Monday, February 6, 2012

Inflammation: What Is That?

A friend responded to a blog post recently by asking "What is inflammation?"  Here's a blog all about inflammation, and I like the intro:
But was does it mean to say "inflammatory"?

First off, it's a description of the body's response to damage or invasion - damaged cells need to be killed off and cleaned out, or repaired.  Invading pathogens must be eliminated, quickly.  And the body has an exquisitely well designed system for doing just those things.  You can somewhat test it just by smacking your arm a couple of times - hard enough to sting.  See the redness?  That's the inflammatory response.  The term of course is a reference to heat, so when you are inflamed - "on fire" - your body is responding with a variety of techniques to save you from something.

Autoimmune disease is caused by the body's immune system turning on some part of the body as if that part were an invading pathogen.  Many folks attribute that process to a leaky gut, which allows particles into the blood that should remain in the gut; as the body amounts an antibody defense to some such particle, it may also begin to recognize some part of itself as that invading particle, and attack it.

Dr. Sears' books always referred to the inflammatory cascade, in which the inflammatory hormones were parented by high insulin levels and built out of omega 6 fatty acids.  So, in the model Sears described, an insulin resistant body, caused by high carb consumption over time, combined with a high omega 6 fatty acid intake, via processed vegetable oils and grains and their processed food products, would be the perfect storm for a state of chronically high systemic inflammation.  The immune system in that case would be hyperactive, and thus cause the damage and abnormal processes that result in disease.

In this model, omega 6 FA are the parents of the inflammatory super hormones (eicosanoids), whereas omega 3 FA are the parents of the "return to normal" hormones.  Just based on that idea, you could imagine the significance of having a balance between the two in your food intake (since we don't make enough of either, therefore, they are designated as "essential fatty acids").  More detail on this here.

Gary Taubes, in his incredible book "Good Calories Bad Calories" made a more clear case for the causes of chronic disease, but without reference to the inflammatory cascade per se.  Nonetheless, the cause of "the diseases of the West" was identified as excess carb intake, the resulting insulin resistance, and the variety of abnormal metabolic impacts that result.

One way to think of chronic inflammation is to think just of pain - if you find yourself reaching for ibuprofen, or one of the other NSAIDS (non-steroidal anti inflammatory drugs), you are looking for a treatment for inflammation.  When I used to eat high carb, low fat, I lived on NSAIDS because my various joint injuries hurt just about all the time.  Now days, it's a rare thing when I take an NSAID, not because the damage has decreased over the years, but because the systemic inflammatory response is not hyper active and thus does not generate the sensation of pain around the injury.

A last thought about inflammation is to consider folks you know with red, irritated looking skin.  Of course, anyone with sunburn has felt the body's inflammatory response to the damage.  Folks with an inflammatory condition in their skin all the time - rosatia as an example - are suffering some similar, but hopefully less intense, response to an irritant all the time.  There are many models that might explain this, but in short, there's some element of their diet and/or environment that is driving an expression of a genetic propensity for inflamed skin.  In most cases, the inflammation is systemic and skin is just one of the warning signs.

Reducing systemic, abnormal, chronic inflammation should be a consideration for any of us.  When wading through a neolithic food world, with only our paleolithic genetics to get us by, we do ourselves great harm by over eating grains, processed vegetable oils (massive amounts of omega 6 FA without a balanced quantity of omega 3 FA), and by not sleeping enough causing overactivity in other hormones like cortisol.  Further, we don't typically have enough vitamin D because we don't get enough sunlight on enough of our skin (or eat enough vitamin D laden sea foods like the Inuit did).

Here's the rub - I don't know of a scientifically valid way to measure inflammation.  You can evaluate your levels of arachadonic acid to eicosapentanoic acid, but your guess is as good as mine as to whether that's a valid measure of health.  Thus, to know if you are doing a good job with inflammation you have to consider your general pain levels, your ability to recover from intense activity, your overall feelings of wellness, and other markers that are quite subjective - for example, decreased skin irritation, or taking less pain medication.   It's possible to have high body fat, but not be chronically inflamed, but more likely, that fat is a correlate with a high inflammation diet.  My guess is the best measure of overall health is blood glucose - if you have glycemic control, you should have good insulin sensitivity, have lower chronic insulin levels, and generally, "normal" inflammatory response.  But I find it troubling to talk about inflammation as the be all end all of health since there's no way to objectively quantify what is being described.

That said, inflammation is an important topic - folks are describing models for all the diseases from depression to heart disease and Alzheimer's/Parkinson's/ALS in terms of inflammation.  Chronic, systemic inflammation is very likely at the root human illness.  To me, it's not the death that is tragic, it's the loss of life that one must endure before the end of chronic illness that I would like to avoid.  It's harder to celebrate the goodness in life after stroke, heart attacks, dementia, or any of the various miseries we have inflicted on ourselves via agriculture.

So while you slog along with the many uncertainties of this life, hoping that you are not killing yourself with inflammation, eat meat, vegetables, nuts and seeds, little fruit or starch and no sugar/wheat.  This Rx provides a starting point which you can adapt as you experiment and find tweaks that make the paleolithic diet work best for you.

More learning here:  Dr. Ayers' 13 posts on inflammation

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