A Silent Fire: The Story of Inflammation, Diet, and Disease

by Shilpa Ravella, Suzie Althens (Narrator)

A riveting investigation of inflammation―the hidden force at the heart of modern disease―and how we can prevent, treat, or even reverse it.

Inflammation is the body's ancestral response to its greatest threats: injury and foreign microbes. But as the threats we face have evolved, new science reveals simmering inflammation underneath the surface of everything from heart disease and cancer to mysterious autoimmune conditions.

In A Silent Fire, gastroenterologist Shilpa Ravella takes us on a lyrical quest across time, around the world, and into the body to reveal hidden inflammation at the root of modern disease―and how we can control it. We meet an eccentric Russian zoologist, the passionate yet flawed inventor of Kellogg's Cornflakes, and dedicated researchers working on the frontiers of medical and nutritional science today. With fascinating case studies, Ravella debunks common myths about anti-inflammatory lifestyles―adding or eliminating any one food, for example, is not a cure-all―and unmasks the links between food, the microbiome, and inflammation. A paradigm-shifting understanding of human health, A Silent Fire shows us how to live not only long, but well.

Runtime: 12. 03 hours, 10 library CDs

Genres: Health, Nonfiction, Science, Medicine, Medical, Food, Audiobook

13 pages, Audio CD

Published October 11, 2022

Reviews

[Liliya · Rating 3 out of 5]

This book was okay.

The first half of this book tells the history of inflammation in the context of research. It goes from super basic discovery of cells to specific food based inflammation studies. I already knew 90% of this, so it was a chore to read and I had to stop and come back multiple times over the course of a few months. The second half was more interesting to me. It has a main theme of inflammation origin via food, but also briefly discusses exercise and general stress. In this portion of the book, the author spent half the time calling out western culture for being The Worst Ever in terms of diet, and spent the other half talking very briefly about diets of various cultures and how they are superior. I do agree with her, however, at some points it felt very fear mongering ish to me. I wish there was more discussion on other origins of inflammation because the book did make it seem like food is the only one and by healing your eating you will heal yourself, but there are other factors and those weren’t talked about enough.

This whole book read like a science textbook. On one hand I think the writing is fairly accessible to the average person, but on the other, this book didn’t necessarily offer any succinct advice on how to avoid and heal inflammation. The advice it does offer is very general and things most people know: eat less animal fats and products, don’t eat processed foods, whole foods are king. I spent months trying to get through this book and while the first half was SUPER in depth the second half fell flat and I wished it was longer.

I think this would be a great book for someone with minimal science knowledge who wants to start a food health journey or just learn more about the history of inflammation research and how food contributes to it.

Thank you to the publisher W. W. Norton & company and NetGalley for an eARC of this book.

[Brittany Baird · Rating 5 out of 5]

A Silent Fire is a fantastic read, even for those without a background in medicine. As someone who has struggled with stomach issues I have been looking to learn more about inflammation/gut health - I found Ravella’s writing to be very digestible (no pun intended) as I begin to take better control of my health. Highly recommend this book!

[Rebecca · Rating 4 out of 5]

A must read. I wish there where more examples, less on the history of immunity science, and more elaboration on current research.

[Melissa Maxwell Davis · Rating 5 out of 5]

A Silent Fire: The Story of Inflammation, Diet & Disease by Shilpa Ravella is a brilliant exploration of chronic (often hidden) inflammation and the havoc it can wreak in “a modern plague of illnesses” that are the most common causes of death today. Inflammation, “an intricate force meant to protect us paradoxically turns against us, leading to collateral tissue damage, autoimmune diseases, allergies, and more.” Ravella is an esteemed transplant gastroenterologist who comes to this work with a keen understanding of the immune system, the importance and power of diet, the gut microbiome, and their interactions. Deeply researched, A Silent Fire is a rich text that warrants multiple readings. Ravella details both historical and cutting-edge discoveries about inflammation in prose so gorgeous and insightful that I highlighted sections on nearly every page. A Silent Fire has changed the way I think of food and health and has empowered me to make better decisions for my long-term health. Highly recommended and potentially life changing!

