Is Inflammation Behind (Almost) All Disease?

You can see your factory-installed inflammation system in action when you cut yourself or get a big zit on your chin. As annoying as the redness, swelling, and pus are, they’re a sign your inflammatory response is functioning well to ward off attackers and keep your body intact.

In the grand scheme of things, inflammation is intended to be a limited, “turn on locally when needed” response to injury or infection. Your body isn’t meant to be smoldering in low-level inflammation day in and day out. Over the past few years, doctors have begun to appreciated that along the road of chronic inflammation, we’re finding more and more varieties of chronic illness.

Inflammatory conditions

Let me list a handful of the conditions unequivocally known to be linked to chronic inflammation:

• Heart disease and stroke  We know that certain triggers (dental plaque among them, interestingly enough) irritate the lining of blood vessels and predispose a person to cholesterol deposits that lead to artery blockage. It’s worth noting that daily flossers, because they remove dental plaque, have fewer heart attacks than the rest of you. In addition, taking a daily low-dose aspirin both reduces inflammation and makes the platelet cells involved in blood clotting less sticky and prone to clot. Inflammation in your body can be measured with tests like the C-reactive protein (CRP) blood test.
• All autoimmune diseases  There are many of these, including rheumatoid arthritis, ulcerative colitis, Crohn’s disease, lupus, Hashimoto’s thyroiditis, multiple sclerosis (MS), psoriasis, and scleroderma. But the essential mechanism behind them all seems the same. Certain individuals have overly efficient immune systems that see enemies where none exist. An unknown something alerts the immune system to trigger inflammation and attack vital parts of the person’s own body. In rheumatoid arthritis, it’s the joints; in Hashimoto’s, the thyroid; in MS, the brain and spinal cord. Doctors have been asking for years “What sets off some people’s immune response like this?” What’s that mysterious something? The answer appears to be that it’s a pre-existing low level of chronic inflammation, which in turn triggers the immune system to go into high gear, accelerating the inflammatory response in all the various autoimmune diagnoses.
• Brain dysfunction  Most recently, chronic inflammation has been linked to an increasing number of conditions, including Alzheimer’s disease, autism, schizophrenia, and treatment-resistant depression (in which people with depression don’t respond to antidepressants). Some patients with these diagnoses are found to have elevated inflammatory markers, like the CRP mentioned above, but also others not routinely measured, like interleukin-6 and tumor necrosis factor (TNF).

Treatments: drug company, herbal, and worms

A variety of drugs exist that specifically block TNF for those with autoimmune disease. You may have heard of the egregiously expensive Humira (adalimumab), Remicade (infliximab), and others in this class for common autoimmune diseases like Crohn’s, ulcerative colitis, rheumatoid arthritis, and psoriasis. These meds do come with side-effects, though. Turning off inflammation renders you more susceptible to infection.

By the way, nature-made TNFs include curcumin (turmeric) and green tea. And to anticipate your next question, yes, followers of anti-aging medicine protocols use both of these in their daily regimen, via supplements or teas.

Research published just last week in JAMA shows promising results by giving TNF inhibitors to people with treatment-resistant depression and elevated CRP. In reviewing older studies, patients with chronic schizophrenia have had some positive responses to anti-inflammatory drugs like Celebrex.

The most provocative study to me, though, had high-functioning adults with autism spectrum disorder regularly swallow eggs of a medicalized parasite, Trichuris suis (harmless in humans), which acted to damp down inflammation throughout the subjects’ bodies and visibly improve autistic behavior.

Is it all starting in your gut?

The evidence seems to be mounting for an idea naturopathic physicians have known about for years: the body’s widespread inflammation starts in your gut. Certain foods (gluten is a frequent villain) can trigger low-level intestinal inflammation, allowing large molecules of inadequately digested food to “leak” into your bloodstream and stimulate your immune system to trigger a bodywide, low level of inflammation. Many people with rheumatoid arthritis, for example, feel better when they eliminate gluten or undertake a low-inflammation eating program.

Leading-edge research is now focusing on our microbiome, the 100,000,000,000,000 (10 to the 13^th power, or 100 trillion) bacteria from roughly 500 to 1,000 species that inhabit our intestines. Here’s a good piece on all this. The metabolic activity of these bacteria have evolved since the dawn of man, the bacteria themselves responsible for manufacturing a wide variety of enzymes and vitamins as well as aiding our digestive processes and food absorption.

The microbiome is often referred to as the human body’s “forgotten organ” and an imbalance of bacteria, usually caused by dietary choices or antibiotics, is now linked with a variety of inflammatory illnesses.

Low-inflammation, healthy-microbiome eating

If you’d like to start eating to keep your microbiome happy and inflammation down (without using worms, I might add), the plan isn’t rocket science, though personally I’d schedule a visit with one of our nutritionists–Marla Feingold, Seanna Tully, or Marcy Kirshenbaum–who know this stuff really well.

The basics:

• Remove high-inflammatory foods–dairy, gluten, sugar (and high fructose corn syrup), soy, refined carbs, and anything with additives/chemicals/preservatives.
• For the rest of your life eat whole foods, emphasizing those that encourage a healthy microbiome. Probiotic-promoting foods include fermented foods (like kimchi and sauerkraut, both of which are easy to make), artichokes, garlic, oats, onions, asparagus, and virtually all green foods and all high-fiber foods. A prescription to go wild at the farmers market.
• Ensure your digestive system is working well and that you have a reasonably good balance of bacteria. A test called the Comprehensive Stool Digestive Analysis (which also checks for parasites and yeast) is partially covered by most insurers.
• If needed, begin using digestive enzymes, probiotics, and specific supplements to repair your intestinal lining.
• If leaky gut (intestinal hyperpermeability) is a strong possibility, there is a second test to check your intestinal lining for leakage.

I think we’ll see evidence in the next few years that a person’s conscious effort to maintain the lowest possible level of bodywide inflammation will be linked with lots of good things.

We have the potential to enjoy a healthy longevity, easier weight control, fewer chronic illnesses, and the most important goal of all health care (!), eternal youth. Well, maybe not eternal, but definitely healthier looking skin and a happier belly.

Be well,
David Edelberg, MD