by Marcelle Pick, OB/GYN NP
Systemic or chronic inflammation has a domino effect that can seriously undermine your health. So how does it all begin?
The immune system and the inflammatory response
Many experts now see inflammation as arising from an immune system response that’s out of control. When you catch a cold or sprain your ankle, your immune system switches into gear. Infection or injury trigger a chain of events called the inflammatory cascade. The familiar signs of normal inflammation — heat, pain, redness, and swelling — are the first signals that your immune system is being called into action.
In a delicate balance of give-and-take, inflammation begins when pro-inflammatory hormones in your body call out for your white blood cells to come and clear out infection and damaged tissue. These agents are matched by equally powerful, closely related anti-inflammatory compounds, which move in once the threat is neutralized to begin the healing process.
Acute inflammation that ebbs and flows as needed signifies a well-balanced immune system. But symptoms of inflammation that don’t recede are telling you that the “on” switch to your immune system is stuck. It’s poised on high alert — even when you aren’t in imminent danger. In some cases, what started as a healthy mechanism, like building scar tissue or swelling, just won’t shut off.
Chronic inflammation and its roots in the digestive system
Are you walking around on simmer?
Just yesterday I saw Nancy, a patient who has been with me for years. When she first came to see me, her triglycerides were sky-high (in the 400’s!), her cholesterol was elevated, and she was overweight, unhappy and stressed. Her face was flushed and chapped, her lips were dry, and she seemed fluttery and agitated. On the surface she looked like a heart disease candidate, but when I probed deeper I saw a woman on fire from the inside out.
Currently there is no definitive test for inflammation — the best that conventional medicine can do is measure blood levels of C-reactive protein (a pro-inflammatory marker) and the irritating amino acid called homocysteine. I use the high-sensitivity CRP test now available at most labs. Anything above 1 mg/dL with this test is too high in my book. With the older tests a reading of between 2–5 mg/dL was considered normal. (If you’ve been tested, be sure to ask your doctor for the results.) Newer ways to assess risk early on for future inflammatory disease include markers such as the apolipoprotein B to A1 ratio (ApoB/ApoA-1). This and other tests are in experimental use and only available through a few labs.
When I first ran Nancy’s tests, I was surprised to see that her CRP levels were normal (this was before the high-sensitivity CRP test was widely available as it is today). This was good news for her heart, since elevated CRP and cholesterol increase your risk of heart disease threefold. But her homocysteine levels were high and all of her other symptoms pointed to inflammation.
I prescribed an anti-inflammation diet, essential fatty acids, other anti-inflammatory supplements, and a daily exercise regime. When Nancy next came in, her triglycerides were down by 200 points, her skin was clear, and her mood was much better. Later tests revealed her cholesterol had gone down, too.
A year went by, and as Nancy entered a stressful period in her life, she again began snacking on unhealthy food and going for days without exercise. Her cholesterol crept back up and she started having irritable bowel symptoms. After a brief pep talk, she got back on track and today she’s feeling great. When I saw her yesterday she looked like a different person. Her blood tests all looked good and her inflammation was back under control. Nancy’s fires are well-tended now, and I feel confident she knows what to do if they start to flare up again.
I think that like Nancy, we are all vulnerable to chronic inflammation. I think it’s safe to say that most of us in this country are walking around on “simmer” — which means setting ourselves up for problems as we age. Our ballooning rates of allergies, obesity, IBS, and chronic pain don’t lie. I’m seeing such a spike in patients with symptoms of inflammation that it’s becoming the norm, not the exception. The good news is, once we understand what causes inflammation and see how quickly our actions can either fan or cool the flames, we can begin to make better choices every day that bring us back into balance.
At our medical practice we are convinced that the seeds of chronic inflammation (and a lot of other health issues) start with the gut. Two-thirds of the body’s defenses reside in the gastrointestinal (GI) tract — yet it is often the last place traditional practitioners look.
Intestinal bloating, frequent bouts of diarrhea or constipation, gas and pain, heartburn and acid reflux are early signs of an inflamed digestive tract. It’s not surprising that your immune system first clicks into hyperdrive in your digestive tract — it was designed to eliminate viruses and bacteria in your food before they infect your body. It has to glean the wheat from the chaff: taking sustenance from the food you eat and ridding your body of the rest.