[Kelly Burke · Rating 5 out of 5]

This book was way more than I even expected! I went in thinking to learn a bit about how we are experiencing more inflammation as a population than before and a bit about why. But instead, the author offers an in-depth full exploration of everything related to inflammation and the immune system! It oscillates between sharing the whole history of immunology and the studies that brought us to our current understanding to case studies of patients today experiencing unusual symptoms and what it takes to understand the symptomology. This book explores so much related to inflammation from cancer to obesity to molecules in food we don't even think about. It's super informative and engaging. You don't want to stop learning or put the book down. I highly recommend for anyone interested in learning more about how our bodies work and how food influences how our bodies work!

[Kasia Kulma · Rating 3 out of 5]

Rarely do I read such an ambivalent book! It felt like reading something written by two different authors. The first half of the book was very heavy and fact-dense - I loved it and I learned loads, even if I had to take an occasional break to digest the content. I wasn't a fan of running effectively three narratives (medical facts, research history and a story about the author's friend's autoimmune illness) but Ravella could get away with it thanks to her good style. However, in the second half... what happened there?! Too many anecdotes, background stories, and distracted and inconsistent lines of argument, not to mention the borderline preachy style that made me want to look for hidden agendas. I do think it's a valuable and important book but frankly, I would have reservations recommending it to friends and family.

[Mana Raval · Rating 5 out of 5]

Through her incredible depth of research and stories from personal experience and history, Dr. Ravella provides a holistic explanation of inflammation and allows readers to understand the connections between our immune system, diet and our body in a practical and relatable way. This book has reshaped my views of modern medicine- it offers an explanation to many underlying symptoms from diet and disease, which has ultimately helped me rethink how to live a healthier lifestyle.

[Lisa Welch · Rating 3 out of 5]

Oof.....somewhere this was recommended as a science book that is understandable to lay people. That is not the case. Lots of scientific history, research, and terminology with few practical, clearly presented solutions. There was some interesting info, but my takeaways are minimal for the effort that went into this one.

[Sara · Rating 3 out of 5]

Three and a half stars. I burned through this book like the proverbial inflammation I've earned from eating bread the last 42 years of my life. The first half of the book was a fascinating history of the scientists and doctors who birthed the fields of immunology and nutrition, and it also described the science behind why inflammation is such a Big Deal. The second half of the book lags somewhat, as it covered some ground already described in the first half while it explores why modern life inflames us all (pollution, processed food, not getting outside enough, etc). If you're looking for specific advince about what to eat/ what not to eat, this book is definitely not for you. The author wisely avoids trying to create a one-size-fits-all diet plan for the billions of different bodies out there, and you can find plenty of books that try to do so at your local book reseller. But if you want the hard science about why a more plant-based, wholesome diet is a good idea, here you go.

[Yama Chen · Rating 2 out of 5]

Her anti-meat ideology strongly influence her scientific viewpoint.

[Esther Turner · Rating 4 out of 5]

what Mac said

[Vikram · Rating 5 out of 5]

A real tribute to all of the amazing doctors and scientists who have advanced our understanding of inflammation and how it relates to modern disease. The history and personal stories really drew me in and the closing arguments for how to live a healthier life are very applicable. Must read if you want to know more about what disease prevention will look like in the coming years.

[Laura]

Abandoned the book at the 72% mark when the author made the super unscientific claim that mineral water promotes gut bacterial health. no.
The first half of the book is actually very good and sticks to science. Don't know what happened with the second half but it started to devolve into more and more speculation. I still need to read which articles showed correlation between macrophage inflammatory response and the presence of salt, I've never heard of it. The research on how artificial sweeteners affect metabolism is based on mouse studies that overfed the animals with doses of sweeteners hundreds and thousands of times over what a human guzzling down only diet soda could ever consume so I'm hesitant about drawing strong conclusions from it. The discussion about how high fructose corn syrup affects hunger didn't read complete either: the author talked about how fructose doesn't lower our hunger and claimed that's why HFCS is so much worse than sugar; the problem is HFCS is not 100 fructose, it's only about half. Same as our table sugar, with the exception that our body needs to snip the bond between glucose and fructose first. So is it this additional step that slows down absorption? Is there something else in the processing? I'll have to read myself because the author didn't address it.

