Inflammation
“Inflammation is the number 1 cause of chronic disease.”
When we think of inflammation the first thing that usually comes to mind is the image of a swollen, painful, sprained ankle. However, this is only a small paragraph in the large story we call inflammation. We are going to expand this story so that you can start to understand the full story of inflammation. Why is this important? The future of your health depends on your understanding and ability to combat inflammation, but before we can do that, we need to learn a little more about the different types of inflammation.
What is Inflammation?
Inflammation is one of those double-edged sword situations in that it is both a necessity for survival, but at the same time, is the number 1 cause of all chronic illnesses.
At a basic level, inflammation is an ancient biological response to injury, infection, or other harmful stimuli, that our body has utilized over thousands of years to heal and protect us. Like an emergency response team, inflammation mobilizes immune cells to the site of an injury, cleans up the damaged tissue, and initiates the repair process. If this process were to ever to break down, without modern medicine, our early ancestors would have been out of luck and we would not be here.
So how can inflammation be necessary for survival, and at the same time, be the number 1 cause of all chronic illnesses? The problem happens when the inflammation process is ‘triggered” continuously and fails to shut down. Over time chronic inflammation begins to slowly destroy the same tissues it was designed to protect.
Acute Inflammation (Rapid, Aggressive, Usually Self Limiting)
Acute inflammation is the response we see with an injury, such as a sprained ankle. The inflammatory response begins when specialized cells that “patrol” our bodies discover bacteria/viruses (foreign invaders) or cellular stress/tissue damage (injury) and set off an “alarm”.
Local blood vessels dilate (become larger) to allow more blood to flow into the area. Local capillaries become more permeable (porus) to allow proteins and White Blood Cells (WBCs) to enter the interstitial space around the cells. These changes are what cause the heat, redness, and swelling of acute inflammation. Within a few hours WBCs begin to “devour” the injured tissues. Pain results from chemical signals that stimulate nerves that alert the brain that something is wrong.
Once the threat is neutralized and cleanup is underway, anti-inflammatory signals tell the WBCs to stand down, inflammation resolving pathways kick in, and the repair process can start.
Fun Fact: Pus
As WBCs engulf large numbers of bacteria and dead tissue they essentially die off as well. Over a few days a cavity forms in the inflamed tissues containing a fluidity mixture of all the dead bacteria, dead tissue, and WBCs, aka pus.
Chronic Inflammation (Silent Killer)
Unlike acute inflammation which is loud and aggressive, chronic inflammation is quiet and stealthy. There are almost never any signs of heat, redness, or swelling. You may not feel sick or unwell. On the surface everything appears normal. However, just like hot embers under the ashes of last nights fire, under the surface your immune system is continually producing low levels of inflammatory molecules that continue to affect tissues for weeks, months, or even years.
Over time, chronic inflammation slowly creates damage in the body that has a cumulative effect as it gradually destroys cells and tissues, and breaks down arteries and organs.
Because this happens gradually over a period of years, this process often goes unnoticed until a disease state has firmly taken hold. In other words, symptoms do not show up until sufficient tissue damage has occurred.
In the next few articles, we will delve a little deeper into chronic inflammation. We will discuss what the research says, what happens in the body, risk factors, tips to reduce your risk factors, and potential supplements you can take.
Chronic Inflammation-The Silent Killer (Part 1)
Over the last couple of decades the research has become clear, chronic inflammation is damaging to our bodies and shortens our lifespan. We now know that chronic inflammation is connected with many of our modern-day diseases. We also now know that most, if not all, people are chronically inflamed to some degree. It doesn’t take a rocket scientist to see that even with all the advances happening in modern medicine, chronic illness is on the rise. Let’s take a closer look at how chronic inflammation affects our body.
Your state of inflammation can be evaluated using a simple blood test. Chronic inflammation produces byproducts that are released into the blood. Your inflammation status can be determined by measuring the amounts of these byproducts in your blood. The 3 most common markers used are:
- C-Reactive Protein (CRP)
- Interleukin 6 (Il-6)
- Tumar Necrosis Factor (TNF)
2 large studies used these markers to evaluate the effects of chronic inflammation on our health.
