Causes of inflammation
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
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.
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
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
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,
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! Much of this research has helped form the basis of our
Personal Program for Weight Loss Resistance: Hormones.
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
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
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.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements,
our exclusive endocrine support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
Last Modified Date: 04/20/2011