FRIENDLY FIRE OR SILENT KILLER?
What do you think of when you hear the work” inflammation”? If you are like most people you will recall a time when you sprained an ankle or strained a muscle. You may have experienced swelling and pain and were told by your doctor or therapist to take an anti-inflammatory medication, use ice and elevation. This is a relatively common, and self-limiting reaction that eventually leads to healing.
Inflammation is the body’s natural, normal defensive response to a tissue injury. A typical inflammatory response has recognizable hallmark characteristics of redness, heat, swelling and pain. While the mechanisms are a bit complex, It is important to understand the basic processes involved, or the cascade of events that occur when the body is in this state we term “inflammation”. I will simplify the explanation with just some essential facts.
The inflammatory response is the body’s elaborate response to an insult. It is stimulated by chemical factors released by injured cells and serves the function of isolating the spread of infection and to promote healing of damaged tissues. The immune system is comprised of 2 subdivisions, namely, the innate, or non specific system, and the acquired, adaptive or sometimes called the specific system. I will only discuss the innate or non specific system briefly.
Immediately following a tissue injury the body sends out chemical mediators ( Cytokines) that cause vasodilation of the blood vessel lining along with increased permeability ( leakiness) resulting in increased blood flow to the area and engorgement of tissues. This is followed immediately by vasoconstriction. We recognize this as the classic sign of swelling or edema. The specialized blood cells arriving on the scene, including neutrophils, macrophages, lymphocytes and immune proteins contained in the tissue fluids can now remain in contact with the inner lining of the blood vessels, or endothelium. This is desired for the next step, which is the binding of the immune proteins ( (immunoglobulins) to the injured tissues or invaders ( bacteria, etc) , effectively immobilizing them. This step also is required for the formation of fibrin, a clotting protein. Macrophages and neutrophils engulf the dead tissues, bacteria and other pathogens at the injury site, they can be thought of as the body’s “clean up crew.”
Most of the time ( in a healthy body) this complex process proceeds without a hitch and ends reasonably well. After all, a normally functioning immune system is designed to restore the body and its’ tissues to near normal form and function.
So why is it that inflammation has recently been named as the primary culprit or contributing factor to many common, chronic diseases? Could it be that this friendly fire is actually a formidable foe that is attacking us from the inside out? As it is with most things, it is all about balance.
The problem arises, when this normally efficient process shifts out of balance and the inflammation process continues out of control, unrecognized and unabated, resulting in a chronic, insidious, sneak attack from within. Chronic inflammation does not always arise from uncontrolled acute inflammation. In some cases it appears to arise on its own from various contributory factors, and is often difficult to detect, progressing slowly and silently inflicting it’s damage.
Recent Research has indicted that Inflammation has been implicated as a causative factor in nearly all of the of age related chronic diseases such as atherosclerosis, diabetes and metabolic syndrome, autoimmune diseases, Inflammatory bowel disease, arthritis, celiac disease, Alzheimer’s disease, COPD, dyslipidemia, Hypertension and cancer.
While normal inflammation produces healing, Chronic inflammation is at the root of disease, causing it’s damage without warning to the casual observer. Unfortunately, as a result of current lifestyle trends and diet , its prevalence and its’ effects are on the rise.
THE ROOT OF THE PROBLEM:
What is at the root of this low grade fire and it’s negative consequences? To answer this we need to look at the basic underlying process. We can look at the genesis of Cardiovascular disease as one example. The blood vessels are active, living tissues that respond to environmental, and chemical irritants. Chronic physical damage to the endothelium, or inner lining of the blood vessels starts the ball in motion. This early inflammatory process was described earlier. Consider that the endothelium is the ‘gate keeper’ and is in constant contact with the blood stream, and therefore is directly impacted and influenced by any substances within the blood. When the endothelium is damaged ( by various agents we will consider shortly) the stage is set for the pathogenesis of all known cardiovascular diseases and and so much more.
And the factors to blame are:
The endothelium damage or ‘dysfunction’ as it is called, is triggered by : Circulating immune complexes (cytokines), sheer stress on the vessel walls (Hypertension), blood fats ( dietary), obesity, hypoxia, ( reduced oxygen), stress, smoking, environmental toxins, acidosis ( dietary) , food allergies and sensitivities, diabetes ( elevated blood glucose and hyperinsulinemia), bacteria and hidden infections, and trauma to name a few. Wow, that’s a lot to think about. Chronic systemic inflammation worsens endothelial damage and so begins a downward spiral.
One can assess the level of inflammation through biomarkers of inflammation. The test which measures CRP-hs ( C reactive protein, highly sensitive) is considered the most available and clinically useful marker. Elevated CRP is related to increased markers of endothelial dysfunction and is also marker of both infection and tissue inflammation. CRP has also been found to be a strong predictor of future stroke and myocardial infarction. ( MI).Also, a protein known as Galectin-3,can trigger chronic inflammation, fibrosis ( scar tissue) and is the prime culprit in metastatic cancer and heart disease. A blood test is also available to measure levels of Galectin -3.
