“The Four Horsemen of the Medical Apocalypse”: It’s All About Inflammation

“Although there may never be such a single path, mounting evidence suggests a common underlying cause of major degenerative diseases. The four horsemen of the medical apocalypse — coronary artery disease, diabetes, cancer, and Alzheimer’s — may be riding the same steed: inflammation.” – Harvard Health Letter, 2006

It has been said that it takes 17 years for new scientific information to change medical practice. So, it’s been 14 years since Harvard posted the article titled “Inflammation: A unifying theory of disease”.

Note the dramatic allegory, “The four horsemen of the medical apocalypse”. The chronic diseases listed plus obesity and probably also depression, which is now costing more in disability payments than back pain and other musculoskeletal conditions combined, are driving our healthcare expenses into the stratosphere and our population into a quagmire of suffering and death from diseases that seem to actually be preventable and in many cases reversible.

What is inflammation?

A cut or scrape heals through the process of inflammation, which is a good thing. But too much inflammation can make that process go overboard and a thick, raised keloid scar forms.

Pounding your heels on a concrete factory floor day after day can cause mechanical stress on the plantar fascia, the tendon-like band that helps maintain the arch of your foot. Through the process of inflammation, part of that fascia undergoes thickening and eventually calcification, and a heel spur forms.

A ruptured disc in your lower back can cause acute pressure on the nerves that supply feeling and control muscle activity in your leg – sciatica. In response to this pressure, the injured nerve swells through the process of inflammation and becomes even more squeezed than it was from the initial injury.

Chronic disc problems can cause calcification, just like with heel spurs, at the corners of each vertebra and sharp bone spurs can form in your back.

Autoimmune diseases like arthritis, psoriasis and colitis involve similar processes in our bodies. Misguided efforts to repair minimal or imaginary (on the part of the immune system) damage or fight off “foreign” invasion cause changes to our bodies like bone spurs or destruction, rashes or peeling skin and diarrhea or ulcer formation, and profound alterations in mood and cognitive ability.

Inflammation can also occur inside our blood vessels. It is now well known that foods and chemicals can increase or decrease inflammation, which helps determine whether blood borne fats start building up in the walls of our blood vessels.

More and more evidence also implicates inflammation as a contributor to obesity , which in turn can promote more inflammation.

The new movement of Functional Medicine is studying and promoting non-pharmaceutical approaches to these inflammation mediated medical conditions. Calling their philosophy “The medicine of why”, they reject the idea that the best way to fight inflammatory diseases is by suppressing the immune system. Instead they focus on avoiding triggers, correcting deficiencies and reversing the modern day imbalance between helpful and excessive immune responses. I have written about this before, here.

The frighteningly simple theory is now more and more anchored in science, down to the specific chemical reactions at work in our bodies and the dietary phytochemicals involved. What we eat, drink, inhale or otherwise expose ourselves to can cause or prevent disease and can determine whether our genetic risks manifest in disease or not. This exploding field is called epigenetics.

How do we fight inflammation?

Here are some very simple fundamentals about what everyone can do to reduce their risk of the inflammation mediated diseases Harvard called the medical apocalypse:

Pro-inflammatory foods to avoid:

Sugar and high fructose corn syrup as well as “refined carbohydrates”, which means anything made from flour (bread, pasta, crackers, boxed breakfast cereals and many snack foods).

Artificial trans fats or partially hydrogenated oils (now phased out from our food supply).

So called “tropical” oils like palm and coconut oil.

Processed meats.

Excessive alcohol.

Also, although not foods, inhaled substances like cigarette smoke can cause inflammation and at the same time decrease normal immune defense responses.

Anti-inflammatory foods to choose:

Healthy Omega-3 fats like olive oil, fatty fish like salmon, avocado and tree nuts.

Berries, cherries, grapes and tomatoes.

Vegetables like broccoli, Brussels sprouts and kale.

Turmeric, cocoa and green tea.

(More details here: https://www.healthline.com/nutrition/13-anti-inflammatory-foods)

Of course, there is more, but imagine if everyone took these simple steps – olive oil consumption alone reduces heart attack risk by 25%, for example. (I just said that in my previous post, too – sorry for repeating myself here).

I am still puzzling about why we aren’t thinking and talking much more about this. Unfortunately, it seems this is not going to revolutionize medical practice in a mere 17 years.

4 Responses to ““The Four Horsemen of the Medical Apocalypse”: It’s All About Inflammation”


  1. 1 marc lippman ms February 3, 2020 at 9:50 am

    this is a very interesting piece. may i suggest you look at RAGE [ the receptor for advanced glycation endproducts ] which binds a host of inflammatory molecules including glycated proteins. HGbA1c is of course a glycated protein and protein glycation with diabetes is in large measure responsible for the tissue injury associated with diabetes. of great interest of course is that a series of RAGE ligands are upregulated in depression, stresss, central obesity as well providing a unifying mechanism for who these inflammatory diseases impair health

  2. 2 JoVeta Wescott February 3, 2020 at 12:44 pm

    On target!

    Sent from my iPhone

    >

  3. 3 James Sedwick February 4, 2020 at 9:26 am

    Dr Duvefelt, What is the earliest indicator of inflammation in the routine blood work that my doctor orders? Can the indicator show mild inflammation? Thanks


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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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