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Inflammation: Both Friend and Foe

A number of buzz-words appear repeatedly in health claims, such as natural, antioxidants, organic, and inflammation. Inflammation has been implicated in a number of chronic diseases, including diabetes, Parkinson’s, rheumatoid arthritis, allergies, atherosclerosis, and even cancer. Inflammation has been demonized, and is usually thought of as a bad thing. But it is not all bad.

In a study in Nature Medicine in September 2011, a research group led by Dr. Umut Ozcan at Children’s Hospital Boston (a teaching hospital affiliated with Harvard Medical School) reported that two proteins activated by inflammation are crucial to maintaining normal blood sugar levels in obese and diabetic mice. This could be the beginning of a new paradigm. Ozcan says:

This finding is completely contrary to the general dogma in the diabetes field that low-grade inflammation in obesity causes insulin resistance and type 2 diabetes. For 20 years, this inflammation has been seen as detrimental, whereas it is actually beneficial.

Increasing levels of these inflammatory signals might actually be therapeutic in diabetes and obesity. On the other hand, they might worsen inflammatory diseases like asthma and rheumatoid arthritis. Ozcan’s findings are intriguing and might eventually lead to new treatments, but there are no clinical applications as yet.

Inflammation is part of the body’s response to infection and tissue damage, and it is crucial to the healing process. It is important for muscle growth with exercise, but conversely, chronic inflammation may be part of the reason for muscle loss in aging. When inflammation is chronic, it can lead to a number of diseases, from atherosclerosis to rheumatoid arthritis. Inflammatory markers are prominent in obesity, and higher levels are associated with meals high in calories and in saturated fat. Strenuous exercise markedly increases the levels of inflammatory markers.

It is simplistic to talk of “inflammation” as a single phenomenon, since it is a complex response involving many different physiological processes, from vasodilation to neutrophil infiltration, from the complement system to cytokines. And its relationship to health is even more complex. The human organism is a mesh of interrelated networks, and it could be hazardous to meddle with one element without understanding how our intervention might affect other parts of the system.

Certain foods are hyped as anti-inflammatory and certain dietary supplements are marketed with claims that they are anti-inflammatory. Integrative medicine guru Andrew Weil promotes both foods and supplements. Unfortunately, it is not clear that they can actually reduce the kind of inflammation that is associated with chronic diseases, or that such reductions actually prevent or improve the clinical course of those diseases. It is conceivable that they might  lead to harm as well as benefit. If they really diminish the body’s ability to mount an inflammatory response, wouldn’t that also tend to impair wound healing and response to infection? Fortunately, most of the anti-inflammatory diet recommendations are consistent with consensus recommendations for a healthy diet (lots of fruits and vegetables, etc.). Anti-inflammatory medications like NSAIDs and steroids do reduce inflammation, but they have had limited use in treating diseases associated with chronic inflammation, and they have problematic side effects. In fact, steroids make people more vulnerable to infection.

For the present, we have only hints. Research like Dr. Ozcan’s will help us better understand the risks, benefits, and complexities of inflammatory processes. Meanwhile, it’s a mistake to oversimplify and to assume inflammation is always a bad thing, and trying to prevent or treat it with special foods and supplements is little more than a shot in the dark, a gamble based on speculation. Eat your vegetables and stay tuned!

Posted in: Basic Science, Herbs & Supplements, Nutrition

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12 thoughts on “Inflammation: Both Friend and Foe

  1. DrRobert says:

    I’m glad to see an article about this, but I wish you would go way further with this, Dr. Hall.

    People constantly talk about inflammation. Any condition is always due to “inflammation”, and all alt-med people claim whatever they do “reduces inflammation.” It’s the perfect application of pseudo-science.

    Do you have any good examples of these claims? For example, Kat James, a alt-med nutrition person with no academic qualifications told me that if I eat a pear, the natural sugars will cause inflammation in my body that will result in all sorts of dermatological manifestations. Does anyone “measure” any of these supposed low-levels of chronic inflammation? (Not inflammation associated with true chronic disease.)

  2. Janet Camp says:

    @DrRobert

    I think Dr. Hall would run out of space if she tried to list even a portion of the altie claims regarding inflammation! One of the more current ones is the whole gluten-free craze. Gluten is supposedly a major inflammatory agent that leads to just about anything that could possibly be wrong with a person.

    Here’s a really good one overheard while looking at espresso machines at Williams-Sonoma:

    Customer: “I want to make my own coffee because I drink too much of those Vienna coffees (the nasty, flavored stuff in the little tins) and I think all the sugar in them is giving me inflammation in my stomach”.

    I said: “maybe it is the acid in the coffee itself?” No response.

    Clerk: “Oh, switch to agave–it’s much milder for your stomach!”