Unfortunately this was just another diet book that overstated current knowledge. To be fair, it did better than some useless books out there. But it was going downhill fast when I decided I've had enough.

[Suzanne · Rating 4 out of 5]

If you can embrace the science terminology and vast referencing of other scientists, this book is well worth the read. I was amazed by the interconnection of so many variables: our environment, germs, how food is produced, what we eat, and our bodies immune response.

Synthesizing medical history, cutting-edge research, and innovative clinical practice, Ravella unveils inflammation as one potential basis for a unifying theory of disease. A paradigm-shifting understanding of one of the most mysterious, buzzed-about topics in medicine and nutrition, A Silent Fire shows us how to live not only long but well.

[Adam Weiss · Rating 3 out of 5]

I always thought I’d want to read a story about the history of immunology and some modern implications of this work, but turns out I found this to be a drag. Felt like the author was trying a bit too hard to make this accessible to a super broad audience. Maybe this book wasn’t meant for me but I found all the stories and analogies to detract from the science. Also the audiobook reader mispronounces SO many things.

[Zach · Rating 3 out of 5]

I was already walking down the path of radicalization, but this finished the job. Inflammation terrifies me. She uses a combination of historical and scientific nonfiction storytelling to highlight how much we’ve learned about inflammation in such a (relatively) short amount of time. To maximize longevity, I’m seriously eating anti-inflammatory meals from here on out.

[Susan Dunn · Rating 5 out of 5]

As a Registered Nurse , this book resonated with my soul ❤️

[Martina · Rating 5 out of 5]

This book is part detective story, part medical history, part nutritional science--and all of it, utterly fascinating and helpful.

[Daniel · Rating 4 out of 5]

A unifying theory of nutrition, inflammation, and immunology over time and history. Food for thought.

[Melissa]

Made it through about 65 pages on audio but am having trouble following the very scientific narrative.

[Tutankhamun18 · Rating 5 out of 5]

This book was so good!

An illuminating non fiction book that examines chronic inflammation in the body as a cause of many health problems and explains how our immune system gets confused by our current Western eating habits into being chronically inflammed. Really well explained and an interesting combination between explaining the biology of the immune system and the history of how things were discovered.

The most fascinating part was the explanation of how your gut has an immune response to everything you eat and an anti-inflammatory diet can really help your immune system ward of inflammation (which can then travel in the blood to other organs in your body) and how fibre is acctually benefical for your gut and how certain herbs and spices can transform foods into unleashing their benefical properties.

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Quotes:

“In all organisms, phagocytes-macrophages and microphages — digested foreign matter, actively participating in inflammation. In more complex animals, blood vessels served as conduits through which phagocytes and other white blood cells could rush to embattled areas.”

