What is Inflammation Telling You?

Joint Pain

May 13

What is inflammation?

Inflammation is a naturally occurring process in our body. It is one of our body’s first lines of defense against infections, toxins, allergies, and injuries. It can often be seen physically as bruising or swelling, which is typically referred to as acute inflammation, and is an important part of the healing process. But what about inflammation we cannot see, inside our blood vessels, fat cells, or brain? This low level, often chronic inflammation, inside the body leads to some serious medical conditions. We now know that when inflammatory cells hang out too long in blood vessels, it promotes the buildup of dangerous plaques, which can eventually lead to a heart attack or stroke. There is also ongoing research about the role of brain inflammation and its link to Alzheimer’s disease and depression. In obese people, the extra accumulation of fat cells, or adipose tissue, release their own inflammatory markers that get circulated throughout the body, thus causing even more inflammation. We now believe that almost every modern day disease has a component of inflammation.

How can we measure inflammation?

Acute inflammation is often easy to diagnose. You can see bruising and swelling almost immediately after bumping into the corner of the dishwasher, ouch! You have a fever and increased white blood cells when you get a viral or bacterial infection. You get a runny nose or itchy eyes during high pollen season. Chronic inflammation is harder to see though, and can come in many forms. The most common complaints of chronic inflammation are; body aches/pain, fatigue/low energy, excess mucus production, skin rashes, and digestion issues. Besides taking a thorough history from the patient, there are some lab tests we can check to rule out acute vs. chronic inflammation. But keep in mind, the lab results can be affected by certain drugs and medications. So, while having these numbers are an important step to finding out if you have inflammation, they are not meant to diagnose any disease or condition. They are also useful to have so we can track if the inflammation is resolving or getting worse.

1. White blood cell count (WBC): Acute elevation of WBC’s usually indicates an acute infection and resolves on its own. Chronically elevated WBC’s indicate that the immune system is in overdrive, and is still undergoing inflammation after the acute phase. Normal WBC range is typically 4,000-9,000 cells per microliter.

2. High sensitivity c-reactive protein (hs-CRP): hs-CRP is a protein made by the liver in response to inflammation. This is a sensitive marker of systemic inflammation, but is nonspecific, meaning it won’t tell you where the inflammation is inside your body. The typical lab range for hs-CRP is between 0-3.0mg/L, but the ideal level is less than 1.0mg/L. If your hs-CRP is consistently above 3.0mg/L, this is a strong indicator of chronic inflammation. Because of its sensitivity, hs-CRP often goes above 10mg/L during an acute infection, but should come back down below 3.0mg/L about 2 weeks post resolution of the infection.

3. Erythrocyte Sedimentation Rate (ESR): The ESR is a measure of how quickly your red blood cells settle in a blood sample. RBC’s typically settle very slowly, so a faster than normal rate indicates possible inflammation in the body. Ideally, you want your ESR <15 mm/hr.

How can we lower inflammation?

Fortunately, there are many things we are in control of that can reduce inflammation.

1. Cigarettes: First off, if you are smoking, now is the time to quit. Smoking is the single largest, preventable cause of disease. Studies show that there is a dose dependent response to smoking. Meaning, the more you smoke, the higher your inflammatory markers are. Just QUIT!

2. Alcohol: There is still a debate about how much is ideal, but in my observations, less is more, especially if you are trying to reduce inflammation. When you drink, you typically get poor quality sleep and make bad food choices, both of which lead to inflammation. Treat alcohol like a “dessert” and only have it on occasion.

3. Diet: This will be different for each individual. To start off, remove foods that are known to cause inflammation in most people, like sugar, dairy, and processed foods. If removing the main culprits does not help, an elimination diet or food sensitivity test may need to be done. An elimination diet would include removing the foods above, as well as other common triggers, like grains, soy, nuts, and eggs. After several weeks, you re-introduce these foods to see if your symptoms or inflammation returns. A food sensitivity test is a blood test that may be performed to see if there are any known triggers and helps you to choose what foods to avoid. Overall, you want to aim for a whole foods diet, low in processed foods, and avoid any known triggers.

4. Exercise: In the short term, exercise actually increases your inflammatory markers, but this is acute, and is seen as a good thing. You are creating little micro-tears in your muscles during exercise, and need some inflammation to repair and strengthen them afterwards. But overall, consistent physical activity will lower inflammation by reducing cytokine production from adipose tissue, improve your insulin sensitivity, and acts as an antioxidant. Be cautions though of overdoing it and make sure to adequately rest and heal between sessions. If you are noticing constant pain in the joints/ligaments, not just muscle soreness, this may be a sign of overuse and an indicator to back off a little. Aim for at least 30 minutes of low level exercise every day, and then add in a few sessions of moderate-high intensity days in there. Listen to your body and adjust accordingly. Find a program that keeps you consistent.

5. Weight loss: We know that overweight and obese people have higher inflammatory markers. The extra adipose tissue (fat cells) actually produces pro-inflammatory cytokines, which leads to an increase in systemic inflammation. While BMI (body mass index) is not perfect, aim for a range of 18.5-25 kg/m2. Any rise in BMI above 25kg/m2 puts you at an increased risk of inflammation and other disease like diabetes and cardiovascular disease. Another great marker is waist circumference. Aim for a waist circumference of less than 40 inches for a man and less than 35 inches for a woman.