    I looked at them both and said it was all nonsense. Frowns ensued. The clerk later tells me she is “studying medicine”! I did not ask whether she meant “Western” or “other”, fearing I might lose any patience I had left, regardless of the answer.

  3. Nice article Harriet Hall. I tend to be inflammatorily concerned. But I find the whole issue rather confusing, so I try not to do much beyond taking appropriate medication when I have pain, sinus or breathing issues. It would be great to have something milder than antihistamines or anti-inflammatories or steroids to cope with inflammation, but besides eating and drinking healthy (which is hard enough), I haven’t come across anything that seemed a good bet.

    @Janet Camp, the lady in WS was right, sugary drinks always gives me a particular kind of flammation, over a few months my waist and hips ballon right up. :)

  4. Janet Camp says:

    @MinM

    LOL–and thanks for making that dreadful encounter slightly more amusing. I must have consumed about four tons of ibuprofen in my “menstrual years”, and I’m looking forward to finding out eventually whether that did more harm or good.

  5. kay8e says:

    I’d love to see some discussion on the ‘reduce inflammation’ vs the ‘boost immune system’ claims. Both claims of CAM and both seem mutually exclusive to me.

    I have an auto-inflammatory disease so I’ve enjoyed the benefits of the ‘boosted immunity’ – where I seemed to skip the occasional cold and rarely bruised much – but also suffered the consequences of skin rashes, blood shot eyes, anemia and the long term issues of hearing loss, pappilledema and joint pains (plus some potential for further problems such as amyloidosis and apparently I’m at a higher risk for osteoperosis).

  6. Harriet Hall says:

    @ kay8e,

    I wrote about boosting the immune system in Skeptic magazine. That article is available online at
    http://periodicals.faqs.org/201001/2068216021.html. I asked what “boosting the digestive system” would mean and I pointed out a number of downsides to “boosting the immune system.”

  7. DKlein says:

    DrRobert, Barry Sears tests for “silent inflammation” and developed his own Silent Inflammation Profile test (SIP) that checks the ratio of arachidonic acid to eicosapentonoic acid in the blood. I’m guessing the test is just a way to reduce one’s bank account.

    A common mantra among the “whole foods nutrition” instructors and practitioners that I have met over the years is “Inflammation is just a lack of omega-3 fatty acids.” When I was in cooking school, specific foods were labeled anti- vs pro-inflammatory depending on which “model of nutrition” the instructor was into: acid/alkaline balance, contraction/expansion, ayurveda, or TCM (pears are anti-inflammatory in TCM). Onions and garlic were antibiotic and antiviral if you dabbled in herbalism but pro-inflammatory if you were following an ayurvedic model – all opinions based on “ancient wisdom.” On a positive note, health benefits from any of these models comes from eating a variety of fruits and vegetables. There is the craziness, however,that comes from trying to avoid specific foods, like pears, because of some minute difference in sugars or pH, etc. with no science to back the claim.

    My personal experience with naturopaths, acupuncturists, and other alt.med. practitioners that I went to was that testing for inflammation was not necessary: we’re ALL inflamed whether we know it or not. I have dyshidrotic eczema and have been told it’s from toxins trying to get out, my inner child trying to get out, leaky gut, cellular grease, yeast overgrowth, use of cortisone cream, use of Advil, lack of fatty acids, lack of a spiritual life, living in NJ, and something with one of my chakras.

    Dr. Hall, your article about boosting the immune system was such an eye-opener. Even though my school taught anatomy and physiology of the immune system, it still taught that one could boost it with the right foods and things like forgiveness and compassion.

    1. Harriet Hall says:

      For more on inflammation and boosting the immune system, see Mark Crislip’s article at http://www.sciencebasedmedicine.org/index.php/boost-your-immune-system/#more-1828

  8. It is simplistic to talk of “inflammation” as a single phenomenon.

    Boy, no kidding!

    Some really nifty 2010 research from the University of Calgary explains why immune cells unnecessarily “swarm” sterile injury sites, causing damage and pain with no direct benefit, oh my. The reason neutrophils do this jiggery pokery is really mind-blowing: they’re reacting to mitochondria, which they perceive as foreign (because they were … a bazillion years ago). Just fascinating biology. I wrote about it thoroughly last year, and explored lots of interesting hypothetical implictions. See Why Does Pain Hurt So Much? How an evolutionary wrong turn led to a biological glitch that condemned the animal kingdom — you included — to much louder, longer pain.

    And then a couple weeks ago Alex Hutchinson of Sweat Science posted on a research item about exercise “boosting” neutrophil activity. So if neutrophils really do pointlessly and painfully attack sterile injury … and exercise really does boost neutrophil activity … well, bloody hell, that would mean that exercise simultaneously bestows better inefection protection and more pain. Nice awkward compromise, natural selection, thanks very much!

    So, yeah, not a single phenomenon. Perhaps we should speak of the immune systems

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