What is inflammation?
Inflammation is our immune systems first line defence. It’s a normal reaction to harmful stimuli that can be triggered by a number of things from a cut to the finger or more serious problems like an infection. In general, any kind of danger injury or infection has the potential to trigger the immune systems inflammatory response and this is one of our most ancient forms of defence, working rapidly and efficiently to protect us in many situations. Ultimately inflammation is a pro-oxidant state, a toxic assault on danger or infection with unfortunately comes with some collateral damage to our tissues. Inflammation can have a major impact on our health and quality of life. Not only experienced when we get an infection or hurt ourselves, it’s the trigger behind many chronic diseases and a growing burden affecting health care across the globe.
When triggered by a bug or danger signal, the immune systems inflammatory response releases a cascade of cells and chemicals that marshal to our aid and work on removing the problem. This process, carefully designed to remove invading bugs or damaging agents, recruits many immune cells to the site and starts the healing process once the threat is gone. Inflammatory chemicals that rush in stimulate nerves causing pain. The permeability of blood vessels increases to enhance access to the site causing an influx of immune cells and fluid (swelling). In the heat of this inflammatory battle, we experience some unfortunate collateral damage to our local tissues too and occasionally loss of function at the affected area can result. The results, though designed to help us, aren’t always pleasant. Depending on the part of your body affected, this is experienced as heat, swelling, pain and redness. Think of the swollen, red, sore, hot area around the cut in your finger, the fever when you catch the flu, or the pain and swelling around the ankle you sprained coming down the stairs. In these situations, inflammation is very obvious and uncomfortable. But it’s doing its job to protect us by aggressively recruiting the immune system to ward off or fight infection or respond to tissue damage.
Once the job is done and stimulus removed, the normal course of events is to start the healing process. Gradually the symptoms of inflammation wear off, our finger or ankle will return to normal as the signs of inflammation wane over days or weeks. This is because inflammation is programmed to stop. Inflammatory chemicals released by immune cells at the site deliberately switch the battle from an attack phase to a healing phase to return our tissues to normal after the danger has passed. But, this is not always the case.
When inflammation goes wrong
Inflammation is acute by design. It’s a toxic assault only ever meant to be short term. Growing evidence suggests that inappropriately triggering or failing to turn off inflammation is a causative proxy or at least a major contributor to a host of wide-ranging chronic conditions. From autoimmunity and allergies to neurological conditions and unexplained maladies, inflammation in the wrong place or at the wrong time has painful and debilitating consequences, as patients with chronic inflammatory diseases will readily agree. In these inflammatory diseases, destructive inflammatory processes persist relentlessly, unabated by the normally reliable on/off chemical controls of the immune system. This wreaks havoc in our body as it damages our own tissues in the absence of any true danger or microbial threat. This is a silent menace, not causing the usual overt signs of inflammation (heat, swelling, redness pain), but compromising our health nevertheless through a slow burn that can take decades to manifest as overt disease. In fact, inflammation has now been singled out as the driver of the ageing process and age related diseases above all other factors even if you feel fit and well. So put down the expensive wrinkle cream and take action against inflammation instead.
Imperfect signs, symptoms & strategies
Allergies and autoimmunity are an obvious and overt sign of inflammatory dysregulation, as could be picking up every seasonal lurgy going (adults normally get 2-4 cold & flu infections per year). Elevated blood levels of acute-phase proteins (e.g. C-reactive protein – CRP) is a somewhat useful measure of an individual’s inflammatory status. But in general and unfortunately, when we talk about low-grade chronic inflammation, we only have imperfect signs and symptoms; hence it is often referred to as ‘silent inflammation’. Painful joints, unexplained headaches, problematic bowels, memory loss, low energy and low mood. Although silent inflammation is considered an important proxy for more serious conditions including cardiovascular disease and neurodegeneration, often, overt clinical disease takes many decades to manifest so we only spot the clues in retrospect.
Frustratingly many factors that can contribute to dysregulated inflammation are beyond our control (e.g. caesarean birth, multiple rounds of antibiotics) such that often the root cause of an unexplained malady may have actually started in infancy. Even if you feel fit and well, inflammation is part and parcel of our day-to-day life, even the act of eating elicits a silent inflammation (perhaps one of the reasons that reduced meal frequency and time-restricted eating garners support as a wellbeing strategy). Nevertheless, contemporary life can further take its inflammatory toll. Our modern environments and fast-paced stressful lifestyles are replete with inflammation triggers. We now live constantly with low levels of inflammatory signals “arming” our immune systems to respond with inflammation. These can be found in cigarette smoke; pollutants in our air, water or food; dysbiosis of our gut microbiome; and in mental cues, such as stress. The cumulative effects of many years of silent inflammatory triggers are still not yet clear. While we can take steroids or anti-inflammatory medications to suppress some of the side-effects of acute inflammation (such as your sprained ankle), these can disrupt the normal healing process and are not recommended for long-term use. Limiting low-grade chronic inflammation is more complex and triggers more obscure.
While problems with our gut microbiome are often considered the root cause of chronic disease, inflammation can be regarded as the catalyst; both can be the cause or the effect of each other; hence there is a close interdependency. Antibiotics undoubtedly take their toll on our microbiome in ways unique to each of us that we are only beginning to define. Diet plays a central role in health and, depending on how you eat, can exacerbate or mitigate inflammation. Scientists developed an Inflammatory Index designed to assess the inflammatory potential of individuals’ diets. The healthy dietary pattern (high in fruits, vegetables, herbs, spices and fibre inversely relates to blood concentrations of the inflammatory marker C-reactive protein (CRP) due to their anti-oxidant and polyphenol content, not to mention the gut-loving fibre which our microbiome thrives on. Keeping your omega 3:6 ratio in check, reducing saturated fats and avoiding industrially-produced trans-fats are also important to switch on anti-inflammatory and pro-resolving pathways. An abundant intake of refined foods with a high glycaemic index relates to an increased susceptibility to chronic inflammation, but the exact mechanisms are complex and not well defined.
There is no magic bullet. Tackling inflammation necessitates an ongoing multi-pronged approach. Sleep or the lack of, and physiological stress also a cause of elevated inflammatory markers. Interestingly, exercise is an effective way to both induce inflammation and reduce it. If you hit the gym regularly then you are probably familiar with the ‘good’ kind of pain after a heavy session. This is a sign of exercise-induced inflammation and isn’t always a bad thing. Creating micro-tears, elicits inflammation that helps your muscles to stimulate growth and repair. It’s a way by which we can ‘stress’ our muscles to get stronger and see results from our efforts. While intense forms of exercise and long-distance running are good for your body in moderation, if you overdo it, they can cause your inflammation levels to spike. If you consistently over without adequate rest, no amount of food and supplements can mitigate the inflammatory assault on your body. Conversely, the long-term effects of regular engagement in exercise are actually anti-inflammatory. Even a light walk is enough to reset, bring down inflammation (and stress) while flushing the lymphatics. Unlocking the complex on/off secrets of inflammation with new research (and hopefully interventions) will be the key to controlling this menace underlying many diseases and ill-defined ailments. If have a chronic inflammatory diagnosis or considered ‘at-risk’ group then always work with your healthcare professional. But small lifestyle modifications, dietary changes, psycho-emotional stress release and physical activity can be quite powerful adjuncts to any clinical therapy for chronic and probably isn’t a bad idea of the rest of us as a buffer to modern life.