Spend the weekend mountain biking and you might experience some acute inflammation of the tendons in your legs and wrists. A little rest, ice, and some ibuprofen may take care of it quickly. Systemic chronic inflammation, however, is a different story. That’s the kind of inflammation we are increasingly discovering to be intimately involved in or even at the root of many of our most challenging and serious diseases, such as Alzheimer’s disease and other dementias, cancer, depression, heart disease, obesity, and stroke.
How can something so seemingly simple as inflammation be behind these life-altering, even deadly illnesses? After all, inflammation is the body’s natural response to attack. It defends the body against invaders such as viruses and bacteria, helps get rid of debris, and assists in repairing damaged tissue. All of these are positive characteristics.
Part of the answer lies in the differences between what we commonly think of as inflammation—a swollen ankle from a hard landing on a trail run, for example—and the chronic inflammatory process that can run rampant throughout your body. Here’s the story and, more important, what you can do about it – to stay healthy and charging forward in life.
Acute vs chronic inflammation – what’s the difference?
Most of us are familiar with the outward signs that accompany an acute injury: swelling, redness, and warmth. Internally, however, numerous players are involved in a complex process. For example, there’s an increase in blood flow to the injured area along with an “invasion” by platelets, mast cells, endothelial cells, and others that join in to call up various leukocytes (white blood cells). These agents work to set off a series of activities, including the release of chemicals called cytokines, resulting in inflammation. Within a few days or weeks, the healing process is over, with or without the assistance of medication, ice and/or heat, and some rest (depending on the nature of the injury).
Chronic inflammation is another matter. It’s like a runaway train, fueled by the cytokines that are continuously spilled out into the body’s circulation and causing inflammation of the tissues. Your immune system wants to put on the brakes and stop the cell and tissue damage and progression toward disease.
Stomping on those brakes however becomes more and more difficult as time goes on because the body gets tired. The cells sent by the immune system to fix the damage just can’t keep up with the demands. In addition, the aging process adds more fuel to the runaway train because as cells age, they become less efficient at repairing any injury but more likely to send out pro-inflammatory chemicals.
Therefore, as the train speeds along, it can cause an accumulation of damaged blood vessels, a buildup of fat (triggered by the secretion of adipokines, hormones that cause fat storage), plaque in your arteries and brain, excess body weight, and other injuries, all associated with chronic inflammation.
Consequences of chronic inflammation
Chronic low-level inflammation is like an insidious villain, running rampant throughout the body yet often without causing any symptoms until things get serious. In fact, left untreated, chronic inflammation can result in a wide range of serious health problems.
- Cancer (e.g., colorectal, lung, lymphoma, ovarian, pancreatic, prostate)
- Heart disease and stroke
- Alzheimer’s disease and cognitive impairment
- Nephritis and chronic kidney disease
- Chronic lower respiratory disease
- Age-related macular degeneration
- Rheumatoid arthritis
- Inflammatory bowel disease
There are also a host of inflammation related disorders and diseases that come under the suffix of “…itis” – meaning “a disease characterized by inflammation”. I had three of them when I was young – pericarditis (heart inflammation), osteomyelitis (bone inflammation), and encephalitis (brain inflammation). A triple whammy between the ages of nine and eighteen years. Scary shit for a teenager. But it focused me on living a lifestyle of prevention and learning how to manage inflammation better.
Causes of chronic inflammation
A variety of factors can cause chronic inflammation, a few of which you have no control over, but others are definitely ones you can take control of.
- You are aging. As we age, the body is less able to fight inflammation, but that doesn’t mean you can’t reduce the impact of aging with lifestyle changes (see “Braking the train”)
- You have bad genes. Although you can’t change your genes, you can take control by implementing lifestyle changes which is what I have done – as I seem to have a genetic predisposition to inflammatory viruses as mentioned above.
- You don’t eat right. This is likely the main preventable cause of chronic inflammation. Foods that contribute to and support chronic inflammation include the following:
- Foods high in sugar
- Foods high in saturated fat (e.g., animal foods such as meat, poultry, and dairy)
- Refined/processed foods
- Foods containing trans fats (e.g., those with partially hydrogenated, hydrogenated oil, margarine on the label)
- Omega-6 fatty acids, which are found in most vegetable oils and seeds
- Gluten, which is found in wheat, barley, rye, spelt, and triticale, and kamut, can be a problem for susceptible people
- Monosodium glutamate (MSG), a food additive. Read labels carefully
- Alcohol, although a few glasses of wine per week (as per the Mediterranean diet) may be fine
- Casein in dairy foods can be a cause of inflammation for susceptible individuals
- You don’t exercise right. It’s been shown that too much or too little physical activity can promote inflammation. Basically, a sedentary lifestyle as well as one that includes a lot of vigorous, stressful exercise can promote inflammation. Moderation is the key. Avoid being a weekend warrior and a couch potato during the week. Regular aerobic and strength building activities performed at least five days a week at a moderate level can support a healthy immune system and help keep inflammation at bay.
