Inflammation is the normal process by which the body responds to injury. When cells are damaged by trauma or infection, they send signals that mobilize the bodies immune system to understand and address the situation. The acute inflammatory response is recognizable by five cardinal signs: calor; rubor, dolor, tumor and functio laesa; if you have just twisted your ankle: it’s warm, red, painful, swollen, and you cannot use it. This response makes sense as it alerts you to your injury, and forces you to rest while facilitating the repair, turnover and adaptation of the injured tissues, or in the case of infection inflammation also prevents the spread of pathogens to nearby tissue.
Without inflammation, we would not survive.
Our challenge is that inflammation is meant to be an acute, self-limited process that facilitates healing.
Chronic inflammation, unlike acute inflammation is a prolonged, maladaptive, low grade, persistent and dysregulated process that is the major contributor to chronic disease and ageing in our society. This silent but destructive nature makes inflammation a special challenge; by the time it is recognized, much of the damage has been done.
Inflammation is implicated in 7 of the top 10 causes of death in Western societies accounting for over 80% of deaths.
It is chronic inflammation that represents perhaps the biggest threat to our health and through the epidemic of chronic disease affects the sustainability of our health care systems.
So where does chronic inflammation come from?
The large variety of stimuli that fuel inflammation converge on a few basic mechanisms and pathways within cells - specifically the activation of the transcription factors NF-κB and Nlrp3 inflammasome which activate gene transcription and the production of inflammatory molecules called cytokines that interact with other cells to elicit a cascading response.
This response leads to increased plasma levels of pro-inflammatory cytokines (Interleukin-6, IL-6, Interleukin-1, IL-1 and Tumour Necrosis Factor-α, TNF-α) as well as increases in the main inflammatory biomarkers such as C-Reactive protein (CRP) and serum amyloid A.
This generalized pro-inflammatory state, interacts with genetic and environmental factors to potentially trigger the onset of inflammation-related diseases:
Given the multitude of triggers and profound potential consequences that chronic inflammation has, the logical question (if you have read this far) is:
Am I inflamed?
The standard test for this in the clinic is the high sensitivity C-reactive protein (hsCRP) - anything greater than 1.0 nmol/L suggests a low-grade inflammatory process, with levels greater than 3.0 nmol/L associated with elevated risk for heart disease (atherosclerosis). Levels greater than 10 nmol/L suggest an acute inflammatory response (infection).
What is an optimal strategy to avoid inflammation?
1. Maintain optimal gut microbiota health and prevent leakage of gut microbes into the body
If you are having symptoms or have concerns about intestinal permeability - there are tests that we can do to determine whether leakage of microbes from your gut is contributing to your inflammation.
Finally, if you are really interested you can check your microbiome and assess it's overall health - two caveats here: 1) there is huge variability between tests - these tests are really just snap-shots; and 2) there really is very limited data from these tests to direct you to a more specific response then I have outlined.
2. Minimize cellular damage from oxidative stress
4. Minimize the deleterious effects of high blood sugars and/or high insulin
Our society is in the midst of a diabetes epidemic - it is estimated that between 50-70% of the population has been diagnosed with diabetes, elevated blood sugars (pre-diabetes) or elevated insulin levels (insulin resistance - the precursor to diabetes). While there are clear genetic risk factors, the overwhelming evidence points to lifestyle: poor diet - excessive nutrients of poor quality - high carbohydrate, high fat, combined with physical inactivity leads to elevated insulin levels which initially maintain blood sugar levels at the expense of increasing the storage of calories in fat. This increased fat storage leads to obesity with overloaded fat cells becoming dysfunctional and senescent and secrete pro-inflammatory cytokines which in turn cause insulin resistance - creating a vicious cycle. The inflammation eventually affects the pancreatic beta cells, decreasing their ability to secrete enough insulin to maintain blood sugars and a person is diagnosed as diabetic.
The frightening part of this scenario is that it often takes 10-20 years to go from insulin resistance to diabetes - during that time levels of chronic inflammation increase as do the associated risks.
For diabetes and insulin treatment and prevention the place to start is with diet as it is the most likely culprit. A whole food, low carbohydrate, healthy fat approach is the way to go.
For diabetics on medication - ketogenic diets have an excellent track record as a therapeutic intervention to decrease or eliminate medications.
As you can see from these strategies to avoid inflammation, the answer lies in your behaviours - especially eating, exercising, sleep and stress. Your optimal strategy will come from assessing and understanding your current situation and addressing your behaviours in a systematic fashion.
If you are overweight (or simply over 40) you should, at a minimum, know your hsCRP, fasting blood sugar, HbA1c (3 month average of blood sugars), HDL cholesterol, LDL cholesterol, triglycerides and GGT (liver enzyme that also is a key marker of oxidative stress), as well as your waist to hip ratio. These are tests that every family doctor can (or probably has already) done for you - the important thing is for you to know. If any of these tests are abnormal (or not optimal), you should develop your own strategy to getting well. If these tests are normal, you should still review your core behaviours and assess what can still be improved.
At Wellness Garage, we deliver comprehensive lifestyle medicine assessments reviewing all of this data, along with other optional tests that are not routinely offered in the publicly funded system: molecular data (genomics, metabolomics, proteomics, microbiome, and other advanced diagnostic tests), DXA scans (to assess body composition). We use all of this data to help you build the optimal strategy for your own personal wellness. We then can match you to a personal coach to help you implement the behavioural changes necessary.
Dr. Brendan Byrne