gut microbiome. I think that that is really the key point to really have a nice strong intestinal barrier with happy healthy bugs. A strong mucus lining which protects us from inflammation. A lot of this chronic systemic inflammation that we were talking about, it also helps with detoxification of our body. So a lot of these scary things that we're being exposed to, having a healthy gut microbiome will be protective of that. And I think to do that, we know it's like we've got to feed it, get the good stuff. So plants is really the answer. More plants, plant proteins. Fiber is really the most beautiful thing ever. 95% of us are deficient in fiber in terms of we just learned that. So I think that that is where we really want to focus. And trying to limit the animal based products that we're eating, trying to limit the ultra processed foods that we're eating. You know, not drawing a line in the sand. We need to be permissive, we need something that's sustainable from a dietary perspective. But I will say some of the longest lived people that we know about, they are mostly plant based. They're 95 to 100% plant based. And so I think that that's, to me important information because you're not going to get a clinical trial that runs for 100 years, right? You want to know how these people live to be 100, it's important to study their lifestyle habits and their diets, their exercise, all these things. So lifestyle medicine works, it really works to decrease inflammation. And to think that a majority, you know, upwards of 80% of our diseases can be modified with lifestyle. I personally find that really promising, really exciting. It's not doom and gloom. I think it's really an opportunity, right, to empower ourselves, to try to do the best we can so that we can maintain our health and Our wellness, our health span. These are super important concepts.
- [46:57]
Noah Michelson
Tamiko, thank you so much. I mean I feel much better versed in this now.
- [47:02]
Raj Panjabi Johnson
I do too.
- [47:02]
Noah Michelson
Maybe a little more terrified.
- [47:04]
Raj Panjabi Johnson
Yeah, but.
- [47:05]
Noah Michelson
But better equipped.
- [47:06]
Raj Panjabi Johnson
Yeah, she's right. Like if we know this stuff, we can start today.
- [47:09]
Noah Michelson
Yeah.
- [47:09]
Raj Panjabi Johnson
Yeah.
- [47:09]
Noah Michelson
Thank you.
- [47:10]
Raj Panjabi Johnson
We appreciate you.
- [47:11]
Dr. Tamiko Katsumoto
Thank you. Thank you.
- [47:16]
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Raj Panjabi Johnson
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- [48:37]
Noah Michelson
Okay, you guys, it's time for better in five. These are our top five takeaways from this episode.
- [48:41]
Raj Panjabi Johnson
All right, number one, contrary to what
- [48:44]
you've heard, inflammation is not always the villain. She's integral to her healing sometimes.
- [48:49]
Noah Michelson
So number two, that's because there are two types of inflammation. There's acute and there's chronic. And chronic is usually the kind that we want to avoid.
- [48:57]
Dr. Tamiko Katsumoto
Yes.
- [48:58]
Raj Panjabi Johnson
And acute is the cute one.
- [48:59]
Dr. Tamiko Katsumoto
Just kidding.
- [49:00]
Raj Panjabi Johnson
Okay, number three, you don't have to
- [49:02]
be a saint when it comes to eating, but when it comes to avoiding chronic inflammation, you do want to stay
- [49:06]
away from ultra processed foods, whatever your definition of that is, and veer a
- [49:11]
little bit more toward whole foods.
- [49:12]
Noah Michelson
Yep. Number four, you also want to get seven to nine hours of of sleep because that can also be anti inflammatory.
- [49:19]
Raj Panjabi Johnson
And number five, at the end of
- [49:20]
the day, your gut health is directly
- [49:22]
related to how much chronic inflammation you're going to experience. Okay, Noah, were you doing inflammation wrong?
- [49:29]
Noah Michelson
I think technically I'm not because I'm doing the things I'm supposed to do. To not be inflamed. I just didn't know what it meant, you know, and so I guess it's kind of a fluke that I have been doing it right. But yeah, ever since we had that gut microbiome episode which was so good, if you guys haven't heard it, I would go back and listen to it. But we learned in that one too, like the 30 different vegetables a week and how much you can protect yourself just by eating a ton of vegetables,
- [49:56]
Raj Panjabi Johnson
plants, remember, Because I like fruit also.
- [49:59]
Noah Michelson
Yeah, fruit, nuts, things that are growing, basically. Beans. Any of that. And you can get 30 pretty quickly. Put some cilantro on something, you have some onion. It adds up.
- [50:08]
Raj Panjabi Johnson
It's that diversity I remember.
- [50:10]
Noah Michelson
Yeah. What about you? Were you doing it wrong?
- [50:12]
Raj Panjabi Johnson
Yeah, unfortunately I did know a little bit more than I thought I did.
- [50:16]
Yeah, I am doing it wrong because I'm not getting enough diversity.
- [50:19]
I like the vegetables I like, I like the fruit I like. And I think that's. This is like shaking me enough to be like, I need to protect my gut.
- [50:27]
Noah Michelson
So didn't you love the idea, though? I love this. The six pillars of health.
- [50:31]
Dr. Tamiko Katsumoto
Yeah.
- [50:31]
Noah Michelson
And like, as a lifestyle doctor, I think she referred to herself as. And just this idea that there are six different things. Sleep and exercise and all these things. The more we can do, the better off we're gonna be. And I think if you think about it that way, different buckets you're trying to fill, it's less pressure and we're not gonna be perfect, but we can all aim for to be better in all of them. And I think that will help.
- [50:51]
Raj Panjabi Johnson
I'm gonna be motivated to improve all six for at least the next six hours.
- [50:56]
Noah Michelson
Yeah, I want to sleep more. That's where I'm at. I can't wait to go to bed tonight anyway, until next time. As long as there are things to get wrong, we're going to be right here to help you do them better.
- [51:08]
Raj Panjabi Johnson
We love you guys and your guts. Am I doing it Wrong?
- [51:13]
Is a co production between HuffPost and Acast.
- [51:15]
Noah Michelson
Our producers are Eve Bishop, Carmen Borca Carillo and Malia Agadello.
- [51:20]
Raj Panjabi Johnson
Our executive producers are Jenny Kaplan and Emily Rutter.
- [51:23]
Noah Michelson
Special thanks to HuffPost's head of audience,
- [51:25]
Raj Panjabi Johnson
Abby Williams, Head of video Will Took
- [51:28]
Noah Michelson
as well as Kate Palmer, Marta Rodriguez and Terry d'. Angelo.
- [51:31]
Raj Panjabi Johnson
And we're your hosts, Raj Punjabi Johnson and Noah Michelson.
- [51:42]
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Dr. Tamiko Katsumoto
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Noah Michelson
See verizon.com for details.
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