- You are exposed to toxins. Exposure to chemicals in the air, water, soil, and general environment can have a negative impact on your immune system and promote inflammation. This is especially true if you work in a building that is hermetically sealed with recirculated air. Some of the offenders include glues, adhesives, plastics, air fresheners, cleaning products, synthetic fibers, air pollution, pesticides, and heavy metals.
- Your stress levels are high. High levels of stress or chronic stress means the body is continuously exposed to the stress hormone cortisol. This hormone has a direct effect on metabolism, insulin levels, the immune system, and chronic inflammation.
- You smoke. Smoking cigarettes exposes you to inflammation promoters, especially pro-inflammatory cytokines, while also reducing factors that help reduce inflammation. Smoking also increases your risk for periodontal disease, which is a risk factor for systemic inflammation.
- Your sex hormone levels are low. Sex hormones have a role in modulating your immune system and inflammatory response. It’s important to have your testosterone levels checked to see if you may need to take steps to boost your free T levels.
- You have periodontal disease. If you suffer with periodontal disease, which involves considerable inflammation, it can affect various other bodily systems, including the heart and kidneys. Therefore it’s a good idea to see your dentist if you suspect you might have some major dental problems, demonstrated by gum bleeding or swelling, gum pain, receding gum line, and/or loose teeth.
- You have problems with sleep. When sleep patterns are disrupted, pro-inflammatory factors such as tumor necrosis factor-alpha and interleukin-6 can become elevated.
Testing for inflammation
Two blood tests that are inexpensive and good markers of systemic chronic inflammation are the high-sensitivity C-reactive protein (CRP) test and fibrinogen. The CRP test can uncover inflammation at the microvascular level. Optimal values of the CRP test for men are less than 0.55 mg/L, although men with a value of less than 1.0 mg/L are considered at low risk for heart disease. For the fibrinogen test, the optimal range is 200 to 300 mg/dL.
Generally, doctors tend to check CRP only for individuals who are at high-risk for heart disease or who already have been diagnosed with an inflammatory condition. However, it is very possible to have low-grade inflammation with elevated cytokines that remains undetected for quite some time; that is, until enough cellular damage has been done to result in disease symptoms.
There are several other blood tests for chronic systemic inflammation that measure levels of specific cytokines that are responsible for inflammation. These tests are more expensive than the CRP and fibrinogen. The tests and their optimal values are as follows:
- Tumor necrosis factor alpha, less than 1 picogram per milliliter (pg/mL)
- Interleukin-1 beta, less than 15.0 pg/mL
- Interleukin-6, 2-29 pg/mL
- Interleukin-8, less than 32.0 pg/mL
Signs of a runaway train
Here are some of the signs of chronic inflammation, followed by what you can do about your runaway train before it turns into a wreck.
- Belly fat. If you’ve put on some extra weight—5 or more pounds of fat—you are likely fueling inflammation. Fat cells, and belly fat in particular, send out lots of pro-inflammatory cytokines.
- Gut problems. Experiencing gastrointestinal problems? Symptoms such as heartburn, acid reflux, gas, and belching are indications of a gut that in inflamed.
- Out of it. Feeling tired, irritable, and not as mentally sharp as you used to be? These are all signs of an inflamed gut
- Insufficient sleep. You need sufficient sleep (7-8 hours per night) for your body to repair itself. If you are getting less than 6 hours per night on a regular basis, you are not allowing critical restoration to take place.
- Exercise problems. No matter how hard you try at the gym or with other forms of exercise, you just can’t seem to get the results you want. In fact, you are tired. It’s possible you’ve been trying too hard and are actually fueling systemic inflammation. You might change your exercise routine to short duration interval training, which can fight it (see below for more on exercise induced inflammation – and how to avoid it).
- Morning stress. If you wake up anxious and tense, you will not be equipped to handle the stressors of your day. That means your immune system will be working overtime, resulting in systemic inflammation.
Braking the inflammation train
Fortunately, the lifestyle choices you make can significantly slow down or even stop the inflammation train. Among the various factors that can fuel chronic inflammation—and there are quite a few–the most important modification you can make concerns your diet. Follow an anti-inflammatory way of eating and you can beat or better manage chronic inflammation and the serious health problems associated with it. Here’s how.