“We now know that the immune system is divided into two major branches: innate and adaptive. An inflammatory response can involve either branch-or both. The innate immune system is our first defense against foreign threats. Its initial barriers are both physical and chemical, including layered sheaths of skin and body orifices opening into hollow tubes-like the airways, intestines, and genitalia-that are lined with sticky, protective liquids. The innate immune system also includes the hair on our bodies, brows, and nares and even the fine lashes on our eyelids. It defends with bodily secretions such as mucus, bile, and acid. Or spit, sweat, and tears. It is made up of our most ancient immune mechanisms, the ones we share with our primordial ancestors, and it is the main force behind acute inflammation.
Acute inflammation comes and leaves quickly, typically in a few days, fighting intruders while minimizing damage to healthy tissue. Phagocytes, including neutrophils and macrophages, rush to the site of tissue damage, ingesting germs or damaged cells and other foreign materials. Other types of white blood cells, like basophils and eosinophils, may join the fray. The four cardinal signs of inflammation noted by Celsus-redness, heat, swelling, and pain— usually accompany acute inflammation. In injured tissues, blood vessels widen and blood flow surges, causing redness and heat. The walls of inflamed vessels become more porous, allowing inflammatory cells, protein, and fluid to leak into tissues, creating swelling and putting painful pressure on nerve endings. Endothelial cells, which line blood vessels, become injured. Clotting systems are activated, making blood stickier by rushing platelets-small, colorless fragments that congregate in clumps —and other special substances into the area.
The adaptive immune system, which involves defenses that only exist in vertebrates, is more complex and slower to react, but also more targeted. The key players are lymphocytes — small, round white blood cells that can be divided into B cells and T cells.' B cells express antibodies on their cell surfaces that can bind to specific antigens, molecules that are capable of stimulating an immune response, Antigens may be present on all kinds of foreign material, including germs, toxins, food components, tissues from other individuals (like transplanted organs), and even cancer cells. T cells take on various personalities, including "helper" T cells, which assist in activating other immune cells, and "killer" T cells, which focus on removing pathogens.”

“Inflammation, as scientists began to realize over the last decades, is more costly than ever imagined. It is involved not only in a few select disorders but in in the a wide range of ailments that are the most common causes of death in the world today.”

“Cytokines and chemokines, for example, are small protein messengers with big effects. When a germ makes its way into the body, cytokines and chemokines are among the first signals the immune system generates. They determine the quantity and quality of the inflammatory response, communicating with immune organs like the thymus, spleen, and lymph nodes to mobilize even more inflammatory cells into the blood-stream. They can inflame nearby blood vessels and tissues or affect the entire body with a fever or rapid heartbeat.”

Cancer and chronic inflammation

“Balkwill studied tumor necrosis factor alpha (TNF-a), a classic inflammatory cytokine typically produced by macrophages and other immune cells. It was named for its ability to kill cancer cells when injected into tumors at high levels. But Balk-will found that TNF-a could behave differently when it lingered as a low-level force, promoting cancer instead. When she turned off the TNF-a gene in mice, eradicating even low levels of TNF-a activity, the mice did not develop tumors. Anyone working on TNF-a as an anticancer agent was horrified to see that the inflammatory molecule was instead working as a tumor promoter.”

“Dvorik made a seminal discovery in 1983 when he found that cancer cels secreted an abundance of a protein called vascular endothelial growth factor (VEGF). VEGF makes blood vessels more "leaky" (allowing molecules or cells to move in and out of the vessel morg easily) and stimulates angiogenesis, the growth of new blood ves sels. Solid tumors cannot thrive without an adequate blood supple.
Angiogenesis helps cancers grow as it does human embryos, allowing cells to obtain reams of nutrients and oxygen to support their wild expansion. Dvorak's findings, along with those of other scien-tists, helped pave the way for anti-angiogenesis treatmeuts to halt or reverse tumor growth.”

“Macrophages, which typically chew up cancer cells as they would a germ, can turn into traitors. These corrupt macrophages, or tumor-associated macro-phages, are found in most malignant tumors. In some cases they comprise up to half the tumor mass… Macrophages help tumors acquire several of the classic hall-marks. They produce immunosuppressive molecules, protecting the tumor from being harmed by the immune system. They secrete growth factors and cytokines, like IL-6 and TNF-a, that promote a tumor's unchecked growth. They produce the angiogenesis-promoting VEGF, allowing tumors to drink from a robust blood supply. Macrophages degrade a tumor's extracellular matrix, its physical scaffolding, just like they swallow dead cells and debris in wounds, paving the way for cancer to spread to distant sites of the body.”

“At least a quarter of all cancers originate from overt, chronic tisPatienis
sue inflammation. In my own specialty, inflammation can spring up anywhere in the digestive tract, from the mouth to the anus. Chronic, uncontrolled inflammation can cause mild to severe gastrointestinal issues and increase cancer risk. Bad heartburn bathes the esophagus, the hollow tube connecting the mouth to the stomach, in acidic fluid.
The ensuing inflammation distorts the cells of the lower esopha-gus, leading to a precancerous condition called Barrett's esophagus.”

Fat cells and inflammation

“But adipose tissue, beyond its known role in metabolism, was pumping out inflammatory cytokines —not just TNF-a, as later studies showed, but many, others as well, like IL-6, IL-1ß, IL-1, and interferon-gamma (IFN-V). It was the beginning of a paradigm shift that connected fat and inflammation.”

“In lean mice and humans, macrophages remained solitary and scattered among the fat cells.
In contrast, macrophages clumped together in the flesh of obese animals, entirely surrounding fat cells in some cases and mimicking the layout of macrophages in chronic inflammatory diseases such as rheumatoid arthritis. Meanwhile, the number of macrophages in the fat of mice and humans grew in direct proportion to the size of fat cells and body mass indices. Their percentage in fat tissue ranged from under 10 percent in lean individuals to 40 percent in the obese and over 50 percent in the markedly obese. And greater numbers of macrophages even sailed through the blood of these markedly obese individuals.
Macrophages respond to stress. But the body has not evolved to manage overeating, which is one of the biggest stresses of modern life. In lean, healthy individuals, existing macrophages in fat tissue help to maintain an anti-inflammatory state through many path-ways, including by secreting anti-inflammatory cytokines. But they alter their behavior in obesity, and an irate immune response ensues.”

“Many hormones in fat tissue, like leptin, have dual roles. Leptin controls food intake and regulates body weight, but it is also an inflammatory molecule. In obesity, as the body becomes resistant to leptin, fat cells secrete more and more of it, promoting hunger and inflammation.”

Ageing and chronic inflammation

“But a third option exists: some damaged cells simply surrender to time. No longer able to carry out their duties, they stop growing and dividing yet remain alive, entering a retirement phase kaown as senescence. Senescent cells initially secrete substances that hep to repair damaged tissue. But over time, as their numbers increase they disrupt the structures of organs and tissues. Senescence is not flip of the switch but rather a gradual evolution, from a transient, reversible quality to a chronic, immutable one. And senescent cells, having divested themselves of their traditional responsibilities, are far from idle. They become potent inflammatory agents, churning out cytokines like IL-6 and IL-1ß, altering the behaviors of normal cells nearby and those all around the body, including immune cells.”

“Microglia, the most numerous cells in our brains aside from neurons, are central to the link between inflammation and neu-rodegeneration. Like macrophages elsewhere in the body, they engage in tissue repair and attempt to protect the brain from infections, toxins, or anything else that can damage neurons.

The crystal-like amyloid plaques that characterize Alzheimer's, with surface molecules reminiscent of some bacteria, are foreigners that elicit an innate immune response honed over millen-nia. Microglia attempt to eat and digest amyloid, much like their counterparts stuff themselves with cholesterol in atherosclerotic plaques. They release loads of cytokines in the process, like TNF-a, IL-1B, and IL-6, activating other microglia. This process, typically fleeting, becomes ongoing in Alzheimer's disease, where microglia are high-strung and hyperactive. The ensuing chronic inflammation maims neurons, feeding dementia. When nerve cells become inflamed, the connections between them are less adept at learning and storing information. Inflammation may also fuel the growth of plaques and tangles directly or by hindering the ability of microglia to clear them.”

Inflammation and Mental Health

“Microglia activated by body inflammation run amok, producing inflammatory cytokines that destroy neural connections in the brain that affect mood and behav-lor. Brain inflammation reduces the amount of serotonin flowing between neurons. Cell studies suggest that inflammation may also increase the risk of depression by suppressing the birth of new brain cells and quickening the death of existing ones.”

Intestines and Inflammation (Chapter 6 was my favourite)

“Much of the immune system lives in the gut, which is heav ily exposed to the external world. There are three major channels through which inflammatory triggers enter our system: the skin, the lungs, and — an especially susceptible point of entry —the gastrointestinal tract.”