The first study was published in the Public Library of Science in Glascow Scottland in 2015. Researchers used blood samples from 160,000 patients and followed these people for 8 years from 2000-2008 (long term study with an extremely large sample size). The researchers used CRP to assign each patient what they called an “inflammation score” at the start of the study.
At the end of the study period, the researchers compared the patients’ health history with their inflammation score at the start of the study. What they found was that the patients with higher inflammation scores were more likely to die from any cause (referred to as all cause mortality in the literature). They also found that high inflammation scores were able to predict death due to cancer and cardiovascular disease.
The second study was published in the Canadian Medical Association Journal in 2017. Blood samples were taken from 6500 patients (aged 45-69) from 1997-1999 and these people were followed for 15 years until June 2015.
The results were similar to the Glascow study. Patients with elevated CRP levels were more likely to die from cardiovascular disease and patients with elevated Il-6 were more likely to die from all cause disease and cancer.
These 2 studies leave no doubt; chronic inflammation is a silent killer! Next time we will discuss risk factors and what changes actually happen in the body to cause disease.
Chronic Inflammation-The Silent Killer (Part 2)
Previously we have defined the difference between acute and chronic inflammation. We have also discussed that, without a doubt, chronic inflammation is a silent killer and is the number 1 reason for the rise in chronic illness that we see in society. If you haven’t read the previous two articles, this may be a good time to do so.
Today we are going to review the risk factors for chronic inflammation and then we will look at how different diseases can develop due to chronic inflammation.
Risk Factors
- Obesity
- Sedentary lifestyle
- Chronic stress
- Age (inflammation increases as we get older)
- Poor diet
- Smoking
- Periodontal disease
- Sleep disorders
By far the most common risk factor for chronic inflammation is our “modern lifestyle”. Modern life, with its fast food, sedentary habits, and chronic psychological stress, creates a perfect storm for inflammation to persist. The very things that make our lives easier often fan the flames of disease beneath the surface.
Inflammation and Cardiovascular Disease
For decades we have been told that high cholesterol was the main factor contributing to cardiovascular disease. We now know that chronic inflammation plays an integral role in this condition as well.
Atherosclerosis, the buildup of plaques inside arteries, begins not just with fat deposition but with immune activity as well. When low-density lipoprotein (LDL) cholesterol infiltrates the arterial wall, immune cells react to it as a threat triggering an inflammatory response. Over time, the plaques become inflamed, unstable, and prone to rupture. When they break apart, they can form clots that block blood flow to the heart or brain, causing heart attacks or strokes. As we saw from the studies discussed in the last article, elevated CRP levels are now recognized as a strong predictor of cardiovascular events, maybe even more so than cholesterol levels.
Inflammation and Metabolic Disease
The root cause of many metabolic conditions is insulin resistance. When cells stop responding to insulin (a hormone that signals them to take in glucose from the blood) our blood sugar levels increase, setting the stage for a whole host of metabolic conditions, including Type 2 Diabetes.
Adipose tissue (fat) is hormonally active. In obesity, fat cells grow larger and become dysfunctional. This creates an immune response, which activates TNF and Il-6, which interfere with insulin activation. This decreases the amount of glucose taken up by our cells resulting in high blood sugar levels.
The end result is that we get stuck in a repeating cycle where inflammation leads to insulin resistance, which leads to more glucose and fat in the blood, which promotes more inflammation. Over time, this contributes to the full spectrum of metabolic syndromes including: obesity, high blood pressure, and increased risk of cardiovascular disease.
Inflammation and Cancer
When it comes to inflammation and cancer, we find ourselves in an interesting paradox. On the one hand, inflammation is designed to identify and destroy cancer cells before they grow. On the other hand, chronic inflammation can create a fertile environment for cancer to grow and thrive. This is due to the fact that inflammatory environments are rich in growth factors, blood vessel promotion, and enzymes that remodel tissues which can all promote tumor growth.
