Inflammation: Friend and Foe

The term “inflammation” is thrown around a lot. But what exactly is it? Is inflammation what happens to muscles or tendons when we sprain them? Does it cause chronic conditions like heart disease? Is it a good or a bad thing? It’s really all of the above. Inflammation can be acute or chronic, and both friend and foe.

Acute inflammation is the body’s short-term response to injury and usually results in healing, says Timothy Mazzola, M.D., of Boulder, Colo., a nonoperative orthopedist who specializes in regenerative orthopedics (nonsurgical treatments to injury).

“When you’re fighting cancer or infection is when your immune system needs to go to bat for you,” says Mazzola. “In my field, where inflammation is so key is in the initiation of the healing response. When you have an injury that your body needs to respond to, to be able to heal itself, that requires inflammation. It is the first step of healing.”

Similarly, when pathogens like viruses, bacteria or fungi infect the body, the immune system fights these infections and causes inflammation. Other external stimuli, such as certain unhealthy dietary factors, cigarette smoking, and exposure to environmental pollutants and chemicals can also lead to acute inflammation but also, more significantly, increased levels of chronic inflammation. Obesity can even trigger inflammatory responses in fat tissue, leading to chronic systemic inflammation, explains Frank B. Hu, M.D., Ph.D., professor and Department of Nutrition chair at the Harvard T.H. Chan School of Public Health.

Hence, the role of inflammation should be to initiate healing and get rid of unwanted stimuli in the body. “In a normal immune response, physiological inflammation is essential for the immune system to fight off foreign invaders and heal injuries,” says Hu. “However, long-term systemic inflammation could trigger cascades of reactions that increase risk of cardiovascular diseases, diabetes, some cancers and respiratory diseases.”

Chronic Inflammation: The Foe

When inflammation doesn’t shut off, it turns into long-term or chronic inflammation, which has been associated with increased risk of succumbing to myriad health conditions and disease. Here’s how it works: The body’s cells produce proteins called cytokines, which are necessary to stimulate the immune response, regulating the body’s response to infection or disease. Yet, the presence of chronic inflammation means that our proinflammatory cytokines never turn off, perpetuating the inflammation cycle.

“Once infection or an injury is fought, things are supposed to go back to homeostasis, with the immune system at-the-ready but not locked in the on position,” says Mazzola. “The latter is what causes systematic inflammation and can lead cancer, heart disease and conditions like osteoarthritis to progress more rapidly. That’s where inflammation is not cool.”

Obesity, for instance, is associated with chronic inflammation. “Inflammation may be an underlying reason for the development of many obesity comorbidities, such as heart disease, diabetes and some cancers,” says Hu. “Weight loss and maintaining a healthy weight can reduce levels of proinflammatory cytokines.”

“I think exercise is the most profound anti-inflammatory, as long as you are not overdoing it. If you can do the proper amount and intensity and duration, then you can actually decrease your overall inflammation,” says Mazzola. As a general goal, aim for at least 30 minutes of moderate physical activity every day, whether it’s walking, biking, going to the gym or even gardening to move your body.

How To Stop The Cycle

So what can we do about inflammation?

“Shutting it off with ibuprofen or NSAIDs [nonsteroidal anti-inflammatory drugs] can help with pain but might also impair the healing response,” says Mazzola. Instead, a healthy diet and lifestyle have been shown to help manage chronic and low-grade inflammation.

Hu notes that physical activity is a key to maintaining a healthy weight and therefore controlling inflammation. On the flip side, cigarette smoking releases numerous chemicals with proinflammatory properties. Sleep patterns also influence inflammation.

“There is some evidence that links sleep disturbance, inadequate sleep duration and obstructive sleep apnea to increased levels of inflammation,” says Hu. Poor sleep can increase production of the hormone cortisol, which functions in part to reduce inflammation. With chronic inflammation (and sleep deprivation), cortisol is constantly being created and, in turn, suppresses the immune system. This puts the body at increased risk for disease and ailments.

