Chronic Inflammation

This page is designed to help you understand why you might be experiencing symptoms relating to chronic inflammation. In this section we look at what inflammation is, what might cause chronic inflammation, some of the health implications of chronic inflammation, certain testing considerations for inflammation and then some natural strategies that may help you combat chronic inflammation.

What is Inflammation and what is chronic inflammation?

Inflammation is something that is occurring all the time in the body, whether you are aware of it of not. It is the immune system that creates inflammation to protect your body from diseases, infections, toxins and injury. When something invades the body or damages your cells, your body releases chemicals that trigger a response from your immune system.

The immune response includes the release of antibodies as well as certain proteins. Your body will also increase blood flow to those areas.

There are two distinct types of inflammation we should consider:

Acute inflammation

Typically very short term, perhaps more severe. Think of when you have bashed part of your body on something, it goes warm, you feel pain, it swells up, perhaps goes red and you lose some function. This is an acute inflammatory response to injury. Same can be said for acute infections, these can cause dramatic spikes in inflammation and immune response in the body.

Chronic Inflammation

This type of inflammatory response is lower and slower in nature. It is often long term, lasting for weeks, months and into years. Chronic inflammation is linked with most chronic diseases, but more on that later on.

Both of the above will typically have different approaches. For example, an acute inflammatory response relating to an acute injury, illness etc is something that we want to occur. In fact, it can often be beneficial to let the body ride out the natural response without trying to interfere or support with that natural process.

On the other hand, chronic inflammation in something that we can and should aim to get on top of, not allowing it to persist and contribute to further health implications.

What causes chronic inflammation?

Chronic inflammation often results from a few key areas, typically.

• Ongoing exposure to something that the body deems as unsafe, think of toxins, pathogenic bugs or excessive opportunistic overgrowths, poor food choices or food allergies and sensitivities. I firmly believe that chronic stressors and past trauma are also a significant factor in chronic inflammation.
• Untreated causes of acute inflammation such as a past infection or injury.
• An ongoing autoimmune condition, where the immune system mistakenly attacks healthy tissue resulting in chronic inflammation.
• Obesity is another significant cause, with fat cells themselves creating inflammatory proteins that then wreak havoc in the body. Hence, optimising body composition is always an important health goal and not just about what you look like in the mirror!

How can chronic inflammation impact your overall health?

Chronic inflammation can lead to a host of symptoms. Fatigue, skin issues, cognitive issues, water retention, sleep issues, weight gain, musculoskeletal symptoms, allergies and more.

Not just this, chronic inflammation is also linked with several diseases as well, these include cardiovascular disease, type 2 diabetes, cancer, asthma, neurodegenerative diseases such as Alzheimer’s.

As you can see, chronic inflammation is something that impacts us on a day-to-day basis and also sets up an environment that is likely to lead to longer term issues as well.

Testing considerations for chronic inflammation

Testing for chronic inflammation is about looking at markers in the body that signify inflammation.

Below are some of the markers that I would look for on very common blood tests to determine if there is likely to be some level of chronic inflammation. Some are more direct assessments of inflammation and others are more indirect.

C-Reactive Protein (CRP) or High Sensitive C-Reactive Protein (HsCRP)

CRP is produced in the liver in response to inflammation and increases in the blood as a result of numerous inflammatory conditions. This test does not determine the difference between chronic or acute inflammation, however, a combination of how high the numbers are, and your symptoms, will likely lead to a conclusion as to whether the inflammation is likely to be chronic or acute in nature.

Conventional ranges state that CRP is within normal reference ranges when below 5 mg/L. However, I consider CRP to be elevated if above 2mg/L, sometimes even 1mg/L, especially if it is coupled with symptoms of chronic inflammation.

Erythrocyte sedimentation rate (ESR)

This marker in the blood looks at the rate at which red blood cells sink in a tube of blood. The quicker they sink, the more likely you are inflamed. ESR is usually performed as part of a haematology assessment, looking at white blood cell levels and the breakdown of those white blood cells. ESR alone does not give you any clues as to the cause of the inflammation, however the white blood cell breakdown may help to steer you in the right direction with determining cause.

Conventional ranges for males are typically <15 mm/hr and females <20 mm/hr, whereas optimal ranges should be more like <5 and <10 for males and females respectively.

White Blood Cell Count (WBC)

These are your immune cells. If they go up, there is usually a sign of an acute infection. Interestingly though, chronically high normal levels of WBCs are also a sign of chronic inflammation.

Conventional ranges for WBC are typically around 3-11, however maintaining a WBC count below 7.5 is more optimal.

Plasma Viscosity

Inflammation can thicken the blood, therefore when inflammation is present, the blood plasma viscosity levels increase.

Serum protein electrophoresis (SPE)

Considered the best way of assessing chronic inflammation, it measures certain proteins in the blood. These include albumin, alpha-1 globulin, alpha-2 globulin, beta globulin and gamma globulin.