Let’s Summarize: Chronic systemic inflammation today is commonly perpetuated by 1.Obesity: Visceral fat, while once thought inert, is chemically active, churning out inflammatory cytokines, and is also a storehouse for toxins. Quite simply, body fat is synonymous with inflammation and toxicity. According to the CDC the percentage of overweight Americans ( 2009-2010) is 69% and percentage of obese is roughly 35%.This rise in obesity is directly connected to the rise in inflammatory diseases. Visceral fat or deep abdominal fat is the worst offender and is on the rise. 2. Infections: chronic, low grade, infections in one body area can lead to widespread systemic inflammation. Examples are tonsillitis, urinary tract infections, gall bladder infections, periodontal disease, diverticulitis, Lyme disease, and mononucleosis to name a few.
3.Environmental toxins or any foreign substance introduced into circulation may trigger an inflammatory response. These can include over the counter or prescription drugs, pollution, chemicals in tobacco products, cleaning supplies and solvents, pesticides, and food additives. There is no shortage of toxins in our environment!
4. Autoimmune diseases: These are a result of pathological responses of the immune system when it attacks it’s own healthy tissues. These conditions include rheumatoid arthritis, type 1 diabetes, MS, lupus, Graves disease, Sjogren’s syndrome, Celiac disease and others and can initiate serious inflammatory mediated tissue damage. These usually have a genetic component and may be ‘switched on’ ( triggered) by environmental toxins, stress, infectious agents and diet. Controlling outside triggers for inflammation may help ameliorate symptoms.
PREVENTION IS ON YOUR PLATE
As we begin to understand the role of inflammation in the process of disease we would be wise to look at these causative factors and direct our efforts at prevention. Most conventional medical treatments will direct aim at the inflammation and will not address the underlying causes. Removing or controlling the culprits just discussed will attack the root of the problem.
The greatest controllable factors lie in the realm of lifestyle and dietary choices. For the individual, These might be the factors most difficult and resistant to change, namely, diet, smoking, exercise, and stress management.
Taking Back Control:
“You are what you eat“. This is true in every sense of the word. Americans are consuming a highly processed, sugar packed, salt laden, pro-inflammatory diet like never before in the history of mankind. There is a cost and your body is paying the price in the form of inflammation.
For the majority of people, breakfast, lunch and dinner are frequently eaten out of a box or a bag. We consume large quantities of processed, nutrient deficient, “food like” substances that are chock full of chemicals, preservatives, food dyes, unhealthy fats ,sugars and sodium. We have become a nation of large portions , and while we are overfed , we are malnourished and barely meeting our basic nutritional needs.
More than 50% of Americans unknowingly consume foods they are sensitive to, if not allergic to, on a regular basis, these include gluten, dairy, yeast, eggs, nuts, corn, shellfish, nightshade vegetables (peppers, tomatoes, eggplant) and wheat to name a few. Whereas, the acute food allergies or I g-E mediated reactions will send you to the Emergency room, the ‘sensitivities’ or allergies that may cause insidious harm are the delayed onset, Ig-G mediated responses. Over time, along with the overuse of antibiotics, this may cause leaky gut syndrome ( increased intestinal permeability) and a general state of intestinal dysbiosis ( messed up intestinal bacteria) . An important point to keep in mind is that over 60% of the body’s immune system resides just beneath the thin, 1 cell thick, delicate lining of the digestive tract. Many of the foods we are eating are also genetically modified, including most corn, soy and wheat which is an additional burden and challenge to the already taxed immune system. Long term studies of the safety of consuming genetically engineered foods have simply not been established.
AN OIL CHANGE IS NEEDED:
This is not referring to your automobile! Inflammatory oils ( vegetable) and unhealthy fats (hydrogenated) and trans fats are consumed in abundance, and most diets are dangerously high in inflammatory omega 6 fatty acids. A healthy diet should have an omega 6 to omega 3 fats ratio of 4:1 and instead in the Standard American Diet it is over 20:1! Incorporating healthy fats such as the omega 3’s in walnuts, flaxseed, wild salmon and fish oils can offset the proliferative dietary omega 6 fats.
SUGAR : THE REAL ENEMY
The greatest and most worrisome trend is the growing addiction to refined carbohydrates, and sugar, with Americans consuming nearly 150 pounds of sugar per person per year! While we have evolved to eat meat and healthy fats, Our bodies are not equipped to handle this toxic sugar burden. Foods like white bread, pasta, crackers, cakes, cookies, bagels, all with a high Glycemic index, are foods that cause rapid elevation of blood sugar, and a rapid release of insulin. Insulin and high sugar diets, promote fat storage (obesity), increased-inflammation, and dyslipidemia ( high LDL , low HDL cholesterol, high triglycerides). A high intake of carbohydrates such as simple sugars was shown to be associated with an elevation of inflammatory markers in a Women’s health study. In addition, high insulin levels cause elevation of ILGF (insulin like growth factor) which causes cells to grow and is implicated in cancer growth. Cancer cells are obligate sugar feeders, preferring sugar as their main fuel source, perpetuating a tragic epidemic that is predicted to increase by 57% worldwide in the next 20 years, according to the World Health Organization. Additionally, sugar causes immune dysfunction, yeast infections, mental and emotional changes and nutritional deficiencies, insulin resistance and of course can ultimately lead to diabetes.