Hu recommends plant-based foods, such as vegetables (especially dark-yellow and leafy-green vegetables and tomatoes); fruits including blueberries, blackberries, oranges, apples and strawberries; foods high in healthy fats—i.e., polyunsaturated and monounsaturated fatty acids—such as walnuts and other nuts, extra-virgin olive oil, seeds and seed oils, and fatty fish and seafoods, which contain marine omega-3s; and whole grains. “All of these have been associated with lower levels of inflammation,” says Hu, adding that coffee, tea and dark chocolate rich in polyphenols may reduce inflammation as well.

Food As Thy Medicine

As with many ailments, a healthy diet can mitigate inflammation. Many recommended diets—including the U.S. dietary guidelines, Mediterranean or Asian-style eating, and a vegetarian diet—mesh well with anti-inflammatory eating. “All of these diets share in common more plant-based choices, more fruits and vegetables, whole grains, legumes and nuts,” says Jeffrey Blumberg, Ph.D., research professor at the Friedman School of Nutrition Science and Policy at Tufts University. “They all have constituent nutrients, vitamins and minerals, and fatty acids, and they contain bioactive components that may help inflammation. If you eat a healthy diet, big-scale studies and smaller clinical trials have shown that you will be at a lower risk for diseases, such as heart disease or certain cancers.”

Although this idea that eating healthy can ward off inflammation is nothing new, Blumberg notes that the medical world has become more savvy in its awareness and comprehension of inflammation. “We have gotten more sophisticated in understanding that inflammation stimulates oxidative stress, which affects glucose and insulin control and glucose regulation. This leads to adverse glycation [when glucose links to proteins in the body], which leads to more inflammation and oxidative stress.” Basically, if left unattended, inflammation can be a vicious cycle.

Avoid Proinflammatory Foods If You Can

The inflammation cycle can be fed by proinflammatory foods, including refined carbohydrates such as white bread and pastries, sugar-sweetened beverages, red meat (burgers and steaks), and processed meat, including hot dogs, sausage and bacon. Blumberg adds, “Processed foods and sugar are the real problems that cause inflammation.” Ingesting sugar, such as in a soda, causes glucose levels to go up quickly, so insulin goes up quickly. “It’s these spikes that are problematic,” he says. Blumberg notes that fruit, on the other hand, is OK, because even though it contains natural sugars, it doesn’t cause the spikes, because the body absorbs it more slowly.

Beyond Food

Although diet can stem inflammation, the reality is that a large percentage of the population fails to meet U.S. dietary guidelines when they eat, Blumberg says. In fact, about three-fourths of the population eats a diet low in vegetables, fruits, dairy and oils, and most Americans exceed recommendations for sugar, saturated fats, sodium and overall caloric intake, according to the National Health and Nutrition Examination Survey conducted by the National Center for Health Statistics.

“We have a big gap—in terms of micronutrients, vitamins and minerals—between what people are eating and what they actually need,” explains Blumberg. In this case, he advises that dietary supplements can help fill the gaps. For instance, if you’re not eating two to three servings of fish a week, he recommends taking fish oil supplements with omega-3 fatty acids to reduce chronic inflammation. A good multivitamin can overcome diet gaps, but it’s necessary to take them regularly. “They don’t work if you don’t comply,” he adds.

The biggest mistake, says Blumberg, is when people think they can’t do anything for inflammation. They might say, “I have type 2 diabetes; I might as well keep eating because it’s too late.” But that’s not right, cautions Blumberg. “At any stage of life, even with a chronic condition, challenging inflammation with an anti-inflammatory diet can be of benefit. You can have a better quality of life.”

Try This
“Turmeric, or curcumin, the active ingredient in turmeric, is also a powerful anti-inflammatory,” says Blumberg. Turmeric can be taken in food or as a supplement.

Don’t Forget Vitamin D

Mazzola emphasizes the need for vitamin D, which is associated with reduced inflammation and yet is another vitamin we tend to be deficient in. “Vitamin D is a hormone in your body, a fat-soluble vitamin, and is involved in a lot of the repair processes,” he explains. “So, if you are low, you are just not going to be able to heal as well. If you live north of L.A., across to northern Florida, at least through the winter months, the vast majority of the population is deficient in vitamin D for lack of sunlight. And you can’t get enough in your food. It’s worth talking about to your doctor,” he says.