The Inflammation Puzzle

In July I posted a blog discussing the overuse of cryotherapy. The controversy surrounding the topic made it one of the most popular blogs I’ve written. What is surprising to me is that a controversy exists at all. Why, where, and when did this notion of anti-inflammation start? Ice, compression, elevation and NSAIDs are so commonplace that suggesting otherwise is laughable to most. Enter an Athletic Training Room or Physical Therapy Clinic nearly all clients are receiving some type of anti-inflammatory treatment (ice, compression, massage, NSAIDs, biophysical modalities, etc). I evaluated a client the other day and asked what are you doing currently – “Well, I am taking anti-inflammatories and icing.” Why do you want to get rid of inflammation and swelling? I ask this question for both chronic and acute injury!

The Stigma of Inflammation
Editor in Chief of The Physician and Sports Medicine Journal (Dr. Nick DiNubile) once posed this question: “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?” Much like a fever increases body temperature to kill off foreign invaders; inflammation is the first physiological process to the repair and remodeling of tissue. Inflammation, repair, and remodel. You cannot have tissue repair or remodeling without inflammation.  In a healthy healing process, a proliferative phase consisting of a mixture of inflammatory cells and fibroblasts naturally follows the inflammatory phase (1).

http://athleticmedicine.wordpress.com/2013/11/07/why-ice-and-anti-inflammatory-medication-is-not-the-answer/

"Why do you want to get rid of inflammation and swelling?"

I have stopped taking NSAIDs - unless I take one.  An example of when I might take them is if I have too much pain to sleep, or too much pain to enjoy being with my family/friends.  What I have found is that sometimes a dose of NSAIDs just shuts down some inflammation cycle that I'm suffering from.

Overall, though, I think many folks take NSAIDs because the standard american diet leaves us in hyper-inflammatory conditions, so that a normal ache or pain becomes a day after day painfest which we might need an NSAID to turn off.

That said, I think the point above is valid.  I feel healthier now that I don't rely on NSAIDs to turn off pain every day.

Inflammation, Autoimmune, What's The Difference

Crohn's disease and colitis, collectively referred to as inflammatory bowel disease (IBD), both involve inflammation of the gastrointestinal tract. Colitis only affects the colon, while Crohn's disease can affect any gastrointestinal area from the mouth to the anus.

Over the past decade, many genes related to Crohn's and colitis have been discovered. Evidence for a genetic basis of the diseases was first uncovered in 2000. But in 2005, only two genes linked to the diseases had been determined. Now, 163 IBD loci, or genetic regions, are known--71 of which were identified in this study.

http://www.thecrimson.com/article/2012/11/9/gut-diseases-genetics/

As you read the press about disease models, virtually all cite "inflammation" or "chronic inflammation". Rarely do they state what that condition is, or what it is characterized by, which is, a heightened inflammatory response when one is not needed.
When you have a cut or an invasive microbe, you need an inflammatory response.  Other times, you need a normal inflammatory response.
In other words, if you buy the "inflammation" argument, the "diseases of civilization" are caused by the body attacking itself through a perverted inflammatory response.  Your genetic predisposition determines whether a diet which drives high, chronic inflammation levels results in, for example, ALS or CVD or pancreatic cancer.
Autoimmune diseases are all of this flavor, so a way to think of "inflammatory" diseases is as a spectrum from the least severe (CVD, cancer) to the most severe (autoimmune).
In either instance, dietary interventions reduce the out of control inflammatory response for many.  Best interventions include wheat elimination, sugar reduction or elimination, and reduction of omega 6 fatty acid intake (combined with omega 3 supplementation).  Other important interventions include vitamin D optimization, optimizing micro-nutrient levels in the body (different from just dumping more of them into your body), and reducing the body's stress response while increasing sleep quality.
Unlike "medical" interventions, these have no side effects.
Which isn't to say I think medicine has no place in disease intervention!  If I get cancer, I'm getting best treatment out there.  Waiting for dietary and lifestyle interventions until after cancer's got you by the liver - aka the late great Steve Jobs - is not my bag.
Eat meat, eggs, vegetables, nuts and seeds, little fruit or starch, no sugar/wheat.

My Top Six Anti-Inflammatory Foods | Mark's Daily Apple

http://www.marksdailyapple.com/top-6-anti-inflammatory-foods/#axzz1kVbkDAgu

Mark lists his favorites, which are:  wild fish fat, pastured animal fat, red palm oil, cruciferous vegetables, berries, turmeric.


The article also presents a useful context for how to think of inflammation, when it is good and when it is not.

Read on:  Any discussion of a concept as nebulous, multifaceted, and confusing as inflammation must integrate the question of context. Inflammation itself is highly contextual – as I’ve discussed in previous installments, there are times when inflammation is a good thing and times when inflammation is a negative thing. There are also times when anti-inflammatory actions, drugs, or foods are negatives, even though “anti-inflammatory” has a positive connotation. If you blunt the post-exercise inflammatory response with an anti-inflammatory drug, for example, you also run the risk of blunting the positive effects of that workout.

We must also pay attention to acute and systemic inflammation when discussing the desirability of an “anti-inflammatory” food. Eating a big meal tends to raise inflammatory markers in the short term. If you’re overeating every single meal, this is problematic; the acute will become the norm – the chronic. If you’re eating big after a massive workout session, or because you’re celebrating at an amazing restaurant with your dearest friends, or because you’re coming off a twenty-four hour IF, it’s fine. Context.