Inflammation and Autoimmune Diseases
Autoimmune diseases are conditions that arise when the immune system mistakes the body’s own tissues for invaders and mounts an attack. The result is self-inflicted inflammation, often chronic and disabling.
Diseases like rheumatoid arthritis, lupus, and multiple sclerosis are all driven by misdirected immune responses. In rheumatoid arthritis, the joints become inflamed as immune cells infiltrate the synovial lining. In lupus, inflammation spreads across multiple organs, including the skin, kidneys, and brain. In multiple sclerosis, immune cells attack the myelin sheath around nerves, disrupting signal transmission.
What triggers autoimmunity remains partly mysterious, but genetic predisposition, infections, hormonal factors, and environmental exposures all seem to play a role.
At this point I hope you now realize just how devastating chronic inflammation is to our body and why I can make the statement that chronic inflammation is the number 1 cause of chronic illness in society. The next few articles will shift focus and we will discuss strategies that you can use to combat chronic inflammation.
Strategies To Reduce And Prevent Chronic Inflammation (Part 1)
The number one cause of chronic inflammation is our modern lifestyle. The inflammatory process is an automated biological process that dates back 1000’s of years to our hunter gatherer days. Society was quite different then. The stresses we have to deal with today are completely different than the stresses experienced by our ancestors. The end result is that our entire community (due to modern day lifestyle choices) is chronically inflamed to some degree.
As such, the best way to combat this is by making adjustments in the ways we live our lives. The next 2 articles will discuss different strategies you can use to decrease your own state of inflammation. Don’t feel like you have to use them all (although the more you use will increase your success rate) and don’t try and change everything at once. Pick 1 or 2 strategies that resonate with you and incorporate them into your lifestyle. As you become comfortable with these changes, and they have become part of your daily routine (habits), revisit these strategies and pick another one to focus on.
- Get Enough Sleep
A study published in the journal Circulation (2010) surveyed 525 middle aged people about how long they slept each night and correlated their responses with their levels of CRP and Il-6. The researchers found that those people sleeping for 6 hours or less had up to 25% higher levels of CRP and Il-6 than those sleeping for more than 6 hours.
- Drink More Caffeine
A study out of Stanford University (2017) studied data from 100 participants over a multiyear timeframe. Researchers wanted to see if there was any protective benefit between caffeine consumption and the 90% of non-infectious diseases associated with chronic inflammation. They concluded that caffeine could provide protective benefits against these conditions with the head author Mark Davis (Professor of Microbiology and Immunology and Director of the Stanford Institute for Immunity, Transplantation, and Infection) stating, “What we’ve shown is a correlation between caffeine consumption and longevity”
- Keep Your Weight Under Control
A study published in Nutrition Research Reviews (2008) found that losing weight (10% weight loss) resulted in a decrease in inflammatory markers (CRP, Il-6, TNF) in the blood. As we discussed previously, fat cells trigger the release of immune cells involved with inflammation and these cells go after healthy nerves, tissues, and organs.
- Exercise
A study reported in Medical News Today (2017) had participants walk on a treadmill for 20 minutes at a moderate pace. Researchers took blood samples before and after the treadmill session. They found a 5% decrease in the number of cells producing TNF.
Keep in mind this change occurred in only 20 minutes. Can you now see the benefit of going for a brisk 20 minute walk every day! As a side effect you will also be addressing #3 above.
- Avoid High Sugar and Highly Processed Foods
A study published by the American Institute for Cancer Research (2013) followed over 10,000 men and women for 16 years and found that those who consumed a more pro-inflammatory diet had a 53% higher risk of mortality than those who consumed a less-inflammatory diet.
Another study published in the European Journal of Nutrition evaluated over 37,000 women and found that those consuming a more pro-inflammatory diet were more likely to die from cancer, cardiovascular disease, and COPD.
Pro-Inflammatory Foods
Fast food Fried Foods Refined Flour (white bread and pasta)
High Sugar Foods Trans-Fats Artificial Sweeteners
Artificial Additives Processed Meats Bad Saturated Fats (chips and pizza)
- Eat Healthy Fats/Omega-3
A study published in Surgical Neurology (2006) followed 250 patients with neck and back pain for 75 days. The patients were asked to take 1200mg omega-3 fatty acid in a fish oil supplement daily.