“The food we eat can directly spark or inhibit an inflammatory response by the immune system. Innate immune cells-including macrophages, neutrophils, and dendritic cells-and the epithelial cells lining the intestines rely on primordial pattern recognition receptors to closely examine germs and other matter. These receptors, which are embedded in cell membranes, recognize alien material and trigger a powerful inflammatory or anti-inflammatory response, activating genes and generating a cascade of signals conserved across the phylogenetic ladder, from insects to plants to humans. They can even respond to distress signals spewed out by stressed cells all over the body. In short, the immune system is prepared to fight food as it would a germ.”

“One critical method by which the conversations between. microbes and immune cells help prevent disease is by training our bodies to distinguish harmless food and germs from their toxic coun terparts. A great deal of this dialogue takes place within the intes-tines. The intestines contain the largest reservoir of macrophages in the body. Their lives are often hard and brief, constantly yielding to younger replacements circulating in the blood. Not only do they heal wounds and fight germs, as in other tissues, but they also learn to live alongside a multitude of gut microbes, functioning within complex layers of the intestinal immune system.
At the inner lining of the intestines, the interface between "self" and the exterior world, rectangular epithelial cells shove tightly against each other like bricks, limiting the entry of harmful sub-stances. These cells soak up nutrients and secrete a protective layer of slippery, watery mucus that coats the digestive system and contains an antibody called immunoglobulin A (IgA), which bars the entry of toxins and bad germs. The mucosal immune system exists not only in the intestines but also in other body cavities exposed to the environment, including the nares, lungs, eyes, mouth, and geni-talia. Burrow deeper into the wall of the intestines and the immune system's vernacular bares a cohesiveness that unites historically fractured segments of immunology. Beyond the fence of epithelial cells lies the lamina propria, loosely packed tissue that holds most intestinal immune cells, the blood supply, and lymph vessels. Here, innate and adaptive immune cells, including macrophages, dendritic cells, and B and T lymphocytes, mingle. Within the lamina propria sits the gut-associated lymphoid tissue, the largest lymphatic organ in the body, consisting of special patches of lymphoid tissue found throughout the intestines and lymph nodes all over the abdominal cavity. Teeming immune cella in these areas stand ready to ignite an inflammatory attack against adverseries.”

“In creating this fine balance, the gut errs towards tolerance, dampening its immune responses, a characteristic that evolved to prevent needless immune activation and inflammation against benign substances. Intestinal macro-phages, the gatekeepers of tranquility in the gut, are distinct from macrophages in other parts of the body. Healthy intestinal macrophages are trained to tolerate, so their ability to recognize microbial structures and to induce an inflammatory response is muted.
They remain patient when provoked by microbes and often shy away from making inflammatory cytokines, although they are still able to engulf, swallow, and kill when needed. But sometimes the response can go awry, with genes and the environment colluding to disrupt a yin-yang state, creating food allergies, celiac disease, inflammatory bowel disease, or other problems.”

“A complex picture of the immune system began to manifest.
The presence of an animal's genetic code does not in itself suffice to create a mature, healthy immune system. Microbes must assist in this nuanced task, as revealed by the isolated anguish of germ-free mice.”

[Raț Robert · Rating 4 out of 5]

Cartea începe prin explicarea și detalierea istoriei inflamației și vine cu exemple concrete către prezent, iar când ajunge în prezent autoarea argumentează concluziile cu studii. Problema e că majoritatea studiilor sunt pe rozătoare și nu poți transpune mereu ce găsești în studiile pe rozătoare pe oameni, efectul la oameni fiind uneori exact opusul. Am aflat și unele lucruri noi dar nu se intră foarte mult în detalii fiind o carte foarte bună pentru a explora ,,suprafața,, inflamației.

[Annette · Rating 3 out of 5]

A fair bit of repetition; a good edit would have helped. The first third was depressing, before the well-known solutions - eat healthy anti-inflammatory foods, be a healthy weight, exercise, sleep well - are introduced in the context of the science explained in the earlier chapters.