And we give our digestive systems plenty of work to do. Our evolution from the hunter-gatherer diet to convenience and fast food is overwhelming our metabolism and GI tract. The deck is now stacked in inflammation’s favor. The modern diet offers us an upside-down ratio of fatty acids (omega-3, -6, and -9), too much sugar and carbs, and high levels of wheat, dairy, and other common allergens.
Foods that cause inflammation
Most polyunsaturated vegetable oils like safflower, sunflower, corn, peanut and soy, are high in linoleic acid, an omega-6 essential fatty acid that the body converts into arachidonic acid, another omega-6 fatty acid that has a predominantly pro-inflammatory influence. These same oils contain almost no omega-3’s (found in rich supply in coldwater fish, phytoplankton, and flaxseed), which soothe inflammation. Our prehistoric ancestors ate a diet with an omega-6 to omega-3 ratio of 1:1. Our current ratio is anywhere between 10:1 and 25:1!
For most people, high-carb, low-protein diets are inflammatory. We’ve seen repeatedly that low-carb diets reduce inflammation for most women. But you will need to listen to your own body and carefully observe which foods fuel inflammation for you. (You may also want to consider our tips for following an anti-inflammatory diet.)
Refined sugar and other foods with high glycemic values jack up insulin levels and put the immune system on high alert. (The glycemic index measures the immediate impact of a food on blood sugar levels; surges of blood sugar trigger the release of insulin.) Short-lived hormones inside our cells called eicosanoids act as pro- or anti-inflammatory compounds depending on their type. Eicosanoids become imbalanced — that is, skewed toward pro-inflammatory — when insulin levels are high. As if this weren’t enough, high insulin levels activate enzymes that raise levels of arachidonic acid in our blood.
There’s also a complicated interaction between the inflammatory messengers, cytokines and prostaglandins, and insulin and glucose levels. In some cases, depending on what other stressors come into play, insulin inhibits the inflammatory agents and in other cases it fuels them. Studies are currently underway to unravel the links between obesity and type 2 diabetes and this mechanism. (To learn more, see my overview of the links between inflammatory imbalance and your weight, or read about these pathways in more depth in my book,The Core Balance Diet.)
Common allergens like casein and gluten (proteins found in dairy and wheat) are quick to spark the inflammatory cascade. Anyone suffering from celiac disease knows how inflammatory wheat can be. Foods high in trans fats create LDL’s, or “bad cholesterol,” which feeds inflammation in the arteries. Trans fats also create renegade cells called free radicals that damage healthy cells and trigger inflammation. (For more on trans fats, see our article on cholesterol and fat.)
So the first step in cooling inflammation on a cellular level is to pay attention to your diet, in particular your glycemic load (a measure of the glycemic index and portion of a food), essential fatty acid intake, and food sensitivities. As we get older, foods that never bothered us before, like dairy and wheat, may trigger chronic low-grade indigestion or other seemingly minor symptoms that put our immune system on guard — with additional inflammatory concerns to follow. Probiotics (supplements containing the “good” bacteria that support healthy digestion) have been proven to be as effective in treating symptoms of irritable bowel as medications like Zelnorm and Lotronex.
If you think you might have a food sensitivity, we recommend going on an elimination diet for two weeks to see how you feel. You may find that avoiding certain foods restores more than just your digestive health.
But your digestive tract is only the beginning of the story. Let’s take a look at some other causes of chronic inflammation.
Inflammation and menopause
Changing levels of estrogen, progesterone, and testosterone have a role to play in age-related inflammation. We still don’t understand all the connections, but it appears that a decrease in estrogen corresponds with a rise in the cytokines interleukin-1 and interleukin-6. This changes the rate at which new bone is formed, a leading indicator of osteoporosis.
We suspect that before menopause the balance of hormones has a calming effect on inflammation, but hormones work on so many levels that it is difficult to identify the exact process. What we do know is that symptoms of chronic inflammation often become more apparent during and after menopause.