- 59% stopped taking the anti-inflammation drugs they were taking for pain
- 60% stated that their overall pain improved
- 80% stated that they were happy with their results
- 88% planned to continue to take their supplements at the conclusion of the study
The authors noted that these supplements appear to be a safer option for neck and back pain than standard over the counter pain pills.
Another study published in the Journal of American College of Nutrition found that healthy fats can be effective in soothing inflammatory conditions such as Crohn’s, Ulcerative Colitis, Psoriasis, Lupus, and MS.
Sources of Healthy Fats
Fatty Fish Flaxseed Hemp Seeds Anchovies
Walnuts Cod Liver Oil Egg Yolks
Strategies To Reduce and Prevent Chronic Inflammation (Part 2)
My hope is that you have now started to make some changes. Before we move on to our next strategies, let’s review our first 6.
- Get Enough Sleep
- Drink More Caffeine
- Keep Your Weight Under Control
- Exercise
- Avoid High Sugar and Highly Processed Foods
- Eat Healthy Fats/Omega-3
- Take Probiotics
A paper published in Current Pharmaceutical Design (2009) noted that a number of inflammatory conditions improved with probiotic supplementation. The authors hypothesised that the probiotics changed the communication between the immune system and the brain.
Another study published in Nutrients (2017) examined data from 20 previous studies and found a significant reduction in CRP measurements following the administration of probiotics.
- Take Care of Your Gums and Teeth
A study published in the Journal of the American Dental Association stated that people with periodontal disease have elevated levels of systemic inflammation markers such as CRP. They found that when the periodontal disease was treated systemic inflammation levels decreased.
- Manage Your Cholesterol
We have already talked about the fact that inflammation has been called LDL cholesterols “partner in crime”, especially when it comes to cardiovascular disease. The combination of high cholesterol and inflammation creates a deadly positive feedback loop. When cholesterol gets into the arteries it triggers an immune response which initiates an inflammatory process. The presence of inflammation speeds up the accumulation of cholesterol in the arteries which further increases inflammation, and around the circle we go.
- Vitamin D
Anyone that knows me well knows what a huge proponent of Vitamin D I am. A study published in Cancer Prevention Research (2015) followed 218 overweight, postmenopausal women with less-than-optimal levels of Vitamin D. The women participated in a 12-month diet and exercise program. Half of the women were given 2000 IU of Vitamin D daily while the other half were given a placebo.
Blood tests measuring inflammation markers were taken at the start of the study and again after 12months. All of the participants showed decreased levels of inflammatory markers at the end of the study, however, the women who took the Vitamin D supplements had a more significant decrease in their blood inflammation markers.
- Tart Cherries
An article published in Medical News Today (2012) reported that women aged 40-70 with inflammatory osteoarthritis who drank tart cherry juice twice a day for 3 weeks significantly reduced their levels of blood inflammatory markers.
Another study published in the Journal of the International Society of Sports Nutrition (2010) looked at long distance runners. The authors stated that long distance running causes acute muscle damage which creates inflammation and muscle pain. They gave long distance runners cherry juice or a placebo to drink twice a day for 7 days prior to a race. The cherry juice group reported significantly less pain than the placebo group after the race.
- Drink Green Tea
A study published in the Journal of Advanced Pharmaceutical Technology and Research (2012) stated that green tea has powerful anti-inflammatory properties, and that women who drink green tea have healthier bones and lower inflammatory markers than those who don’t drink green tea.
Supplements For Inflammation
Before we start, I would like to make a few points. First, don’t start taking supplements and expect to see positive results if you are not putting in the effort to alter your lifestyle habits that we talked about in the previous articles. The purpose of supplementation is to support and enhance the work you are putting in to modify your lifestyle, not replace it.
Second, if you are taking any medications, it is imperative that you check with your pharmacist before starting any type of supplements. Just because you can buy supplements over the counter without a prescription does not mean that they can’t interact with any prescription medication you may be taking.