OUR TOXIC ENVIRONMENT
Exposure to toxic chemicals is increasing and these chemicals are ubiquitous in our environment, foods, personal care and cleaning products. Pesticides, herbicides, xenoestrogens and pollution from the air we breathe through cigarette smoke, pollution, and genetically altered foods are at an all time high. An alarming two million tons of food chemicals are used in the food industry every year. Some 50 thousand chemicals are released into the environment by industry and 500 million gallons of pesticides and herbicides are sprayed on to food and pastures. This increases our toxic load and further burdens our immune system and detoxification organs. When it comes to the environment, watch the company you keep.
What can we do to extinguish the internal fire and put ourselves on the path to better health?
- Start with what’s on your plate! We can begin by examining our food sources and choices. “Let food be they medicine”, as Hippocrates wisely said. We must also consider what we are not eating and obtaining from our foods. Few Americans are eating the recommended daily amounts of fiber and servings of vegetables, especially alkalizing leafy green vegetables. The typical diet of simple, carbohydrates, meats, and excess sugar is highly acidic to the blood and body tissues, not to mention, deficient in the antioxidants, micronutrients, vitamins, and phytonutrients the body requires to have a strong immune system, provide cellular protection, and minimize damage from free radicals and oxidation.
An anti inflammatory, produce dominated (vegetables mostly) diet, containing small amounts of lean, grass fed or organic, meat and fish, healthy nuts and oils and low in sugar is an effective and proven dietary formula for reducing inflammation. Studies have demonstrated that the Mediterranean diet has a protective effect against low grade, chronic inflammation. By contrast, The Western diet of processed meats, feed lot ( conventionally reared) red meat, trans fats, refined grains, fried foods, sweets, as mentioned, is at the foundation of inflammation, and is associated with elevation of hs-CRP, an inflammatory biomarker.
- Stop the assault of chemical toxins. Smoking is an established risk factor for many diseases, and results in direct blood vessel endothelial injury and increased inflammatory markers. Cessation of smoking will greatly improve these markers. Reduce exposure to toxic chemicals of all kinds by using environmentally friendly cleaning products and non toxic personal care products. Support local farmers and buy organic when possible.
- Move more. Physical activity or exercise is inversely associated with inflammatory markers, namely, high levels of activity are associated with reduction in chronic inflammation. Incorporating mindful exercise practices such as yoga and tai chi are also helpful for the mind and body.
- Renounce the Negative effects of Stress. Stress, and the fight, flight and freeze response can produce physiological systemic changes , including rapid heart rate, rapid, shallow breathing, ( hypoxia) , release of cortisol with resultant immune-suppression, elevation of blood glucose, elevation of blood fats, high blood pressure, incomplete digestion, insomnia and much more. Isolated stressful events, and the chronic, ongoing stress response that occurs more commonly in today’s society, are contributing to adrenal imbalances and heightened inflammation and its negative effects. As a society, we need to address the ravages of constant stress with effective strategies, including breath work, meditation, enjoyable hobbies, adequate rest and sound restorative sleep.
We can reduce the ravages of inflammation and improve the outcome and management of many chronic and age related diseases. Simply making intentional choices to incorporate specific, simple lifestyle changes in the form of enjoyable exercise , and stress management techniques, employing the healing properties of whole foods, with their protective and anti-inflammatory benefits, is a great place to start in stacking the deck in our favor and quelling the internal fire.
1. Inflammation: Causes, Prevention & Control, Annell St. Charles PhD, R.D, L.D.N
2. Treating cancer with nutrition, Patrick Quillin, PhD, RD,CNS
4. WHO: Imminent global cancer ‘disaster’ reflects aging, lifestyle factors, by Tim Hume and Jen Christensen, CNN, updated February 4, 2014,. http://www.cnn.com/2014/02/04/health/who-world-cancer-report/
5.MedicineNet.comDefinition of inflammation. www.medterms.com/script/main/art
6. “Stop Inflammation now!” Richard Fleming MD
7. Dr Hyman.com/blog/2012/01/27/inflammation-how-to-cool-the fire-inside you
8. “The immune protective effect of the Mediterranean diet against Chronic low grade Inflammation”.,www. ncbi.nlm.nih.gov./pubmed/25244229
9. “Circulating Galectin -3 in the bloodstream, an emerging promoter of cancer metastasis.” www. ncbi.nlm.hih.gov/pubmed