The hormonal changes leading up to menopause also contribute to weight gain. And there is clear evidence that extra fat cells, especially around the middle of the body, add to systemic inflammation by creating extra cytokines and C-reactive protein. Just one more reason to lose those extra pounds!
Environmental causes of inflammation
I once walked into a giant office supply store, and within two minutes I had a numbing headache, my eyes were swimming, and my throat felt dry and tight — typical signs of an allergic response. I noticed an odor and asked the checkout clerk what it was. He didn’t know, but when I told him how I felt, he said he went home with a headache everyday — and often a bloody nose!
Synthetic fibers, latex, glues, adhesives, plastics, air fresheners, cleaning products — these are just some of the vast array of chemicals we are exposed to every day. Many of us work in hermetically sealed office buildings with re-circulated air that only increases our exposure.
Sick buildings make sick people. As do pesticides, pollution, and heavy metals. Lead and mercury are just two of the 30 heavy metals in our environment that our bodies must detoxify. And these toxins are in everything: our drinking water, our food, even our breast milk. Many of these chemicals are fat-soluble, meaning they are stored in fat and accumulate in our bodies until they reach toxic levels. Chemical sensitivity is just the most visible end of the spectrum.
Constant exposure to noxious chemicals and airborne irritants — even if it’s a low dose — makes your immune system crazy. Some people are naturally better detoxifiers and can withstand more exposure before they have symptoms. Others need more support. Learning as much as you can about the products you use, the buildings you live in and the water you drink is crucial to preventing or fighting inflammation.
Psychological stress — cortisol and inflammation
Have you ever had a panic attack? Woken from a scary dream in a cold sweat with your heart pounding? These are vasoreactions initiated by a perceived threat that dilates your blood vessels — just like inflammation. Wider capillaries mean more blood and nutrients to your organs to better ward off an attack or deal with a situation. This “fight or flight” response is orchestrated by your HPA axis and triggers the release of the stress hormone cortisol from your adrenal glands.
Cortisol directly influences your insulin levels and metabolism. It also plays a role in chronic inflammation and your immune system. I’m sure you’ve seen this relationship in your own life: how many times have you worked endless hours only to go on vacation and get sick? Your body is good at keeping a lid on things, but it can’t do it forever. Coping with persistent stress takes a steady toll on your immune system, your adrenals, and your central nervous system.
Your body reacts to stressors universally, whether they are biological or psychological. The more acute the threat feels, the more dramatic the response will be. With inflammation, painful emotional baggage is as incendiary as physical stress. Think about asthma. An emotional shock will trigger an attack in some people as often as physical exertion or an allergen. Thoughts and internalized feelings are very powerful — and they manifest themselves physically all the time with symptoms of inflammation. Stress makes your skin break out. Your intestines go into revolt during a painful break-up. But the good news is your feelings can — and should — be enlisted as allies in the healing process.
With all the other factors contributing to inflammation, coping with stress and emotional pain is often overlooked — but it’s really important. And it can play a big part in restoring your immune system’s balance before it gets overloaded.
Why chronic inflammation is on the rise
Our bodies weren’t designed for a daily barrage of toxins, infectious agents and stress, seen and unseen. This kind of demand requires a lot of support to maintain your immune’s system resilience. Our go-go lifestyle just doesn’t make room unless we pay attention — to everything: what we breathe, eat, drink and absorb and feel. It all has a pro- or anti-inflammatory effect, and for most of us, the factors are skewed toward inflammation.
Well-documented research links depression and stress to a rise in the inflammatory markers, such as CRP, signaling an increased risk for atherosclerosis and coronary heart disease (CHD). One study showed that a depressive state increases the odds of developing CHD by 50%. (For more on CHD, please see our articles on heart disease.) And one thing is certain about society today: we appear to be more stressed and depressed than ever.
While the incidence of inflammation and inflammatory disease is rising in all developed countries, it’s important to remember that each of us has an individual response to the stressors in our life. Some of that unique response is determined by genetics. But much of it is within our control — if we understand how our choices affect our health.
You can see that countering chronic inflammation takes a combination approach because it arises from a combination of causes. The good news is that so much of it is in your control. For more information on what you can do, see our article on reducing inflammation — a natural anti-inflammatory approach.