6. Stress and sleep: This is typically the hardest part for people to fix. Whether it is the job you hate, family issues, or money problems, sometimes this is out of our control. Do your best to de-stress at the end of the day. Try yoga or meditation. Start your day off with a gratitude journal and a few minutes of deep breathing. Aim for a solid 7-9 hours of uninterrupted sleep. Get black out curtains to ensure a completely dark room. Sleep in a slightly cool environment, never hot. Avoid electronic screens and artificial light 2 hours before bedtime. The list goes on, but find a routine that works for you and seek help from a counselor or therapist if you need it for managing stress.

7. Supplements/medications: For episodes of acute inflammation, we have several medications to help. We have all taken Advil for muscles aches and pains, or Tylenol for a fever. Even plain old ice can help acute inflammation. But none of these are meant to be taken daily, nor do they help much with chronic inflammation. While many supplements can help to lower inflammation, they can never be traded for the lifestyle changes mentioned above. No amount of fish oil or curcumin will correct a poor lifestyle and diet. If you are pregnant or on any prescription medications, always consult with your provider before starting any new supplement. Some can interfere with medications and make them less or more effective. The dosage recommendations are for adults only.

ALA, alpha lipoic acid: fatty acid made by our own body and also functions as an antioxidant. Some studies showed reduced inflammatory markers, while others have shown no change. This is well tolerated in most people, with little side effects. May lower glucose, so caution with diabetic patients. Dose 300-600mg daily.
Curcumin: component of the spice turmeric, curcumin has been around for centuries in Asia. Known for its bright yellow color and intense fragrance, it has been well studied for inflammation. There are also ongoing studies about curcumin being protective of certain cancers. Dose 100-500mg daily. Boost absorption by taking it with black pepper or a supplement that also contains bioperine or piperine.
Fish Oil: High in Omega-3 fatty acids, most importantly EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Both DHA and EPA have been studied extensively in lowering inflammation. If you are not eating fatty fish (salmon, mackerel, anchovy, sardines) at least three times per week, you may need to supplement. Look for a high quality fish oil supplement that contains both EPA and DHA at a dose 1-5g per day. An added benefit of high dose fish oil is the ability to lower triglycerides, which if elevated, put you at a greater risk of cardiovascular disease and metabolic syndrome. Some can cause a fishy aftertaste or cause “fish burps”, so you can keep them in the freezer or take with food.
Vitamin D3: Fat-soluble vitamin that is naturally present in very few foods, and typically added to foods as a supplement. It is produced endogenously when UV rays from the sun strike the skin and trigger vitamin D synthesis. The main role of Vitamin D is to help with calcium absorption, which enables normal bone growth and repair. Vitamin D also plays a role in our immune system primarily by boosting our innate immunity. While taking a Vitamin D3 supplement will not lower inflammation, we do know that people who are deficient in Vitamin D have higher levels of inflammation and are at a greater risk for developing certain disease like cardiovascular disease, diabetes, cancer, and depression. The ideal way to ensure adequate Vitamin D levels is to expose 25% of the skin (no SPF applied) to direct sunlight for 15 minutes, three days per week. For us living in the PNW though, that can be difficult, so supplementing is often recommended. Before starting any Vitamin D3 supplement, you need to check your blood level of the inactive form 25-Hydroxy Vitamin D. The goal range for this is often debated, but aim for 30-70ng/ML, with optimal level around 50ng/ML. Dosage of Vitamin D3 will range, depending on your blood level. Maintenance dose is typically 1,000-2,000 IU’s per day, but some people may need as high as 5,000-10,000 IU’s per day for a short-term boost.
Ginger: another plant that has been around for centuries, ginger contains two compounds that can help lower inflammation; gingerol and zingerone. Ginger is also often used to aid in digestion and quell nausea. You can cook with it whole, use it in powder form, or take a supplement at a dose of 1-2g daily.
CBD Oil: cannabidiol is the non-psychotropic derivative of the hemp plant. Unlike THC, it will not get you “high” and has a host of health benefits, which includes reducing inflammation, pain control, and reducing oxidative stress from free radicals. CBD can be applied topically to a specific area to reduce pain and inflammation or it can be taken orally as a tincture. It is best to discuss this with your provider to obtain the proper dosage for your condition and to ensure it does not interfere with any other medications you are taking.
Resveratrol: powerful anti-oxidant found in grapes, blueberries, and other fruits with purple skin. This is the compound found in red wine that people tout as having health benefits, but the amount of resveratrol in red wine is not nearly high enough to make any impact on inflammation. You would have to drink 3 gallons of red wine per day to get the recommended dose of 150mg for health benefits. Daily dose is between 150-500mg per day, with some digestive issues occurring at the higher doses.
Spirulina: another strong antioxidant, this is a type of algae with blue-green colors. The main active compound found in spirulina is phycocyanin, which fights free radicals and helps inhibit inflammatory signaling molecules. It is also packed with other nutrients (Vitamin B1/B2/B3, cooper, and iron) and can help regulate blood sugar and fat metabolism. Typically it comes in a powder form, and can easily be added to a smoothie. Dosage is 1 Tbs (7grams) per day.

If you have symptoms of chronic inflammation, please reach out to your provider and ask if a lab draw and supplements are appropriate for you.

References:

https://health.clevelandclinic.org/why-you-should-pay-attention-to-chronic-inflammation/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507106/

https://www.parsleyhealth.com/blog/5-signs-chronic-inflammation/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653962/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1160597/

https://jamanetwork.com/journals/jama/fullarticle/192183

https://www.sciencedirect.com/science/article/pii/S0735109705004705

https://www.healthline.com/nutrition/6-anti-inflammatory-supplements#section1

https://www.healthline.com/nutrition/13-anti-inflammatory-foods#section4