[irving m adler · Rating 5 out of 5]

effects of inflammation on health

Provides a very good historical and contemporary understanding of the causes and effects of inflammation. Definitely worth while read. Will make you think twice about what you are eating relative to your long term health. Helps to better understand previously difficult to explain or understand bodily reactions to trauma.

[Rachel Miller Wright · Rating 4 out of 5]

This book is comprehensive and packed with science and the history of science around the immune system. It was more than what I was looking for, but I encourage you to hang in there for the second half when it really digs into diet (and environmental factors to an extent) on inflammation. Although I did love the fascinating education about the role of inflammation in atherosclerotic plaques and heart disease.

This definitely has me thinking in a new way about what goes into my body- this one in particular made me think in new ways about meat, processed foods, fiber, and antibiotics. Everything that goes on in the body is such a complex cause-and-response - like a conversation - between so many hormones, cells, and molecules (and gut bacteria are so involved in the conversation). Anything we put in or on our bodies might scratch one specific itch but sets of a cascade of reactions, many of which are immune system responses.

I suddenly want to learn to ways to eat and enjoy exclusively whole foods.

[Bonny · Rating 3 out of 5]

A Silent Fire is an interesting read, but I had hoped for more dietary recommendations than it provided. Ravella explains what inflammation is, how it is both a cause and consequence of disease, why it is important, and how it figures in many disease processes. Inflammation can be linked to various chronic conditions such as heart disease, mental health issues, and autoimmune diseases. The recommendations provided are mainly common sense that most of us have heard before - eat a plant-based diet with few processed foods, try fermented foods, don't overeat, and get plenty of rest and exercise. There was this interesting observation: “Exercising too much, or in the wrong way, injures and inflames. Long, intense periods of exercise, particularly for those unaccustomed to such rigor, can increase the risk of chronic, hidden inflammation.” This is the first book I've ever read that has cautioned me about exercising too much or too hard!

[Jill Bowman · Rating 3 out of 5]

I felt like although there were some good points made (inflammation causes problems in the body) a lot was ignored.
There was a lot about Ancel Keys - but no mention that he ‘Cherry picked’ those 7 countries.
She states that meat causes putrefaction but uses an egg and sausage McMuffin as her example.
She talks about the healthy way of eating when her mother lived in India but with no mention that Indians have one of the highest rates of diabetes in the world.
Talk of all the health benefits of vegetables 👍🏼 and grains 👎🏼 with no mention of what decades of glyphosates have done to our bodies.

This book is readable and others may like it a lot but it disagrees with so much of the research I’ve done (though I’m no one in the field, just someone looking after my own health) I can’t recommend it.

[Shanna Klutts · Rating 4 out of 5]

So very interesting. Needed to hear most of this. Docked a star because the beginning was pretty technical, and I almost gave up as I am not a geneticist or medical student. But the practicals and the information were excellent. And the stories at the beginning and end of the chapters to tie everything in were great antidotes and examples! I have a new fire for ridding us of as much inflammation as possible, and now have feasible steps in order to do this. 🙌🏻

[Andrew Kline · Rating 4 out of 5]

This is a difficult book to rate. I really enjoyed learning about the history of the study of inflammation. I thought the author did a good job of balancing the technical terms and more layman's language. As far as actionable advice, it boils down to a plant-based diet. But even that is prefaced with the fact that veggies today aren't as nutritious as they used to be. Good information, but being able to follow it really depends on income and location.

[Venky · Rating 5 out of 5]

Inflammation as we all know it, in its most rudimentary and reductionist parlance, represents a visual phenomenon that is putting it mildly, discomforting. Redness accompanied by swelling and carrying a common label that invariably has “itis” at its end – tonsilitis, appendicitis etc. However, as transplant gastroenterologist and Assistant Professor of Medicine at Columbia University, Dr. Shilpa Ravella, exquisitely reveals, there is yet another kind of silent and insidious inflammation lurking behind the shadows while wreaking havoc with our bodies in a sustained yet stealthy, and incremental yet impactful manner.