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:
      COOLING INFLAMMATION

INFLAMMATION IS THE FOUNDATION FOR CANCER AND DEGENERATIVE/AUTOIMMUNE DISEASES.  SMALL CHANGES IN DIET AND EXERCISE, E.G. OMEGA-3 OILS, VITAMIN D, LOW STARCH, PLANT ANTIOXIDANTS, AND MAINTAINING MUSCLE MASS, CAN DRAMATICALLY ALTER PREDISPOSITION TO DISEASE AND AGING, AND MINIMIZE THE NEGATIVE IMPACT OF GENETIC RISKS. BASED ON MY EXPERIENCE IN BIOLOGICAL RESEARCH, I AM TRYING TO EXPLAIN HOW THE ANTI-INFLAMMATORY DIET AND LIFESTYLE COMBAT DISEASE.  (This is Art Ayers' blog)

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

Butter and Coconut Oil for Inflammation Control?

BLUF from @Dr Eades:  "Direct evidence showing anti-inflammatory effects of short chain fatty acids found in butter and coconut oil." 

http://www.sciencedirect.com/science/article/pii/S0955286310001865

Here's the abstract:

Short chain fatty acids (SCFAs) are fermentation products of anaerobic bacteria. More than just being an important energy source for intestinal epithelial cells, these compounds are modulators of leukocyte function and potential targets for the development of new drugs. The aim of this study was to evaluate the effects of SCFAs (acetate, propionate and butyrate) on production of nitric oxide (NO) and proinflammatory cytokines [tumor necrosis factor α (TNF-α) and cytokine-induced neutrophil chemoattractant-2 (CINC-2αβ)] by rat neutrophils. The involvement of nuclear factor κB (NF-κB) and histone deacetylase (HDAC) was examined. The effect of butyrate was also investigated in vivo after oral administration of tributyrin (a pro-drug of butyrate). Propionate and butyrate diminished TNF-α, CINC-2αβ and NO production by LPS-stimulated neutrophils. We also observed that these fatty acids inhibit HDAC activity and NF-κB activation, which might be involved in the attenuation of the LPS response. Products of cyclooxygenase and 5-lipoxygenase are not involved in the effects of SCFAs as indicated by the results obtained with the inhibitors of these enzymes. The recruitment of neutrophils to the peritonium after intraperitoneal administration of a glycogen solution (1%) and the ex vivo production of cytokines and NO by neutrophils were attenuated in rats that previously received tributyrin. These results argue that this triglyceride may be effective in the treatment of inflammatory conditions.

Would be interesting to know the Dr.'s opinion on the therapeutic impact of these compounds on those with gut permeability and/or inflammatory conditions, but it sounds as if this is the scientists discovering what folks like Sally Fallon have been advocating with regard to the benefits of grass fed butter cows, and coconut ingestion.

The Beer Tumor

http://feedproxy.google.com/~r/blogspot/mnKK/~3/_ePysVl4czw/let-go-of-my-love-handles.html?utm_source=feedburner&utm_medium=email
"When is fat not just fat? When it's visceral fat. Visceral fat is the fat that infiltrates the intestinal lining, the liver, kidneys, even your heart. It's the stuff of love handles, the flabby fat that hangs over your belt, or what I call "wheat belly."  (editor's note:  also called the "beer tumor")
"Unlike visceral fat, the fat in your thighs or bottom is metabolically quiescent. Thigh and bottom fat may prevent you from fitting into your "skinny jeans," but its mainly a passive repository for excess calories.
"Visceral fat, on the other hand, is metabolically active. It produces large quantities of inflammatory signals ("cytokines"), such as various interleukins, leptin, and tumor necrosis factor, that can trigger inflammatory responses in other parts of the body. Visceral fat also oddly fails to produce the protective cytokine, adiponectin, that protects us from diabetes, cancer, and heart disease. Visceral fat also allows free fatty acids to leave and enter fat cells, resulting in a flood of fatty acids and triglycerides (= 3 fatty acids on a
glycerol "backbone") in the bloodstream. This worsens insulin responses ("insulin resistance") and contributes to fatty liver. The situation is worsened when the very powerful process of de novo lipogenesis is triggered, the liver's conversion of sugar to triglycerides. Visceral fat is also itself inflamed. Biopsies of visceral fat show plenty of inflammatory white blood cells (macrophages) infiltrating its structure.
"So what causes visceral fat? Anything that triggers abnormal increases in blood glucose, followed by insulin, will cause visceral fat to grow. It follows logically that foods that increase blood glucose the most will thereby trigger the greatest increase in visceral fat. Eggs don't lead to visceral fat, nor do salmon, olive oil, beef, broccoli, or almonds.
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"But wheat, cornstarch, potato starch, rice starch, tapioca starch, and sugars will all trigger glucose-insulin that leads to visceral fat accumulation. Fructose is also an extravagant trigger of visceral fat. Fructose is found in sucrose (50% fructose), high-fructose corn syrup, agave syrup, maple syrup, and honey."
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"Increased visceral fat can be suggested by increased waist circumference. The inflammatory hotbed created by excess visceral fat has therefore been associated with increased likelihood of heart attack, cardiovascular mortality, diabetes, cancer, and total mortality.
"So I'm not so worried that you can't squeeze your bottom into your size 8 jeans. I am worried, however, when you need to let your belt out a notch . . . or two or three."