The balance of these proteins in the blood helps to determine the possible source of inflammation and also whether it might be chronic or acute.

Ferritin

Whilst ferritin is typically used to determine storage levels of iron in the body, ferritin is also an acute phase reactant. As a result of this, it is a type of protein that can increase in response to inflammation, infection and trauma. It should not be used to determine inflammation alone because of the influence of iron status on its levels. It can be used alongside other test results and a decent symptom analysis.

Omega 6:3 ratio (AA:EPA)

Whilst not a marker for inflammation, we often look at this fatty acid ratio to assess risk of chronic inflammation. The higher the AA:EPA ratio, the more risk there is of inflammation. I’ll talk more about this in the section relating to nutrition to help with inflammation.

Optimal levels are typically below a 3:1 ratio. However, this is exceptionally rare to see. It is not uncommon to see levels above 10:1 or even 20:1. In these individuals I’m very concerned on their ability to manage inflammation and what role fatty acid balance in their diet might be having on chronic inflammation. In fact, research has shown that a ratio lower than 5:1 is beneficial in managing a host of inflammatory conditions, and for that reason below 5:1 is my personal and more realistic target.

Beyond just testing for the presence of inflammation, you then need to consider what might be the cause of that inflammation. Further testing may be required to uncover this.

We would look at some of the following areas to assess our clients depending on their history and symptoms:

• Gut microbiome analysis for infections, overgrowths, evidence of intestinal permeability, evidence of high endotoxin producing bacteria etc.
• Immune responses – Looking at antibody responses to foods, toxins, pathogens etc.
• Hormonal assessments, to look for physiological indicators of stress such as levels of cortisol through the day, DHEA levels etc.
• Body composition analysis, looking at fat percentage and visceral fat levels.
• Assessment of the levels of insulin and blood glucose.

Natural strategies to help reduce chronic inflammation

Conventionally, chronic inflammation is treated with non-steroidal anti-inflammatory drugs and steroid medications. The challenge with this is that these often come with significant side effects. Therefore, it is important to see what we can do naturally to help reduce inflammation in the body to lower or eliminate the need for medications.

Don’t get me wrong, some people will require medical intervention and more acute pharmaceutical therapies, perhaps even maintaining some lower dose therapies to manage the immune and inflammatory responses. However, the role that natural therapies and optimising overall health can play on chronic inflammation is huge and should not be overlooked.

As well as looking for the reason for the inflammation in the first place, below are some recommendations that can both address possible causes of inflammation and also help to manage inflammation as well.

Nutrition

From a dietary perspective, foods have the capacity to both positively and negatively influence inflammation.

What are some of the foods that are most likely to contribute to inflammation?

The more refined/processed your food is, the higher the risk that it will contribute to inflammation. Research has shown that refined carbohydrates such as sugars and breads are one area, another is that of excessive omega-6 fatty acids, especially from refined vegetable oils, hardened vegetable oils as well as excessive intake of saturated fatty acids from animals, seen more in conventionally raised animals’ vs wild caught or free range.

Fatty Acid Balance

The high consumption of omega 6 fatty acids, especially arachidonic acid (AA) comparative to omega 3 fatty acids, especially Eicosapentaenoic Acid (EPA) can serve to promote inflammation. Below are some tips to help manage the AA:EPA ratio.

To help balance the Omega 3 and 6 levels to become more anti-inflammatory, our focus should be on increasing foods that are rich, in particular fatty acids, EPA and GLA. We should do this whilst lowering fats that are rich in the omega 6 fatty acid arachidonic acid (AA).

Below is a list of foods that will support EPA and GLA and foods that are high in AA that should be limited.

Food rich in EPA (good to eat)

• Oily fish such as sardines, salmon, mackerel, trout, herring etc
• Algae/seaweed
• Other fish and seafood
• Grass fed lamb or beef (still have to limit somewhat due to AA content)

Food rich in GLA (good to eat)

• Hemp oil/seeds
• Spirulina
• Blackcurrant seed oil
• Borage oil

Food rich in Arachidonic acid (limit consumption)

• Arachidonic acid is mostly found in animal foods, therefore is most in abundance in meats, eggs, dairy, seafood. Because of some these foods also contain helpful omega 3 fatty acids, it is about focusing on the meats/fish that offer higher levels of omega 3 EPA to balance the arachidonic acid.

I write more extensively on how to manage and balance fats here as well as how to choose the right fats to cook with here.

Carbohydrate Balance Blood Sugar Management

Eating the right levels and types of carbohydrates is important. Research has shown that the Glycaemic Load (GL) of food is significantly and positively correlated with markers of inflammation such as C-Reactive Protein. Therefore, lowering the GL of the foods that you eat may help to lower inflammation levels.

I write more in depth about carbohydrates here.

One of the ways in which managing your carbohydrate choices helps with inflammation, is the reduction in oxidative stress within the body, caused by acute or chronic periods of high blood sugar. Another factor may be the reduction in insulin within the body as well. Insulin, the hormone that helps us to manage blood sugar levels can promote the production of inflammatory proteins when over-stimulated.

