Best Defense: Tackling Inflammation

by Lisa Schofield | September 28, 2018

Inflammation is at the root of many conditions. Here’s how to spot it and what to do.

It’s only recently that medical science has found that inflammation is a cause and risk factor of numerous illnesses. And the research to reveal more roles of chronic and systemic inflammation is fast and furious.

The good news is that more Americans are aware that something they don’t feel may be in existence and causing a cascade of biochemical actions that may result in illness.

Jaquel Patterson, ND, MBA, medical director of Fairfield Family Health in Connecticut, related that she has seen “a much greater awareness regarding inflammation. Patients have requested information about herbal products like curcumin, ginger, fish oil and anti-inflammatory diets to improve their health and provide relief from pain. I would say a large majority of my patients are seeking support for pain relief and to decrease inflammation related to chronic disease and autoimmune conditions.”

In agreement is Jacob Teitelbaum, MD, best-selling author, who observed that the public is starting to recognize that imbalanced inflammation may be the single most important factor contributing to illnesses of modern life.

Amy Rothenberg, ND, Naturopathic Health Care (Northampton, MA) said that in her practice, there is a portion of her patient population who understands that there is increased importance about the role of inflammation, and how lowering inflammation can improve health. Many have a basic understanding of the roles of exercise, food and stress impact overall states of inflammation. “That said, there are many patients who do not have an understanding of this fact,” she stated. “They may understand inflammation only in as much as a knee is inflamed after walking too long.”

There are several other myths and misconceptions that patients still have. For example, according to Dr. Patterson, people still tend to dismiss aches and pains as a result of something (like lifting something heavy too fast or bumping into something) or due to aging, and that we need to live with pain. Also, many individuals tend to wait to address their problem until the symptoms become severe enough to drive them to medical consultations. “It’s important to address inflammation issues as soon as they begin to appear,” she emphasizes. “Further, and equally as important for people to understand is that inflammation is also not limited to joint pain, muscle pain and stiffness; there are numerous inflammatory processes that can occur in our body that affect our organs like our heart and liver.”

The public has the misconceptions that all inflammation is bad, according to Dr. Teitelbaum. It is not. Inflammation is a critical part of the body’s defense and repair systems. The problem arises when it is allowed to become excessive, which then exacerbates pain, as well as heart diseases and the epidemic of autoimmune issues.

Systemic inflammation has four causes, he pointed out:

1. A marked increase in the use of sugar and white flour, which constitutes one third of our calories

2. A major decrease in omega-3 intake because of increased use of grain-fed beef and food processing

3. Adrenal fatigue

4. Leaky gut coupled with incomplete digestion of food.

Compelling Research

As mentioned, the study of inflammation is yielding greater clarity of its destructive role in human physiology. Several recent studies demonstrate just how far-reaching inflammation can be.

One used a mouse model to pinpoint how inflammation affects the brain. The researchers pointed out that as mammals age, microglia (the brain’s immune cells) become chronically inflamed, and begin to produce chemicals that impair cognition and motor function.

The researchers looked at how dietary fiber can impact this process. Dietary fiber naturally promotes growth of beneficial microflora, which produce short chain fatty acids (SCFAs) when they consume the fiber. One of their byproducts is butyrate.

Study co-author Rodney Johnson, PhD, professor and head of the Department of Animal Sciences at the University of Illinois, explained “Butyrate is of interest because it has been shown to have anti-inflammatory properties on microglia and improve memory in mice when administered pharmacologically.”

Although positive outcomes of sodium butyrate—the drug form—were seen in previous studies, the mechanism wasn’t clear. According to Dr. Johnson, the new study reveals that in old mice, butyrate inhibits inflamed microglia from producing damaging chemicals, such as interleukin-1, which has been associated with Alzheimer’s disease.

The researchers sought to find out if feeding fiber to the mice would provide the same effects as sodium butyrate, which is not consumed directly due to offensive odor. A practical way to obtain the ingredient is through soluble fiber. Butyrate obtained from dietary fiber should provide the same positive impact in the brain as the drug form, so the researchers fed low- and high-fiber diets to groups of young and old mice, then measured the levels of butyrate and other SCFAs in the blood, as well as inflammatory chemicals in the intestine.

“The high-fiber diet elevated butyrate and other SCFAs in the blood both for young and old mice. But only the old mice showed intestinal inflammation on the low-fiber diet,” Johnson reported. “It’s interesting that young adults didn’t have that inflammatory response on the same diet. It clearly highlights the vulnerability of being old.”