Third, you may notice that some of the supplements we will talk about were already covered in previous articles, namely Vitamin D, Omega-3, and probiotics. This is not by accident and I strongly suggest that these 3 would be a good place to start if you want to add supplements to your regimen.
- Fish Oils/Omega-3
A study published in the Journal of Strength Conditioning Research (2014) found that Omega-3 supplementation can decrease levels of inflammatory markers compared to a placebo. They also stated that Omega-3 supplementation may decrease muscle damage and inflammation post exercise, however, more research is needed.
Note: There are 2 primary Omega-3’s, EPH and DHA. Most supplements contain various combinations of the 2. Dosages containing less than 2 grams of EPH and DHA combined are usually safe. Aim for a supplement that contains 1200mg of EPH and DHA combined.
Side Effects: fishy burps, bad breath, heartburn, and upset stomach
- Vitamin D
A paper published in Critical Reviews in Food Science and Nutrition (2018) outlined the researchers’ findings after reviewing several studies on Vitamin D. The authors noted that there is a well documented link in the literature between low Vitamin D levels and the presence of inflammation. Make sure you are getting Vitamin D3.
- Probiotics
A study published in the Journal Nutrients (2020) found that a combination of fish oil supplements and probiotics may help inflammation. The authors stated that, “this is a promising strategy that promotes beneficial immune system regulation via the gut microbiome”.
- Curcumin/Turmeric
Curcumin, known for its bright yellow colour, is a compound found in turmeric which is a staple of Indian cuisine. A study published in Clinical Nutrition (2015) found that people with Metabolic Syndrome who took curcumin had a significant decrease in CRP compared to a placebo group.
Note: Curcumin is poorly absorbed by the body so you need to make sure that any supplement you buy includes piperine (black pepper) to increase absorption. Likewise, if you are using turmeric with your cooking make sure to add black pepper as well. With supplementation you can take up to 500mg/day.
Side Effects: nausea, diarrhea, headaches, do not take with blood thinners
- Ginger
Ginger has long been a home remedy for indigestion and nausea. A study published in the International Journal of Food Sciences and Nutrition found that when diabetics were given 1600 mg of ginger daily for 12 weeks their blood sugar improved and their inflammatory markers decreased significantly compared to a control group.
Note: Up to 2 grams of ginger a day is usually safe.
Side Effects: May have a blood thinning effect.
- Resveratrol
Resveratrol is an antioxidant found in purple skinned fruits such as grapes and blueberries. It can also be found in red wine and dark chocolate. In a study published in Archives of Medical Research (2015) researchers gave patients with Ulcerative Colitis 500 mg of resveratrol for 6 weeks. At the end of the 6 weeks patients’ reported improvements in their quality of life and Ulcerative Colitis symptoms and their blood inflammatory markers were lower.
Side Effects: May interact with blood thinners.
- Bromelain
Bromelain is a powerful enzyme found in pineapple and is the reason pineapple leaves a burning sensation if you eat too much. Two separate studies (Journal of Pakistan Medical Association (2017) and Physiotherapy Research (2016)) found that bromelain has the same anti-inflammatory capacity as NSAID’s, but with fewer side effects. They did note that further research is needed.
- Green Tea Extract (GTE)
A small study published in the European Journal of Applied Physiology (2020) followed 15 middle-aged overweight men for 8 weeks. The researchers found that 500 mg of GTE a day combined with exercise 3x/week significantly reduced inflammatory markers compared with exercise alone.
Note: Be aware that GTE supplements contain caffeine unless otherwise labelled.
- Garlic
A study published in Clinical Nutrition (2018) gave 51 obese adults 3.6 grams aged garlic extract or a placebo for 6 weeks. At the end of 6 weeks researchers found that the garlic group showed a significant reduction in TNF and Il-6 and theorized that long term supplementation of garlic may decrease the risk of inflammation related chronic illness.
Note: May experience anti-inflammation effects by eating 2g (1 clove) of fresh garlic every day.