What is chronic inflammation?

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What is chronic inflammation?

An integrative approach to explaining systemic, or chronic, inflammation and its significance to your health.

by Marcelle Pick, OB/GYN NP

Acute and chronic inflammation — when a good thing goes bad

The root of chronic inflammation: an imbalanced immune system

Aspirin and other NSAID’s vs. nutritional and lifestyle changes

Five things you can do right now to reduce inflammation

I’m thrilled that inflammation is the new buzz word among many health and medical circles — I’ve been trying to raise awareness about its importance for years! But among all the talk, there is some confusion around what chronic inflammation is and what you can do about it.

Like an unattended fire, chronic inflammation can slowly spread and lead to serious metabolic breakdown, with vast implications for your long-term health. You may have heard that disorders like rheumatoid arthritis, inflammatory bowel disease, and eczema stem from inflammation. But chronic inflammation has now been connected to a host of modern diseases, from obesity, diabetes, atherosclerosis, and high blood pressure, to Alzheimer’s, osteoporosis, Parkinson’s, cancer, and even depression! In the functional medical world, we view all chronic and degenerative illnesses — and even biological aging — as rooted in

chronic inflammation.

The good news is that there are so many things you can do in your life to cool your inflammation — even if you’ve already been diagnosed with an inflammatory-related condition or have an elevated CRP. And doing something about it now is one way to ensure aging with vitality and strength. As a functional medicine practitioner, I’ve seen firsthand how simple things like cutting back on red meat and soda, getting more sleep, and regular exercise (without overdoing it) make a difference. So let’s take a closer look at the concept of chronic inflammation and give you some resources to turn back the clock, prevent disease, and curb your inner fire.

Acute and chronic inflammation — when a good thing goes bad

Are you inflamed?

Here is a list of symptoms commonly associated with low-grade chronic inflammation.

body aches and pains

congestion

frequent infections

diarrhea

dry eyes

indigestion

shortness of breath

skin outbreaks

swelling

stiffness

weight gain/obesity

For more about why inflammation is on the rise, see our page on the causes of inflammation.

For more on the effects of inflammation, take a look at our list of symptoms, conditions, and related inflammatory disorders.

Just as the plants in your garden need a good mixture of sun and rain to thrive, we all need a measure of inflammation to survive. Acute inflammation is the short-term immune response our bodies mount in cases of trauma, infection, and allergy. Whether you’ve broken a bone, burned yourself on a hot stove, or been exposed to a foreign microorganism, the body is programmed to carry out a similar response. In this response, it will identify the infectious or dangerous substance, determine which cells are “self†cells (non-threatening) and which are “non-self†cells (threatening), assess the level of the threat, mount a response, and repair any resulting damage. In a perfect world, this response occurs just as it should, releasing pro-inflammatory compounds when needed and then turning them off with anti-inflammatory

compounds when the threat has been sufficiently addressed.

Chronic inflammation arises when this response is not completely turned off or extinguished. It acts like a slow-burning fire, continuing to stimulate pro-inflammatory immune cells when they may not be needed. What happens when these excess immune cells are circulating in our systems? They can damage healthy areas in our bodies, such as blood vessel linings (as in atherosclerosis), pancreatic tissue (in diabetes), joint tissue (in arthritis), gut mucosa (in lactose and gluten intolerance) — just for starters.

Let’s look at the GI tract system as an example.. I had a patient, Debra, who was sensitive to gluten, but it wasn’t enough of a sensitivity to cause her to completely eliminate gluten from her diet. Each time she ate bread or pasta or anything with gluten in it, her body mounted a small immune response in the gut. This gave her some gas and discomfort, but not enough to send off any alarms. Over time, the immune cells that were continuously activated began to disrupt the mucosal lining of her bowel. This lead to what is commonly called “leaky gut syndrome,†where particles in the digestive tract leak into the bloodstream through perforations in the gut, causing the immune system to be on higher alert. With each passing day, Debra’s inflammation increased, and soon she started to see more symptoms.

The root of chronic inflammation: an imbalanced immune system

Many of my patients ask about the underlying cause for inflammation, and it doesn’t come as much of a surprise that the root of chronic inflammation is an imbalanced immune system. Your immunity is comprised of two major systems: your innate immune system and your acquired immune system. The innate immune system is what we were all born with and deals with many of the more nonspecific threats to our bodies. The acquired immune system is what we develop based on our behavior, environment, and exposures. In other words, the more bugs or allergens we’re exposed to and successfully fend off, the more our acquired immune system grows in complexity.