Silent inflammation in contrast to “acute inflammation” can be tricky to detect. Acute inflammation has been examined, analysed, and written upon in copious terms from time immemorial. In 25CE, Aulus Cornelius Celsus in Rome held forth on inflammation. Believing that a noxious build up of one of the four ‘humors’ in the body resulted in the four cardinal symptoms of inflammation, he identified the typical symptoms as rubor (redness), tumor (swelling), calor (heat) and dolor (pain).

Silent or simmering inflammation, on the other hand, can remain unnoticed and often there will be no symptoms until disease occurs. Only recourse to several tests, such as those included in the Inflammation Panel, can help an individual identify the amount of inflammation prowling within their body.

The beauty of Dr. Ravella’s book lies in its astounding simplicity. Elucidating seemingly convoluted and complex physiological workings into simple layman terms, Dr. Ravella unravels the perniciousness that is silent inflammation. The book draws extensively on pioneering research in immunology conducted by Russian zoologist Ilya Ilyich Mechnikov. Now recognised as “father of innate immunity,” Metchnikoff was responsible for discovering a process of immunity called phagocytosis and the cell responsible for it, called phagocyte, specifically macrophage, in 1882. This discovery turned out to be the foundation of the concept of cell-mediated immunity.

Beginning her utterly compelling book with a poignant personal experience, Dr. Ravella illustrates the deleterious effects of silent inflammation that can render an otherwise healthy person utterly helpless and debilitated. Silent inflammation plays a vital role in exacerbating and even triggering chronic and dangerous conditions such as heart disease, cancer, Type 2 diabetes, depression, and dementia. It is fascinating to read how a human being’s adaptive and innate immune systems – trusted sentinels and gatekeepers engaged in a perpetual vigil to ward off predatory germs – can transform into wrathful renegades that destroy the very stuff they are invested with a responsibility to protect, with a frightening degree of rapaciousness and precision.

So, is there no means of protecting oneself against the workings of this silent inflammation? Dr. Ravella identifies diet as a powerful means to combat this unseen peril. Including a diverse array of plants for a start is a good beginning. According to her our diet ought to include “foods we have been conditioned to avoid: whole grains – even beans and those containing gluten – are anti-inflammatory foods.”

Cruciferous vegetables, such as broccoli, cauliflower, and kale, are especially healthy because they contain molecules called isothiocyanates, which remove toxins, prevent DNA damage, and kill cancer cells. Dr. Ravella also urges her readers to look favourably towards the soluble fibre found in bananas, oatmeal, and beans. “Gut bacteria love these foods. They ferment soluble fibre to make short-chain fatty acids which lower inflammation in the intestines and throughout the body.”

Of especial interest to me personally, is the Chapter highlighting the famous Ancel Keys “Seven Countries” study. This study was the vision of Ancel Keys, a Minnesota physiologist, who aimed to evaluate questions about heart and vascular diseases among countries having varied traditional eating patterns and lifestyles. The countries identified for the study were Italy, Spain, South Africa, Japan, Finland, Greece, and the United States of America. The findings of this humongous study exhibited with startling clarity the fact that dietary patterns in the Mediterranean and in Japan in the 1960s were associated with low rates of coronary heart disease and all-cause mortality. A healthy diet and lifestyle (sufficient physical activity, non-smoking, and moderate alcohol consumption) according to the study was also associated with a minimal risk of cardiovascular disease and all-cause mortality. A healthy diet and sufficient physical activity, the study postulated, may also postpone cognitive decline, and decrease the risk of depression.

Dr. Ravella has rendered yeoman service to the lay and the learned alike with A Silent Fire. This book has all the makings of a breakthrough work in its genre. Dr. Shilpa Ravella has undoubtedly put herself on par with the arresting writings of Dr. Siddhartha Mukherjee and the alluring persuasions of Dr. Atul Gawande with this wonderful book. She has this enviable gift of the pen in addition to her core accomplishments in the field of medicine. This is indeed a boon for her readers as it would undoubtedly be the case for her patients.

A Silent Fire – a magical journey into the invisible world of pain, protection, and prophylaxis.