Understanding Inflammation

The trouble with chronic inflammation and what to do about it
By Jeffrey Hendricks, MD

In medical centers and universities around the world physicians and researchers are searching for cures to diseases that plague our society—diabetes, cancer, cardiovascular dysfunction, Parkinson’s, and autism, to name a few. Exciting recent discoveries have shown there may be a common thread running through them: chronic inflammation.

What is inflammation?

Inflammation is the body’s natural response to injury, infection, or irritant. It is necessary for healing and to protect the body from further damage when we are injured. In the acute inflammatory phase, as with a sprained ankle, the inflammatory response triggers the healing cascade, but also causes swelling and pain that tells us to “guard” that injured area. This allows the injured area a break from the normal stress of walking and allows it to heal. The swelling and inflammation subsides and we are free to resume our normal activities.

What happens if the inflammation doesn’t let up? What if we keep walking or running on this injury? The inflammation will become chronic, damaging tissue, causing scarring, limiting mobility, and leading to chronic pain.

A similar process can occur inside our body but can remain silent for years—we call this systemic inflammation and measure it by testing for C-reactive protein, or CRP. Elevated CRP tells us there is an increased level of inflammation somewhere in the body, and is an indicator of cardiovascular risk. Ideally the CRP number should be less than one. One to three is considered average, and above three is associated with higher cardiovascular risk.

Chronic inflammation: a devastating disease

Chronic inflammation may be one of the root causes of the majority of illnesses we see. Until recently it was almost completely ignored except in acute cases of injury, infection, or autoimmune disease. Wouldn’t it be nice if we could focus on one problem—inflammation—and lessen the medical and financial burden that these inflammatory diseases pose?

The good news is that we may be able to do this. Previously, much of the research on chronic inflammation has focused on fighting it with drugs, but a growing body of research is revealing how obesity, poor diet, stress, hormone imbalance, and even nutritional deficiencies can lead to inflammation. Also, scientists are investigating how certain components in foods can help.

Restoring homeostasis

The closer we stay to our natural state, called homeostasis, the less inflamed we are. If we can restore homeostasis, we will naturally decrease the triggering of inflammatory cascades and chronic inflammatory cycles that may have developed.

Doing this is not that difficult, but it requires a very different approach than we have traditionally taken. In mainstream medicine we use tests and treatments, usually in the form of medications, to normalize physiologic parameters outside of the normal range. This approach may or may not improve symptoms, and it may decrease or delay outcomes, but it does not restore homeostasis or resolve the problem at its root.

Inflammation in one disease can lead to another disease

Another problem with just treating the number—i.e., the systolic or diastolic blood pressure—is that the inflammatory response triggering high blood pressure can trigger more inflammation. Failing to reduce inflammation or restore homeostasis in one disease can lead to another disease. Insulin resistance, high triglycerides, and hypertension occur together so often we gave it a name: metabolic syndrome or syndrome X.

Foods that fight chronic inflammation

We are beginning to understand how certain foods may decrease inflammation. Science is catching up with folklore, and it’s now possible to apply the scientific method to many components of foods long considered medicinal in Eastern medicine. We are identifying active compounds in foods and beginning to understand the pharmacobiochemistry and epigenetic (epigenetic refers to the ability of a compound to affect gene expression) effects of these compounds. In the following list are some of the standout foods.

Turmeric (curcumin): Turmeric works to inhibit the activity and synthesis of enzymes implicated in inflammation. Its anti-inflammatory action may also be attributed to inhibition of proinflammatory leukotrienes, prostaglandins, and arachidonic acid, as well as to its neutrophil function during inflammatory states. The curcuminoids are the main feature in turmeric, but the volatile oils present are also responsible for the anti-inflammatory activity.

Pineapple (bromelain): Circumstantial evidence suggests that bromelain inhibits the synthesis of the proinflammatory prostaglandins without affecting the anti-inflammatory ones. Bromelain therefore tends to reestablish the balance of the two types of prostaglandins that characterizes the state of the healthy organism.

Tea (EGCG): White, oolong, and green teas are full of catechins, antioxidant compounds that reduce artery plaque and inflammation. Tea also has been linked to reduced risks of heart disease, diabetes, and cancer.

Salmon (omega-3 fatty acids): High in anti-inflammatory fatty acids, wild-caught salmon have a significant impact. Omega-3 fatty acids also have a host of cardioprotective functions, pointing to a role in prevention both before and after heart attack.

Olive oil (omega -3 fatty acids): The omega-3s in olive oil are natural COX-1 and COX-2 inhibitors that work similarly to Celebrex, ibuprofen, and naproxen.