These two branches of the immune system are constantly communicating with each other to maintain balance in the body. Their communication system involves specialized sensors and signals that unleash a cascade of biochemical reactions, producing metabolites that activate genes to relay protein messages that communicate an inflammatory call-to-action. Most critically, they are designed to turn that action off when they aren’t needed anymore. But patients with chronic inflammation may show increased levels of certain pro-inflammatory markers, even when there is no obvious reason for inflammation. Some of these markers include C-reactive protein, IFN-gamma, IL-1, IL-6, and TNF-alpha. These are

the same mediators that become elevated in an acute reaction — but the difference is that the acute phase is turned off when the job is done.

As I’ve mentioned above, we need a healthy balance of inflammation to stay healthy. But if your body is constantly on the defensive, it makes sense that your overall health would be compromised. First of all, inflammation takes a lot of your body’s energy and resources. Second of all, our inflammatory cells have evolved to be powerful (this helps rid us of invaders before they can do harm!) — and having a constant, low-grade flow of powerful inflammatory markers in the blood stream can cause damage with time. To make matters worse, once the balance is disrupted, the immune system’s hyperactivity can self-perpetuate and quickly spiral into disease.

Recent research at Harvard Medical School supports the connection between an imbalanced immune system and metabolic disorders, like type 2 diabetes. Scientists found an abundance of immune cells called mast cells in diabetic and obese mice. In healthy individuals, mast cells help to heal damaged tissue, but they accumulate in the fat tissue of obese and diabetic mice and can leak “molecular garbage†into this tissue when unstable. The good news is, the group of mice given a healthy diet and immune system support, had nearly a 100% recovery! We’ll have to wait and see if the same results play out in humans.

Aspirin and other NSAID’s vs. nutritional and lifestyle changes

If you pay attention to Oprah, you may have heard about Dr. Oz’s advice to take two baby aspirin per day as an anti-inflammatory approach to prevent heart disease, cancer, and possibly even wrinkles. Relative to heart health, the research shows this approach is both gender-specific and age-specific — its benefits are not equally distributed across the board. I think Dr. Oz has some wonderful advice about health, but I have to say I’m skeptical of having my patients regularly take baby aspirin. This is because even the use of mild anti-inflammatory drugs can lead to concerns like leaky gut, ulcers, increased bleeding, and kidney problems. While it may be helpful for some women, in others, like Debra, long-term use of even baby aspirin can lead to small perforations in the small intestine that allow pathogens and

incompletely digested food particles into the bloodstream. The body recognizes these particles as “foreign antigens†and mounts an immune response every time you eat, only furthering inflammation in the system.

Dozens of pharmaceutical drugs have been developed to override the inflammatory cascade, and many more are in the pipeline. NSAID’s (nonsteroidal anti-inflammatory drugs) like Motrin and Aleve disrupt the production of prostaglandins, which are needed to regulate inflammation, constrict or dilate vessels, and much more. Corticosteroids like prednisone, COX-2 inhibitors like Vioxx and Celebrex, and antihistamines each shut down a different inflammatory mechanism, leading to further long-term risks in the body.

Routinely taking aspirin or other NSAID’s runs counter to the functional medicine approach to inflammation, which strives to support the body’s natural healing mechanisms. As a functional medicine practitioner, I urge my patients instead to look closely at their diets, and to supplement with omega-3’s and other natural anti-inflammatories before turning to aspirin or other non-aspirin NSAID’s. Let’s look at some simple drug-free ways to put out the flames.

Five things you can do right now to reduce inflammation

It’s sad to say that we are living in a toxic world, where fuel for inflammation is present at every turn. We’re unintentionally exposed to toxins like lead and mercury in our environment; industrialized foods are replacing many of the natural anti-inflammatory foods once prevalent in our diets; and stress and lack of sleep are everyday events for many of us. What’s exciting to me and many of my patients is that we still have a lot of choices. There are so many things you can do to reduce inflammation naturally — I’ve written a whole article on the subject, and even that doesn’t cover it all! But here are five simple steps you can take right away.