Conversely, when old mice consumed the high-fiber diet, their intestinal inflammation was reduced dramatically, showing no difference between the age groups. Dietary fiber, stated the researchers, was able to clearly manipulate the inflammatory environment in the gut.

The team also examined signs of inflammation in the brain by looking at approximately 50 unique genes in microglia. They found the high-fiber diet reduced the inflammatory profile in aged animals. In another study, researchers discovered that neural inflammation caused by the human innate immune system plays an unexpectedly important role in stress-induced depression. This insight could potentially lead to the development of new antidepressants targeting innate immune molecules.

Previous research suggested a link between inflammation and depression, such as increased levels of pro-inflammatory cytokines and activation of microglia (inflammation-related cells in the brain) in depressive patients, and a high percentage of depressive episodes in patients exhibiting chronic inflammatory disease. However, the exact relationship between depression and inflammation still contains many unknowns.

The research team focused on repeated social defeat stress (a type of environmental stress) with the aim of clarifying the mechanism that causes an emotional response to repeated stress in mice. The results showed that repeated social defeat stress activates microglia in the medial prefrontal cortex via the innate immune receptors TLR2/4. This triggers the expression of several inflammation-related cytokines, which led to the atrophy and impaired response of neurons in the mice’s medial prefrontal cortex, resulting in depressive behavior.

In another 2018 study, scientists found what they said is a new metabolic process that can switch off inflammation. Itaconate—a molecule contained in glucose—turns off macrophages, immune cells that are central to many inflammatory diseases including arthritis, inflammatory bowel disease and heart disease.

The scientists, working in the School of Biochemistry and Immunology in the Trinity Biomedical Sciences Institute at Trinity College Dublin in Ireland, hope their discovery will have relevance for inflammatory and infectious diseases—and that their findings may also help to develop much-needed new drugs to treat people living with these conditions.

Professor of Biochemistry at Trinity, Luke O’Neill, was, along with Dr. Mike Murphy of the University of Cambridge (U.K.), the joint leader of the work just published in leading international journal Nature. The discoveries were made using both human cells and mice as a model organism. “It is well known that macrophages cause inflammation, but we have just found that they can be coaxed to make a biochemical called itaconate,” said O’Neil. “This functions as an important brake, or off-switch, on the macrophage, cooling the heat of inflammation in a process never before described.”

“The macrophage takes glucose, whose day job it is to provide energy, and surprisingly turns it into itaconate,” added Co-author Evanna Mills. “This then blocks production of inflammatory factors, and also protects [the study] mice from the lethal inflammation that can occur during infection.”

The findings are cutting-edge inflammation research and O’Neill and his team are now exploring its relevance to the onset and development of inflammatory and infectious diseases.

Dr. Patterson also has pointed to this study and investigation of the ratio of macrophages M1 and M2 in inflammation. “Research by Trinity Biomedical Institute have also just found that macrophages can make a biochemical called itaconate which can work as an ‘off-switch’ to the macrophage and block production of inflammation,” she affirmed.

Additionally, she said, there also has been accelerating research and continued development on molecular mimicry as it pertains to autoimmune conditions. She explained that these foreign sequence similarities share structural similarities to self-antigens. When T cells are activated, these foreign peptides mimic specific T cells, which cause the production of cross-reactive antibodies to bacteria. Molecular mimicry has been connected to pathogenesis of autoimmune conditions like MS, diabetes mellitus and lupus causing an exacerbation of symptoms. For example, viruses like Epstein Barr and its molecular mimicry has been shown to contribute to the development of lupus.

Medically, said Dr. Teitelbaum, the focus has been on the role of the prostaglandin E1 in inflammation. Treatment is more often than not prescribing NSAID (nonsteroidal anti-inflammatory drugs) medications or prednisone. NSAIDs have been associated with an up to 40 percent increased risk of heart attack and stroke along with up to 16,500 excess bleeding ulcer deaths each year. This translates to approximately 50,000 preventable deaths in the United States alone from these medications. “This research has essentially been ignored by the mainstream media,” Dr. Teitelbaum noted. “This is not surprising, as Motrin and Naprosyn are some of their biggest advertisers.”

Pro-inflammation Factors

Because higher levels of inflammation is so pervasive, there are factors that a patient interview can reveal that will help get an idea if this is the case causing their symptoms and complaints.

As the aforementioned study about butyrate and inflammation shows, diet can have substantial impact on the body’s inflammation response. “The most controllable causes are diet, lifestyle and environmental factors,” emphasized Dr. Patterson. Lifestyle factors that are known to contribute to inflammation include smoking, alcohol, lack of sleep and chronic stress. People who are obese are also at greater risk of inflammation and foods such as fried foods, processed meats and refines carbohydrates are pro-inflammatory foods.