- Cut gluten. A growing number of people are discovering that they are sensitive to or intolerant of gluten. This protein, which is found in wheat and several other common grains, can cause the intestinal wall to become irritated and porous. This creates a situation commonly known as leaky gut in which substances leak out of the intestinal tract into the bloodstream and lymph system, eventually resulting in systemic inflammation. The solution? Eliminate gluten from your diet for several weeks, then introduce one gluten food item back to see how you react. If you experience symptoms such as gastrointestinal problems, anxiety, fatigue, skin reactions, and headache, then you are likely hypersensitive to gluten.
- Go Mediterranean. The Mediterranean way of eating has been shown to be effective in the prevention of cardiovascular disease, Alzheimer’s disease and cognitive decline, and cancer, and to play a significant role in obesity and depression. What’s it mean to go Mediterranean?
- Base your meals on fresh fruits and vegetables, whole grains, legumes, olive oil, beans, nuts, seeds, herbs, and spices. Some specific foods in these categories that are regarded as anti-inflammatory include dark leafy greens, nuts, bell and hot peppers, tomatoes beets, ginger, turmeric, garlic, onions, olive oil, berries, and tart cherries. Note: Peppers and tomatoes are nightshade vegetables and can cause inflammation/joint pain in some people.
- Enjoy omega-3 fatty fish at least three times a week (eat the smaller fish like sardines rather than the big fish like tuna that are being depleted from our oceans)
- Include some organic-only dairy in moderate amounts 2-3 times a week. Avoid eggs if you can, but if you have to eat them – have only 1-2 a week
- Eat red meat/or poultry only once, or maximin twice, a week. And make sure it’s always grass-fed and hormone free
- Choose local foods when possible
- Enjoy meals with family and friends whenever possible, as this can reduce stress and improve digestion
- Spice it up. Although I’ve already mentioned the use of herbs and spices as part of the Mediterranean diet, it’s worth emphasizing it here. Anti-inflammatory herbs and spices such as turmeric, ginger, cloves, curry, cinnamon, sage, and marjoram, among others, should be part of your daily diet and at every meal whenever possible.
- Go easy on anti-inflammatory drugs. Very occasional use of anti-inflammatory drugs such as aspirin and ibuprofen (a “NSAID”) can be okay, but overuse can damage the gastrointestinal tract lining and lead to chronic inflammation as well as other serious side effects. Try and avoid them altogether as most of them do more harm than good.
- Manage stress. Churning out the stress hormones like cortisol promotes inflammation. Practice stress-reduction activities on a daily basis, such as meditation, listening to music, tai chi, yoga, or guided visualization. I use the Headspace App for daily meditations.
- Exercise. This is a two edged sword as exercise is, after all, a state of acute inflammation. The problem is when that inflammation becomes chronic, which is most likely induced by consistent, chronic cardio, marathons and other hard endurance training (like Crossfit WOD’s). Yes, you get stronger via the rebuilding that occurs through the exercise induced inflammatory response, but when this inflammation becomes chronic that’s when it can be a problem. So the key here I think is to still train hard, but REST and RECOVER as well. Don’t operate in a chronic state by pushing too hard day in and day out. Take “active rest” days and allow your body to heal during that time.
- Take probiotic supplements. Maintaining a healthy gut is one of the keys to having a strong immune system and inflammatory response. Together with Dr. Geo Espinosa N.D, I formulated my own vegetarian probiotic which I take on a daily basis (in a double dose). You can buy it here.
- Limit alcohol. If possible, avoid it all together for a while while your symptoms settle down. A glass of wine with dinner (part of the Mediterranean diet) occasionally is acceptable. Or vodka..
- Avoid processed foods. Refined, processed foods are chock full of preservatives and other chemicals that can contribute to chronic inflammation. Go fresh and organic as much as possible and walk by the processed food aisles.
- Sleep. Seven to eight hours per night on a regular basis can help keep inflammation in check.
- Do not smoke. Smoking promotes inflammation – this is a no-brainer.
- Limit omega-6 fatty acids. These pro-inflammatory fats are commonly found in oils such as corn, soybean, and peanut. You should avoid all soy products (especially soy protein isolates) as they are full of estrogens and hormone disrupters.
- Avoid all trans fats. These are found in fried foods and foods with ingredients such as hydrogenated and partially hydrogenated oil and margarine. Be sure to read labels carefully. You should have a “zero trans fat policy”
- Reach and maintain a healthy weight. Carrying excess body weight and fat, especially around the midsection, promotes chronic inflammation. Losing just 5 percent of your body weight can help reduce inflammation.
Chronic inflammation is invisible, insidious, and life-threatening and is one of the biggest underlying causes of chronic disease. Don’t let it get you down and out—fight back with healthy lifestyle changes.
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