Revise your diet. Start by limiting or cutting out your intake of trans fats and refined carbohydrates. Replace these with healthy fats, such as omega-3’s and olive oil, and unrefined carbohydrates, like antioxidant-rich fruits and vegetables.

Add omega-3’s. There is an extensive and growing body of evidence that omega-3’s can reduce inflammation. In our modern diets, we consume an overwhelming amount of omega-6’s in proportion to omega-3’s. This imbalance may well be a predominant cause of runaway inflammatory health issues.

Get a good night’s sleep! Between seven and nine hours of uninterrupted sleep can do wonders to repair and restore your system. Though many scientists are still debating why we sleep, we know that a good night’s sleep is one of the best anti-inflammatories out there! So make getting to bed on time a priority.

Supplement with a high-quality multivitamin/mineral. Folic acid, B vitamins, and vitamins D, C, and E all have anti-inflammatory effects in your body. For a strong anti-inflammatory base, take a high-quality daily multivitamin–mineral complex like the one we offer in our Personal Program.

Rebalance your immune system with probiotics.. The beneficial flora (probiotics) in your body work hard to protect and rebalance your immune system. You can help them help you by eating more naturally fermented foods like yogurt, kefir, sauerkraut, kombucha, and kimchee, as well as plentiful fiber. There are also many superb probiotic supplements available, as well.

Restore balance and prevent disease

It’s certainly disturbing that chronic inflammation is at the root of nearly every modern disease on the rise today. But accompanying that news is the opportunity to make everyday choices that limit the fuel for the fire and profoundly lessen our chances of disease. Simply being aware of inflammation is a great start. And the more I learn about the human body, the more I appreciate that we’ve evolved with all the natural tools needed to maintain healthful balance in our systems. Start reducing chronic inflammation now, so you can improve your health for the rest of your life!

LDN - LOW-DOSE NALTREXONE FOR IMMUNOMODULATIONNaltrexone is an FDA-approved drug used as an opiate antagonist for treating opiate drug and alcohol addiction since the 1970's, available in generic form as well as ReVia in 50mg tablets. At regular dosing, usually 50mg a day, it blocks the euphoric response to opiate drugs such as heroin or morphine. I as well as many other DAN! doctors have tried Naltrexone with our ASD children hoping to offset the "opioid" effects of the large peptides in wheat, milk and soy. I found it mostly ineffective and abandoned this therapy long ago. Naltrexone has always been considered very safe and has never been reported as being addicting.Opioids are known to operate as cytokines, the principal communication signalers of the immune system, creating immunomodulatory effects through opioid receptors on immune cells. A popular

immune classification method is referred to as the Th1/Th2 balance; Th1 cells promote cell-mediated immunity while Th2 cells induce humoral immunity. The inability to respond adequately with a Th1 response can result in chronic infection and cancer; an overactive Th2 response can contribute to allergies and various syndromes and play a role in autoimmune disease, which most ASD children show on immune testing.Bernard Bihari, MD, a New York physician studying the immune responses in AIDs patients, discovered that a very low dose of naltrexone in less than one-tenth the usual dosage boosts the immune system and helps fight diseases characterized by inadequate immune function. Low-Dose Naltrexone (LDN) tends to normalize the immune system by elevating the body's endorphin levels and accomplishes its results with virtually no side effects or toxicity. Since endorphins are an integral part of the immune

system, when a tiny dose of naltrexone is given between 9-12pm at night the body attempts to overcome the opioid block and the endorphins rise, to stay elevated throughout the next 18 hours.LDN had been studied in ASD children using from 5-12.5mg daily or every other day in the early 90s; researchers were looking for opioid antagonism. Results were equivocal with non-compliance because of the bitterness of the drug. Dr. Tyrus at Coastal Compounding agreed to create a transdermal cream for my study; that way we could adjust the dose easily (some of the smaller kids did better with only 1-1/2mg), the bitter taste was no problem, and it could be put on their bodies while they slept. The cream is put into syringes, ? cc providing 3mg, with a month's supply of the child dose (3mg) costing $19, the adult dose (4.5mg) $30, plus shipping, no refrigeration required. Dr. has offered to share this