However, there are some conditions, notably most autoimmune conditions, that are hallmarked by elevated inflammation, but there are ways to lessen symptoms and outbreaks, via promoting healthier inflammatory response.

“Overactivation of some parts of the immune system will show up as pain, or elevated c-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) blood testing,” Dr. Teitelbaum explained. “But many if not most aspects of excessive inflammation will not show on testing. Given the modern diet, environment and lifestyle, it is reasonable to simply presume that inflammation needs to be balanced to thrive in the modern environment. This means cutting back on sugar and white flour.”

Dr. Rothenberg noted that the role of inflammation in cardiovascular disease is significant and not often discussed. Chronic inflammation can come from poor food choices, lack of exercise, stress, autoimmune illnesses, food sensitivities and more. Inside arteries, inflammation can instigate atherosclerosis, which narrows arteries and raises the risk that arteries will become blocked. This can be a risk factor for heart attacks and stroke.”

Meanwhile, in her practice, Dr. Rothenberg’s antennae will be on alert when patients seem to have a range of issues. “Many complaints from iritis, to digestive dysfunction (inflammatory bowel disease) to heart disease, to irritability and anger” will warrant an examination into the person’s inflammation levels. Depending on the issue and body part involved, she will order blood tests.

Dr. Patterson also noted there are numerous symptoms she sees that indicate inflammation such as joint or migratory pain, chronic fatigue, not feeling well, brain fog/memory issues, headaches, frequent colds and illnesses, digestive complaints, allergies, weight gain and insomnia. The most common tests for inflammation include ESR, CRP and creatine kinase (CK). “If you suspect something more autoimmune related, it may include looking at rheumatoid factor, ANA, anti-CCP, ANCA or HLA B27,” she added.

Inflammation-control Protocol Ideas

Once unhealthy levels of inflammation are confirmed, Dr. Patterson first tackles dietary factors and lifestyle. She related that she has patients who now consume foods high in omega-3 and rich in antioxidants through foods like salmon, sardines, olive oil, fresh fruits and vegetables. She also instructs them to decrease intake of processed foods, refined sugars and fried foods. Supplements she recommends to manage inflammation include high-dose omega-3s, and alpha lipoic acid-containing herbs like turmeric or ginger. “And in clinical practice I also consider CBD oil and bone morphogenic proteins (BMPs), as indicated for the case. I also use low dose immunotherapy in our office for chronic illnesses to restore balance in the immune system’s response and reduce inflammation,” she said.

According to Dr. Teitelbaum, one third of Americans live with chronic pain, and more than 15,000 per year are dying from prescribed narcotic overdoses. A major issue dramatically impacting Americans, especially those in chronic pain, is that the government has essentially declared war on people in pain. Many people of pain are having their medications stopped abruptly as physicians fear for their licenses. This is leaving the public desperate.

When inflammation has been addressed for pain, post-surgery and related health conditions for which NSAIDs were prescribed. Dr. Teitelbaum endeavors to help his patients stop using them due to NSAID-related fatalities. “The good news, he emphasized, is that pain can be effectively treated with natural tools. For example, “research shows that a combination of a unique highly absorbed curcumin plus boswellia (CuraPhen from EuroMedica) has been shown to be more effective than Celebrex in repeated head on control studies,” he commented. “This also balances numerous arms of the inflammatory system.”

He added that he personally takes one Vectomega and one CuraPro 750 mg capsule daily as part of his overall regimen. These are outstanding simple investments in staying healthy, feeling great and notably balancing inflammation easily,” he noted.

Dr. Rothenberg related that her inflammation-management protocol includes testing for and removal of food allergens, reducing refined sugars and carbohydrates, adding fermented and cultured food and drink in the diet, ensuring healthier digestive function, exercise and mindfulness meditation to lessen anxiety and stress response, which will reduce inflammation.

Stress is always going to impact everyone, and inflammation therefore is going to be a significantly widespread factor causing many imbalances and potential risks for disease. Getting your patients on a “mindful” protocol that addresses healthy inflammation will help increase their well-being at the very least.

Healthy Take Aways:

• As mammals age, microglia (the brain’s immune cells) become chronically inflamed.
• Itaconate—a molecule contained in glucose—turns off macrophages, immune cells that are central to many inflammatory diseases.
• Chronic inflammation can come from poor food choices, lack of exercise, stress, autoimmune illnesses, food sensitivities and more.
• One third of Americans live with chronic pain, with more than 15,000 a year dying from prescribed narcotic overdoses.