The Nature of Inflammation and Health

Note: For a more thorough insight into the nature of inflammation and health please go to www.DrSears.com

All pain is caused by inflammation. The primary focus of medicine since the beginning of time has been the search for compounds that reduce pain. Yet your doctor may be at a complete loss to explain what inflammation is and how it triggers pain in the body.

The ancient Greeks described inflammation as an “internal fire.” By the first century A.D. ancient Roman physician Celsus elaborated on that definition when he stated that inflammation is “redness (rubor) and swelling (tumor) with heat (calor) and pain (dolor).” Two thousand years later, this ancient Roman description of inflammation hasn’t changed much. We still think of inflamed areas of injury as swollen, red, and warm to the touch. And, yes, also painful.

Inflammation, however, encompasses much more than meets the eye. It is our ultimate weapon to fend off alien invaders (such as bacteria, viruses, and parasites) that enter our body and cause infectious diseases. The moment one of these invaders slips into our bloodstream, inflammation coordinates an all-out attack that destroys the enemy and any tissue it may have infected. Inflammation is also the way the body responds to trauma and injury in order to repair itself. Once the healing process begins, inflammation immediately vanishes and the body resumes its normal functioning. Without inflammation, we would be sitting ducks for opportunistic organisms and injuries to our bodies that would never heal.

Sometimes, however, the inflammatory process doesn’t shut down when it’s supposed to. Inflammation becomes chronic rather than transitory, but now it maintains itself below our ability to perceive it as pain. Chronic silent inflammation is dangerous. This constant generation of silent inflammation may be due to a genetic predisposition or a lifestyle factor like obesity, poor diet, or smoking. Whatever the cause, an increased level of silent inflammation becomes a long-term war that decimates healthy blood vessels, tissues, and cells and sets the state for chronic illness.

Silent inflammation harms the body in a number of ways. Studies have found that it destabilizes cholesterol deposits on coronary arteries. It also attacks nerve cells in the brains and triggers rapid cell division.

The secret to maintaining wellness is controlling silent inflammation the best you can over a lifetime. Yes, your body needs to have a functional inflammatory system to survive, but it also needs to shut down this process once the invader is thwarted or the wound is healed. The foot soldiers of silent inflammation are hormones known as eicosanoids. These hormones work in a coordinated system with your immune cells to win any battle that may arise in the body. They also need to be decommissioned after the battle ends. If they don’t they become the mediators of silent inflammation.

So let’s look at your immunological army a little closer.

• Eicosanoids: These hormones ultimately control the entire inflammatory process. They allow specialized inflammation cells (neutrophils and macrophages) to mobilize and squeeze between the linings of blood vessels in order to get to the battlefield site. These special cells then destroy the invaders and gobble them up. Eicosanoids also cause the release of more inflammatory proteins, called cytokines, which signal for reinforcements. Soon an army of immune cells descends on the site, destroying the microbes and any damaged tissue. Other eicosanoids are the hormones of repair and rejuvenation. When these opposing eicosanoids are balanced, you are well. When they aren’t, you are moving toward chronic disease.
• Immune Cells: Your body’s guardian cells, called mast cells, are always on the lookout for any sign of trouble. At the first sign of a foreign invader, these mast cells release the chemical histamine, which signals to your immune system that it should launch an attack. Histamine circulates through your bloodstream and attaches onto certain cells, causing a cascade of reactions to occur starting with a burst of pro-inflammatory eicosanoids. Blood vessels dilate in response to these eicosanoids, allowing more soldier cells (neutrophils and macrophages) to reach their target as quickly as possible. This dilation of blood vessels is mediated by eicosanoids and causes the trademark signs of inflammation: swelling, heat and redness.

