In my clinic, I often hear the phrase, “But I’m not in any pain.” Unfortunately, in the context of modern medicine, this does not mean that a person is healthy. Many of the most serious diagnoses are virtually asymptomatic for years – they do not hurt, burn or prevent you from going to work. Until the first “symptom” is a heart attack, stroke, sudden kidney failure or a fracture from a minor injury.
Chronic non-communicable diseases (cardiovascular disease, diabetes, cancer, chronic lung disease, etc.) account for approximately two-thirds of all deaths worldwide. A typical patient lives for years with high blood pressure, prediabetes, fatty liver or early-stage kidney disease – subjectively relatively fine. Autoimmune thyroiditis or early-stage osteoporosis also progress silently.
From a biochemist’s point of view, we can see that the common denominator of these “silent” diagnoses is chronic low-grade inflammation and oxidative stress. In the blood, we find higher levels of inflammatory cytokines, reactive oxygen species, and products of glycation and carbonyl stress. These are associated with obesity, a sedentary lifestyle, smoking, highly processed foods, and long-term stress. The organ does not hurt, but at the cellular level, changes have been taking place for years, paving the way for a clinical “catastrophe.”
The basis of prevention remains not smoking, maintaining a normal weight, exercise, a diet rich in vegetables and fibre, quality sleep and stress management. However, there is growing evidence that certain special nutraceuticals can specifically target these silent mechanisms – the Nrf2 antioxidant system, glycation stress, NAD⁺ metabolism, the microbiome and microcirculation. These are not “miracle pills,” but tools that, when used sensibly, complement conventional treatment and lifestyle.
One of the most well-studied molecules in this area is sulforaphane from broccoli sprouts. It activates Nrf2 and increases the expression of antioxidant and detoxification enzymes. Clinical studies have shown that sulforaphane can improve metabolic syndrome parameters, reduce inflammatory markers, and have a beneficial effect on glycaemic control and fatty liver. It is a typical example of a substance that targets the “background” – low inflammation and oxidative stress – rather than a single specific laboratory parameter.
L-carnosine is another substance with potential in silent diagnoses. It has anti-glycation and antioxidant effects, binds reactive carbonyl compounds and prevents the formation of advanced glycation end products that damage blood vessels and kidneys. Initial clinical studies suggest that in people with prediabetes and early type 2 diabetes, carnosine supplementation can improve selected parameters of glycaemic control and metabolism without significant adverse effects. It is not a “diabetes pill”, but rather a brake on glycation and oxidative stress at a time when complications are still developing.
The role of NAD⁺ is increasingly being discussed in relation to vascular ageing. With age and chronic inflammation, its levels decrease, weakening mitochondria, DNA repair and vascular elasticity. Clinical studies with NAD⁺ precursors (e.g., nicotinamide riboside) have shown that supplementation increases NAD⁺ metabolites and may improve arterial stiffness and certain cardiometabolic indicators in middle-aged and older adults. This is still a developing field, but it makes a lot of sense from a biochemical point of view, especially when it comes to “silent” vascular ageing.
The gut microbiome is an important “conductor” of systemic inflammation. Dysbiosis is associated with obesity, metabolic syndrome, NAFLD, insulin resistance, but also with depressive symptoms and certain autoimmune diseases. Targeted probiotics and prebiotics have been shown in studies to slightly reduce inflammatory markers, improve glycaemic control and lipid profile – again, not dramatically, but in line with the concept of “tuning the background on which diagnoses that do not hurt arise”.
Other interesting nutraceuticals include astaxanthin, a powerful antioxidant with anti-inflammatory effects and benefits for microcirculation and the eyes; coenzyme Q10, which supports the mitochondria and heart; and polyphenols (resveratrol, anthocyanins, grape seed extracts), which improve endothelial function and antioxidant capacity. Clinical studies with Q10, for example, have shown a reduction in cardiovascular mortality in patients with chronic heart failure with long-term use.
For the average person, this implies a simple, though not always comfortable, message. Just because “nothing hurts” does not mean that there is no damage. Once a year, it makes sense to check your blood pressure, blood sugar, lipids, liver and kidney parameters, at least the basic inflammation marker (CRP), and, if you are over 50, some specific risk factors as recommended by your doctor. A healthy lifestyle is based on this – and only then does sensible, targeted supplementation with substances that we know actually interfere with the mechanisms of chronic inflammation, oxidative and glycation stress, and not just marketing, have their place.
The worst diagnoses often do not hurt. Therefore, we should not wait for pain, but read the silent signals – from laboratory results, blood pressure monitors, mirrors and everyday fatigue – and consider prevention before the first major complication arises.
MUDr. Renáta Lenártová, PhD – physician and clinical biochemist
Selected studies and reviews:
