Despite its bad reputation, inflammation is an essential function of the body. Without the immune system’s inflammatory powers, we could die from injuries as small as paper cuts and illnesses as minor as the common cold. We simply wouldn’t have the capacity to heal.
“Inflammation is an ancestral response that evolved to protect the body from threats and contain damage from infections and injuries,” explains Columbia University Irving Medical Center assistant professor Shilpa Ravella, MD, author of A Silent Fire: The Story of Inflammation, Diet, and Disease.
The immune system continually monitors the body for viruses, bacteria, and foreign chemicals. When it spots one, it deploys specialized cells (such as leukocytes) and molecules (such as inflammatory cytokines) to mark and dispose of it.
The four classical signs of inflammation were described in ancient Roman texts as rubor et tumor cum calore et dolore: redness and swelling with heat and pain. These are indications that your immune system is fighting for your health.
“Inflammation both brings in the cavalry and sends a warning signal to the rest of the body, saying, ‘Hey, I need help over here; come heal what needs to be healed,’” says naturopathic doctor Cassie Wilder, NMD, founder of the Minneapolis Integrative Medicine Center.
Ideally, inflammation subsides once an injury has healed or the threat of illness has waned, says functional-medicine practitioner Will Cole, IFMCP, DNM, DC, author of The Inflammation Spectrum. When all is running smoothly, the fire ignites, vanquishes the threat, and quickly dies out.
Yet for many of us, the fires are never quite extinguished.
“Today, we find that inflammation can become chronic and simmer in the body,” Ravella says. “Whether it’s overt or hidden, chronic inflammation can have adverse consequences.”
Rather than simply seeking to banish inflammation at all costs, learning more about chronic inflammation — as well as the diet and lifestyle strategies that can mitigate it — can help. Here, integrative healthcare experts offer their insights and tips for effectively managing it.
1. What are some signs of chronic inflammation?
A variety of indicators may reveal ongoing inflammation in the body. Some of the most common include weight-loss resistance, brain fog, anxiety and depression, fatigue, gut dysfunction, joint pain, and headaches.
The signs won’t be the same in every person, however. “Inflammation can manifest in multiple areas of the body, but since every person’s biochemistry is different, symptoms of inflammation can vary between individuals,” Cole says.
Conditions such as rheumatoid arthritis, inflammatory bowel disease, and lupus are what Ravella calls “overtly inflamed” disorders — inflammation-based conditions that can be clearly diagnosed based on tests.
Chronic inflammation can also be hidden, or silent. In such instances, someone may have one or more of the symptoms listed above, or they might feel perfectly well.
Certain tests can gauge general inflammation levels in the body. Tests for high-sensitivity C-reactive protein (CRP) measure levels of this inflammatory protein in the blood; there are also tests to measure interleukin 6 (IL-6), another pro-inflammatory protein. Both CRP and IL-6 have been linked to overtly inflammatory conditions.
Cole also looks at levels of homocysteine, an inflammatory amino acid linked to heart disease, destruction of the blood–brain barrier, and dementia. This marker is commonly elevated in people diagnosed with autoimmune conditions.
High levels of ferritin, an iron-containing blood protein that’s normally measured to help diagnose anemia, can also be a sign of inflammation.
The usefulness of these tests, however, can be limited. “These markers aren’t always specific — you can generate the same proteins if you have a cold or a cut,” Ravella says.
Scientists hope to eventually locate other markers that better indicate whether a body is silently inflamed — as well as reveal the cause.
Still, currently available tests can point toward important avenues of investigation, Wilder notes. “If you suspect inflammation is coming from the gut, for instance, you could run stool testing or food-allergy testing that might lead you down a specific path.”
2. What causes the inflammation response to become chronic?
When the inflammation response gets stuck in the “on” position, it’s due to two primary mechanisms, Wilder explains.
The first is the presence of a continuous trigger: This might be an infection, polluted air, other environmental toxins, a disrupted gut microbiome, or excess visceral fat, which can produce inflammatory cytokines. (Notably, the stress hormone cortisol is implicated in the accumulation of visceral fat, which also links chronic stress to runaway inflammation.)
The second is when the body lacks the resources it needs to quell inflammation. “If your immune system is rundown from chronic stress, poor sleep, and a poor diet, your body doesn’t have what it needs to go out and fight the inflammation being presented to it,” Wilder says.
These two factors — a continuous trigger and lack of resources — can also work in tandem.
3. How does chronic inflammation affect the body?
Chronic inflammation creates an abundance of pro-inflammatory cells and molecules in the body, Cole explains. These include tumor necrosis factor, interleukins, nuclear factor-kappa B, prostaglandins, and free radicals.
These substances all play a role in a functioning system, but they cause significant damage when left unchecked. Persistent inflammation can damage insulin-producing cells in the pancreas, leading to high blood-sugar levels and type 2 diabetes.
Over time, inflammation may damage nerves in the brain and spinal cord, contributing to multiple sclerosis. Persistent inflammation in the brain can lead to mood disorders and Alzheimer’s disease. In the gut, it can cause inflammatory bowel disease. In the blood vessels, it can lead to heart disease.
4. Which health conditions are considered inflammatory?
You can often spot an inflammatory condition by the suffix “-itis” — think arthritis, dermatitis, sinusitis, appendicitis, bronchitis, myocarditis, etc. Before 1800, only 20 such nouns existed. Today, there are hundreds, and inflammation has been found to be a culprit in many more.
“Anybody with a chronic condition is typically inflamed at some level,” Hyman says. The list includes autoimmunity, allergies, eczema, skin disorders, heart disease, cancer, type 2 diabetes, obesity, Alzheimer’s, mood disorders, and osteoarthritis.
Because chronic inflammation taxes the immune response, it weakens immunity, leaving us more susceptible to infections.
It also increases the odds that our bodies will mount the type of overwhelming attack on infections that does more harm than good; this was exemplified by the “cytokine storm” that killed many people infected with COVID-19 early on.
“Hidden inflammation may shed light on why ostensibly healthy individuals can succumb to severe illness during epidemics and pandemics,” Ravella notes.
5. What contributes to chronic inflammation?
Chronic inflammation can be spurred by a broad range of factors; identifying them can be key to restoring balance. “If you can discover your own inflammatory triggers and where your inflammation resides, you can learn how to douse it at its source,” Cole explains.
These are some of the most common culprits.
One of the main contributors to chronic inflammation is a leaky gut, says functional-medicine pioneer Mark Hyman, MD. “Having a healthy microbiome allows us to properly regulate our immune systems and to let in the nutrients that we need . . . but it keeps out the bad stuff.”
The microbiome is also key to strengthening the gut lining that separates the contents of the stomach from the rest of the body. “When that barrier gets broken in the gut, all of a sudden, your immune system is exposed to a sewer,” he explains. “That starts to aggravate your immune system, and you start to create systemic inflammation.”
Gut microbes themselves can also produce pro- or anti-inflammatory molecules. Confoundingly, some microbes can do both, depending on the presence or absence of other microbes.
Studies have consistently shown that a healthy microbiome boasts a rich diversity of species. “A diverse microbiome is more likely to consist of germs that will counter — rather than propagate — inflammation,” Ravella notes.
(Learn more about leaky gut at “How to Heal a Leaky Gut“.)
The typical American diet is another culprit. Neglecting plant foods in favor of too much starch and sugar drives insulin resistance, which in turn can lead to the development of fat cells, called adipocytes. These fat cells, when concentrated in the belly, produce inflammatory molecules called adipose cytokines. “It puts your body on fire,” Hyman says.
Someone with excess visceral fat may be suffering from silent chronic inflammation even in the absence of any symptoms, Ravella explains. “Visceral fat is churning out inflammation at all hours of the day, even in someone who basically feels OK overall.”
The stress hormone cortisol plays an important role in managing inflammation. But prolonged stress can lower immune cells’ sensitivity to cortisol, weakening the hormone’s ability to control inflammation. Severe stress can even dampen the beneficial effects of an anti-inflammatory diet.
Studies have shown that people experiencing a prolonged stressful event are more susceptible to an inflammatory (symptomatic) response to a cold virus. And chronic stress is a leading risk factor for inflammatory conditions, including heart disease and cancer.
“Stress can not only dysregulate how your body responds to inflammatory situations, but it also impairs production of glutathione, the body’s master antioxidant, which cleans up the aftereffects of an inflammatory event, such as an infection,” Wilder says.
The stress induced by poor sleep and loneliness is also a well-known inflammation trigger.
Lingering infections, such as Lyme, Epstein-Barr virus, or cytomegalovirus, can keep the immune system in a state of inflammatory activation. Addressing the trigger in this case might mean working with a provider to resolve the underlying infection or send an active virus back into remission. (Learn more about Lyme disease at “A New Look at Chronic Lyme“.)
6. How can I manage inflammation?
Inflammation is highly responsive to diet and lifestyle interventions, which can help our bodies cool down and our immune systems become better regulated. Focusing on these behaviors can make a difference.
“Food is foundational when it comes to managing inflammation,” Cole says. A diet that emphasizes whole foods and includes plenty of plants and fiber supports a healthy microbiome, helps prevent leaky gut, and minimizes inflammatory inputs to your digestive system.
Consuming a diverse array of plants provides gut microbes with many unique fibers on which to feast. “The most critical factors in designing an anti-inflammatory microbiome are the quantity and diversity of plants in the diet,” Ravella notes. “Each plant contains unique fibers, and each fiber may feed one or more kinds of germs, creating beneficial metabolites yet uncharted.” (Learn more. Explore these “5 Rules for Anti-Inflammatory Eating“.)
Fermented foods play a starring role in an anti-inflammatory diet, too. A Stanford University study published in 2021 found that consuming foods and drinks such as yogurt, kefir, fermented cottage cheese, kimchi, vegetable-brine drinks, and kombucha for 10 weeks led to an increase in overall microbial diversity, with stronger effects from larger servings.
Participants who ate fermented foods also experienced less activation of immune cells and decreased levels of 19 inflammatory proteins compared with those eating a high-fiber diet.
Anyone suffering from joint pain, fatigue, headaches, digestive issues, or other symptoms of inflammation may benefit from embarking on an elimination diet as well, Cole notes. This can reduce inflammatory inputs, giving the gut lining a chance to heal.
After the elimination period, a careful reintroduction process can help identify foods that may trigger inflammation. (For a sample elimination protocol, see “The Institute for Functional Medicine’s Elimination Diet Comprehensive Guide and Food Plan“.)
“Prioritize sleep hygiene and getting deep, high-quality sleep,” Wilder advises. Sleep deprivation is associated with higher levels of inflammatory molecules, including cytokines, IL-6, and CRP. This may be one reason people who sleep poorly are at higher risk of inflammation-based conditions, such as cardiovascular disease, high blood pressure, and type 2 diabetes.
Sleep deficits also interfere with the brain’s ability to flush out accumulated beta-amyloid protein, which has been linked to brain-cell damage and, potentially, Alzheimer’s disease. An overabundance of these proteins can cause inflammation to simmer in the brain.
Prioritizing sleep allows your natural housecleaning system to get to work throughout the brain and body. (For ideas to improve your sleep patterns, visit “Reclaim Your Sleep Rhythm“.)
People in Blue Zones — regions around the world where individuals tend to live longer and enjoy lower levels of chronic disease — almost universally incorporate movement into their daily routines. “You don’t have to run marathons,” Ravella says. “But in places where people live the longest, they tend to seamlessly incorporate movement into their daily lives, even with activities like walking, routine housework, and gardening.”
Research shows that regular, moderate exercise (walking the dog, biking to work, doing yard work) helps prevent chronic inflammatory diseases, whereas inactivity feeds them. “Dozens of human clinical trials across age groups show that regular exercise tones down chronic, low-level inflammation,” Ravella reports.
It helps reduce inflammatory visceral fat and mitigate neuroinflammation in the brain. It increases gut microbial diversity and decreases inflammatory fat around blood vessels, helping to ward off heart disease.
Exercise also achieves some of its salutary effects by causing inflammation. Strength training, for instance, breaks down muscle tissue and elicits an inflammatory response that leads to building muscle.
“Remember, not all inflammation is bad,” Cole says. “That’s why it’s important to monitor your exercise patterns to give yourself plenty of rest between workouts and work your way up to longer or more intense periods of exercise.” Giving your body time to recover between workouts ensures that inflammation can settle back down rather than hover at a low level.
Wilder notes that an anti-inflammatory exercise routine emphasizes low-impact activities, such as walking and yoga, over high-intensity workouts. “People think that unless you can barely breathe or walk afterward, it’s not exercise. But moving and contracting muscles in a low-impact way supports circulation, moves the lymphatic system, and gets [a few] toxins out through sweating,” she says.
Those who do enjoy high-intensity workouts can benefit from mixing them up with low-impact and restorative activities that produce less inflammation. “It’s important to find that sweet spot, because regular exercise is invaluable for calming inflammation,” Ravella says.
Resolvins are molecules derived from omega-3 fatty acids that help resolve inflammation. Animal studies suggest that stimulating the vagus nerve (the main component of the parasympathetic nervous system, which controls the relaxation response) induces the release of resolvins and boosts anti-inflammatory effects. Research has shown that higher heart-rate variability, a key measure of vagus-nerve function, is associated with lower inflammation levels.
Practices that stimulate the vagus nerve and help promote relaxation include yoga, tai chi, meditation, breath work, laughter, humming, forest bathing, massage, singing, chanting, and cold water exposure. (Learn more about the vagus nerve at “Why the Vagus Nerve Matters to Your Health“.)
“Loneliness is an intense stressor for a species adapted to tribal tendencies for survival,” Ravella notes. Not only is taking the time to forge and maintain strong social connections good for our mental and emotional well-being; it also has a direct impact on our risk for chronic disease.
Researchers have explored whether the increased risk associated with loneliness is due to higher levels of inflammation. A recent study of 222 socioeconomically and racially diverse older adults in the Bronx found that those in the cohort who reported being lonelier exhibited higher levels of the inflammation marker CRP. Other research has shown that lonely people are more likely to have an enhanced inflammatory response to stress. (For more on the health effects of loneliness, see “Why Social Bonds Are So Important for Our Health“.)
When it comes to cooling inflammation, the important thing is to find sustainable lifestyle strategies that bring you pleasure. Whether it’s eating fresh whole foods, moving your body, prioritizing sleep, or connecting with loved ones, choose a starting point that feels accessible and build additional anti-inflammatory habits from there.
This article originally appeared as “The Bigger Picture of Inflammation” in the March 2023 issue of Experience Life.
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