Eat an antioxidant rich diet

A high intake of antioxidants from our diet, typically found in colourful vegetables and fruits, has been shown to be significantly and negatively associated to elevated C-Reactive Protein. Therefore, consuming more antioxidant rich foods has been shown to lower the levels of inflammation.

Antioxidants and phytonutrients have been well researched for their impact on lowering inflammation. I speak about phytonutrients extensively here.

Eating good levels of fibre

There is an inverse association between the total dietary fibre intake and C-Reactive Protein. Meaning, the higher the fibre level in the diet, the lower the C-Reactive Protein is likely to be. Elevated levels of CRP were 63% lower in those with the highest intake of fibre vs those with the lowest intake.

Part of the reason may be fibre’s role in helping to manage body composition, but also the role the fibre can play on maintaining a healthy gut microbiome, and therefore managing immune responses and thus inflammatory responses.

Another factor is the chemical structures of fibre having inherent anti-inflammatory activities.

Eating a more plant-based diet

On the most part, a diet that it dominated by plant-based foods, appears to be more beneficial for inflammation management than your typically modern-day diets. This does not mean you need to be vegan or vegetarian to experience the benefits, the goal is just to allow plant-based wholefoods to dominate the plate.

This also fits into the recommendation of eating a diet rich in antioxidants and fibre.

Are there some do’s and don’ts?

I don’t like to ban foods from clients, I don’t believe in foods that we should never eat unless they have such a negative consequence for that individual, such as an allergy or if they are in a position where they need to following a specific therapeutic diet.

However, below is a list for general guidelines for a more anti-inflammatory diet

Eat more of:

• Colourful vegetables and some fruits
• More monounsaturated fats from foods like olives, avocado and macadamia nuts
• Oily Fish
• Herbs and Spices
• Teas

Eat less of:

• Sugary foods
• Refined flour-based foods
• Processed meats
• High fat conventionally and grain-fed animals. Choose leaner or grass-fed options instead
• Alcohol
• Vegetable and seed oils, especially hardened versions or those used in processed foods or deep frying

Social Engagement & Chronic Stress

Stress can create inflammatory responses. When under stress, our sympathetic nervous system (fight or flight) jumps into action. A nervous system that is constantly activated, such as those with chronic stress can lead to chronic inflammation.

One study has shown social rejection to light up the same parts of the brain as physical pain and trauma. I see this relationship a lot in clinical practice. Psychological traumas and stress eventually presenting as physical symptoms.

So many people that I see with chronic inflammatory based symptoms/conditions, also have a history of significant stressors/life events as well as ongoing chronic stress. I have no doubt that managing stress and working through past traumas can be one off the most powerful steps in addressing chronic physical conditions. Yet this is often overlooked when someone presents with physical symptoms. Thankfully a more integrative/functional medicine approach does incorporate the person as a whole and does not treat the physical, mental and emotional health as separate entities.

Sleep and Chronic Inflammation

Disturbed sleep, sleep deprivation and also excessive sleep, have been linked with increased inflammatory responses in the body.

Research has shown there to be a bidirectional link between sleep and immunity. The immune system can alter sleep, and changes in sleep quality can impact on the innate and adaptive aspects of our immune system.

Sleep appears to promote inflammatory balance. Research findings demonstrate that prolonged sleep deficiency can lead to chronic, systemic low-grade inflammation and is associated with various inflammatory diseases.

The majority of adults should be aiming for 7-9 hours of good quality sleep. This can of course be challenging for some people with life stressors, kids etc interfering with our ability to get optimal amounts of sleep. Equally, we should not simply accept poor sleep as a product of having kids or modern day living. Working on finding an appropriate sleep schedule and routine for you is important.

Appropriate movement

Physical activity is well recognised as an important strategy for reducing the risk of chronic disease. Large studies have shown an inverse correlation between markers of inflammation and fitness status, therefore the fitter you are the less likely you are to be inflamed.

But is more always better? This depends on the tolerability someone has to exercise and how good their recovery is. Exercise is a stressor, and many types of exercise are inducing tissue damage and a short-term inflammatory state. If the recovery rate is not sufficient and one continues to train, this can result in an exercise induced chronic inflammatory state and often presents itself as “overtraining/under-recovery.”

When someone enters an over-trained state, the levels of inflammation in their body become amplified and can therefore worsen any inflammatory issues that may already be present.

It is important to plan out your training and where necessary, periods of recovery. This essentially allows you to reduce the training volume/intensity/frequency to help prevent an overtraining state.

Equal to this is ensuring that your recovery matches your training. What are you doing with your diet, are you eating enough in general, the right levels of macro and micronutrients? Are you supporting recovery with stretching, massage work etc? Are you sleeping adequately? How much psychological stress do you have going on at the moment?

Just be aware of not allowing exercise to be the stressor that is the straw that breaks the camel’s back.