An interview with Shilpa Ravella


Dr. Shilpa Ravella is a gastroenterologist and author of A Silent Fire: The Story of Inflammation, Diet and Disease.

She treats a range of general gastrointestinal ailments and has unique experience in managing complex rare diseases, including intestinal failure and intestinal or multiple-organ transplantation.

This interview with Ravella was conducted by the editorial board of The Mero Tribune.

Why are more young people getting colon cancer?

Colorectal cancer was once rare among young people. However, early-onset colorectal cancer, which is colorectal cancer that develops in those younger than age 50, has been on the rise over the past few decades. Some studies suggest that genetics may be to blame for this phenomenon, but genetics can’t explain the full picture.  

Research has also tied early-onset colon cancer to changes in diet and lifestyle. One 2022 Harvard study found that early-onset cancer, including colorectal, breast, esophageal, kidney, liver and pancreatic cancer, have increased globally since the 1990s, and that diet and lifestyle may help to explain this increase. 

Dietary factors tied to increased cancer risk include high intakes of processed foods, sugar and red meat, as well as binge drinking. A rise in obesity, decreased physical activity, and exposure to environmental pollutants may also be contributing factors.

What is inflammation?

Inflammation is an ancestral force that evolved to protect the body against pathogens, poisons and traumas. It can be grasped by the naked eye. Slam your knee onto the edge of a table with enough force, for example, and redness, heat, pain and swelling—the four cardinal signs of inflammation—inevitably ensue, as blood flow quickens and vessels dilate, allowing fluid and protein to leak out into tissues.  

Inflammation works to handle and to eventually heal the wound. But inflammation is not always helpful, or even harmless. In autoimmune diseases like rheumatoid arthritis, lupus, and inflammatory bowel disease, it rages against the body’s own tissues, disrupting essential functions and leading to disability. 

Today, we know that inflammation plays an important role not only in autoimmunity but in many other chronic conditions as well, including heart disease, cancer, obesity, diabetes and aging. In fact, low-level, invisible inflammation, simmering quietly in the blood of ostensibly healthy people, may be a common thread running through nearly all diseases. 

What are the signs of hidden inflammation?

We are not accustomed to routinely diagnosing and treating most cases of hidden inflammation despite the damage it is known to cause, and this is perhaps its salient unifying thread at present. However, this definition is evolving. As we learn more about hidden inflammation, as we improve upon testing techniques and as we continue to accrue large-scale clinical trials on successful treatment modalities, we will indeed be attempting to detect more instances of chronic, low-level inflammation in the future.  

One sign that you may have hidden inflammation is the presence of high blood sugar. Another sign is excess belly fat, which is a marker for the highly inflammatory visceral fat that wraps around the body’s abdominal organs.

What are the best ways to decrease inflammation?

Diet and lifestyle play an important role in preventing and treating inflammation. A whole-foods, plant-based diet like the Mediterranean diet contains foods with high anti-inflammatory potential, like fruits, leafy greens and other vegetables, whole grains, legumes, nuts, spices and herbs.  

These foods contain a host of substances that are essential for regulating the immune system, like polyphenols, carotenoids, and other phytochemicals, as well as unsaturated fats like omega-3s. Other lifestyle factors that can adversely contribute to inflammation include smoking, environmental toxins like air pollution, stress, physical inactivity and lack of social connections.

What is the gut microbiome? 

The gut microbiome consists of trillions of germs that live in our intestines. We now understand that these germs are symbionts crucial to human health. The gut microbiome plays a critical role in immune function and inflammation.  One of the reasons that it is important to eat more plant-based foods is because fiber and other components of plant foods are essential fuel for our gut germs.  

Gut bacteria ferment fiber to create beneficial anti-inflammatory compounds in the body, like short-chain fatty acids. Unfortunately, most adults fail to take in even the minimum recommended daily allowances for fiber, which is our most important anti-inflammatory nutrient.


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