Quercetin: Quercetin can help stabilize the cells that release histamine in the body and thereby have an anti-inflammatory effect. It also plays a role in cancer prevention by inhibiting the growth of certain malignant cells in vitro and has other unique anti-cancer properties.

Antioxidants: B-complex, bioflavonoids, carotenoids, vitamins A, D, E, and C. While not directly anti-inflammatory, any antioxidant by the very nature of their mechanism of action helps to reduce the overall inflammatory consequences of free radical damage by “quenching” these free radicals before they can injure cells or organs.

Trehalose: the anti-inflammatory sugar

Here is one you probably have never heard of that is starting to turn heads in the medical community. Trehalose is a plant-based disaccharide, or sugar. Unlike most sugars which are proinflammatory, trehalose is actually an anti-inflammatory sugar. It has the ability to cross the blood brain barrier and inhibit something called NF-κΒ. NF-κΒ is the highest upstream initiator of inflammation that we know of. NSAID medications like ibuprofen, aspirin, or naproxen work by blocking at the receptor level, long after the inflammatory cascade has started. By blocking the NF-κΒ, trehalose prevents inflammation from being initiated.

Problems stemming from too much sugar

While necessary for life, too much sugar has two problems. First, large amounts of sugar trigger the release of large amounts of insulin, initiating an inflammatory cascade. For this reason, too much sugar, via its effect on insulin, has a proinflammatory effect.

The second factor is a continuation of the first. Large amounts of sugar cause the pancreas to secrete large amounts of insulin which, over time, may contribute to insulin resistance. Once you are insulin resistant, your body requires more insulin to control blood sugar than it should. Since insulin is a fat-storing hormone, the more you secrete, the more your body stores fat.

Trehalose, however, does not spike insulin like glucose. It is absorbed through the entire digestive tract along the brush border, instead of being absorbed in the stomach and proximal small intestine. This means there is no single large bolus of sugar hitting the bloodstream but rather a steady, even absorption over a long period of time. That means a steady energy supply without spiked insulin levels. By replacing normal sugar with trehalose and thereby limiting insulin secretion, trehalose may limit overall inflammation in the body.

Foods that increase inflammation

There are well-established links to certain foods and their proinflammatory effects. One of the most common is gluten, a protein (peptide), found in wheat. For those with celiac disease, the most severe gluten sensitivity, inhaling just a few airborne gluten molecules from someone cutting a sandwich can be enough to trigger the inflammatory cascade. Gluten can be inflammatory for many people to a lesser degree—it appears there is a continuum of sensitivity when it comes to wheat.

Foods that are processed or highly refined tend to have large amounts of sugar, plus one or more artificial colors, flavors, or preservatives. These factors tend to trigger the immune system into a proinflammatory state. There are numerous studies showing the proinflammatory and/or adverse health effects of things like MSG, aspartame, and high fructose corn syrup, to name a few.

Exercise and inflammation

Inflammation appears to be the new “root of all evil” and exercise is supposed to be the single most potent “drug” for prevention in the world. And it is…usually.

To make sense of the apparent contradictions we return to the distinction between acute and chronic inflammation. Acute exercise induces acute inflammation which leads to acute healing. Chronic inflammation is the body telling us something didn’t get fixed right.

Acute inflammation occurs when you have an injury or trauma, even a minor trauma such as that to a muscle that has just been exercised. When you lift weights to increase muscle mass, the muscle is exercised, fatigued, and “broken down” slightly. When it recovers after rest, hydration, and protein ingestion, it is built back up to its original state plus a little more. The injury (exercise) triggers the healing cascade (inflammation). The CRP count will be elevated then.

The problem is when acute inflammation becomes chronic. This tells us that something still isn’t repaired. It is all about balance. Inflammation would not have developed if there were not a benefit from it. Indeed, there is a benefit, but too much of a good thing can be bad.

The testing that is most commonly done to measure inflammation in the body is C-reactive protein, or CRP. If you measure CRP right after exercise, or within a day or so of a good effort, it will be elevated, as it should be. If you measure it after exercise in someone who has been exercising for several months and has improved their fitness, it will be lowered, as it should be. Exercise causes a short-term increase of CRP and is not a problem. In the long run, exercise will lower CRP, or inflammation, which is a good thing.

 

Jeffrey Hendricks, MD, has practiced emergency, occupational, family, alternative, and integrative medicine. He has served as medical director for Shoreline Occupational Medicine, Bosch Automotive Corp, Shoreline Alternative and Integrative Medicine, and Biogenesis Medical and Wellness Centers. He is a triathlete, inventor of RIZE health drink, and CEO of Nothing Ventured, LLC.