very effective formula with any compounding pharmacist who wishes to call him, .I have completed an 8-week informal clinical study on 15 of my ASD patients using 3mg of LDN transdermally between 9-12pm. Several adults participated also, one with Crohn's Disease and one with Chronic Fatigue Syndrome using 4.5mg nightly. Parents reported weekly; 8 of the 15 children had positive responses, with five of these 8 having results considered quite phenomenal according to their parents. The primary positive responses have been in the area of mood, cognition, language, and socialization. 5 of the children had equivocal results and three children dropped out, one because of no response after 4 weeks, the other two for personal family reasons. Two very small children did better when changed to 1-1/2mg dosing. No allergic reactions were noted to the cream, with the primary negative side effect being

insomnia and earlier awakening when first taking it, usually lasting 3-5 days. The two adults in the study, one with Crohn's and the other with Chronic Fatigue Syndrome, have had very positive responses; the Crohn's participant says she has been in remission since starting LDN (almost 3 months now). All participants who completed my study have indicated they wish to continue, and hundreds of other ASD kids have started this non-toxic, non-invasive, inexpensive intervention by now.All my study children were on well-controlled dietary restriction. I am receiving reports from the e-lists I monitor of about 5% of other children besides those in my study having side effects such as irritability, agitation, and restlessness. Side effects subside as soon as the drug is withdrawn. I am querying these parents about gluten/casein/soy in diet, as this could be withdrawal symptoms of opioid block. I suspect

that children on a strict GF/CF/SF diet may demonstrate the positive immune modulation effect sooner than the child who needs to go through opioid withdrawal first, but I assume it is possible for the block to stimulate withdrawal effects and also have the endorphin rush if parents want to stick out the side effects.It may be a while before a formal study can be conducted, so although I assume the positive effects are due to up-regulation of the immune system, I do not yet have studies to prove it. I suspect we will get lots of informal clinical data long before we can get a formal study conducted. I am hoping this will be another weapon in our ever-expanding arsenal to help the children get as immune-efficient as possible. I want to thank those who participated in the study for being trusting enough to go along with me in trying something new, and I thank Dr. Tyrus at Coastal Compounding for

helping devise a successful form to use in our children. This yahoo list has been started for reporting and discussion of this intervention. Jaquelyn McCandless, M.D. 7-18-05

References & further reading:

1 Rountree, R. 2005. Chapter 23: Immune imbalances and inflammation. In Textbook of Functional Medicine, ed. D. & S. Quinn, 300. Gig Harbor, WA: Institute for Functional Medicine.

2 Rountree, R. 2005, p. 300.

3 Pahl, H. 1999. Signal transduction from the endoplasmic reticulum to the cell nucleus. Physiol. Rev., 79 (3), 683–701. URL: http://physrev.physiology.org/cgi/content/full/79/3/683 (accessed 06.17.2009).

4 Rountree, R. 2005, p. 308.

5 Liu, J., et al. 2009. Genetic deficiency and pharmacological stabilization of mast cells reduce diet-induced obesity and diabetes in mice. Nat. Med. [Epub ahead of print.] URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/19633655 (accessed 07.30.2009).

6 Oprah.com. 2009. Dr. Oz’s anti-aging checklist. URL: www.oprah.com/slideshow/world/health/slideshow1_ss_oz_20080205/18 (accessed 06.16.2009).

7 Algra, A., & Greving, J. 2009. Aspirin in primary prevention: Sex and baseline risk matter. Lancet, 373 (9678), 1821–1822. URL (no abstract available): http://www.ncbi.nlm.nih.gov/pubmed/19482200 (accessed 07.08.2009).

Chiang, N., et al. 2005. Aspirin has a gender-dependent impact on antiinflammatory 15-epi-lipoxin A4 formation. A randomized human trial. Arterioscler. Thromb. Vasc. Biol., 26 (2), e14.. URL: http://atvb.ahajournals.org/cgi/content/full/26/2/e14 (accessed 07.06.2009)..

Ridker, P., et al. 2005. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. NEJM, 352 (13), 1293–1304. URL: http://content.nejm.org/cgi/content/full/352/13/1293 (accessed 07.06.2009).

8 Antithrombotic Trialists’ (ATT) Collaboration. 2009. Aspirin in the primary and secondary prevention of vascular disease: Collaborative meta-analysis of individual participant data from randomised trials. Lancet, 373 (9678), 1849–1860. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/19482214 (accessed 07.08.2009).

Ivanhoe Newswire. 2009. Aspirin causes bleeding for some. URL: http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=21575 (accessed 07.08.2009).

9 Rountree, R. 2005, p. 312.p

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