How do these immunological soldiers cause pain? Pro-inflammatory eicosanoids make it easier for immune cells to pass through blood vessel walls to reach the battlefield. The same eicosanoids also trigger an accumulation of excess fluid in the area of the battle. This causes blood vessels to swell even more, which touches off nerve endings, sending a message to your brain that you’re in pain. Just to make sure your brain gets the message, eicosanoids increase the sensitivity of the nerve fibers so they send out an even stronger pain signal. Your body wants your brain to know you have an immunological battle going on so you can stop what’s causing it and take your body out of harm’s way. For instance, if you put your finger into a flame, your body’s pain reaction tells you to take it out quickly. After the battle has been won, your body normally recalls the immune system army. It does this by sending out anti-inflammatory agents in the form of hormones cortisol and anti-inflammatory eicosanoids, which have the opposite effect of pro-inflammatory eicosanoids. These anti-inflammatory agents stop pain and begin to stimulate the healing process.

WHEN INFLAMMATION PERSISTS

Trouble starts when the inflammatory process persists and is transformed into chronic silent inflammation. There is a breakdown in communication so that pro-inflammatory eicosanoids continue to be generated, though at a lower level. These eicosanoids continue to fight an immunological war, but now it’s against you. Healthy tissues, cells, and blood vessels come under continuing attack.

If the intensity of the attack is high enough, you’ll continue to feel pain. This is the screaming pain that sends you running to the medicine cabinet for anti-inflammatory drugs like aspirin, ibuprofen (Advil, Motrin, Nuprin), or naproxen (Aleve). And yes, you might be able to effectively manage pain with one of these drugs or with new, more expensive prescription drugs, such as COX-2 inhibitors, or even more powerful drugs, such as corticosteroids. That’s because virtually all pain medications stop the overproduction of pro-inflammatory eicosanoids.

Unfortunately, like dumb bombs, these same drugs also stop the production of anti-inflammatory eicosanoids, which your body needs not only to repair the damage on the battlefield, but also to maintain a state of wellness. Long-term use of these medications can cause a host of side effects, from stomach ulcers to a digestive lining malfunction called leaky gut syndrome to heart failure or even death.

At least with screaming pain you’re doing something that is proactive. With silent inflammation you do nothing, and that’s where the true danger begins. Silent inflammation doesn’t trigger the kind of intense inflammation that touches off nerve endings sending pain signals to the brain. You do, though, have enough inflammation to make your body susceptible to long-term damage. It can gradually wear away your blood vessels, immune system, and brain, causing serious health conditions.

Though driven by the same inflammatory eicosanoids as screaming pain, silent inflammation remains hidden for years. You can’t feel it, so you do nothing to stop it. And that’s why it’s so destructive to your health. This gives rise to a terrible trade-off. Do you use anti-inflammatory drugs on a regular basis to keep silent inflammation under control? This would decrease the likelihood of chronic illness like heart disease, but also elevate your risk of gastrointestinal side effects and possibly death. Or is there another alternative? Reaching the Anti-Inflammation Zone is that alternative.

The latest research shows that silent inflammation damages your body in a number of ways. What’s fascinating is how far the ill effects of silent inflammation seem to extend. Like a poison, it seeps into all the body’s systems, wreaking havoc with cell division, the immune system, and major organs like the heart and brain. As a result, much of the conventional wisdom doctors have held about disease is now being challenged.

THE CAUSE AND THE CURE FOR SILENT INFLAMMATION

Inflammation is a complex cellular process that protects the body from a hostile world, both external and internal. Microbial invaders, viruses, bacteria even the foods we eat can trigger an inflammatory response. We usually associate inflammation with pain, redness and swelling--- something that can be detected that the body first attacks to prevent continued cellular destruction, turns off the response and then repairs as part of the healing process.

But what if the body’s natural inflammatory assault is not turned off completely and low level inflammation that you cannot see or feel continues a relentless attack undetected? This is Silent Inflammation. Excess weight gain, the inability to shed unwanted pounds, pre-mature aging and the increased risk of chronic disorders that affect heart, brain and immune function are caused by Silent Inflammation.

Silent Inflammation is regulated by three inter-related hormonal systems:

Eicosanoids

Insulin

Cortisol

Each of these hormonal systems contributes to the systemic spread of Silent Inflammation. Fortunately, each can be controlled when you follow the diet and lifestyle recommendations that are part of the Zone Wellness Pyramid.

EICOSANOIDS

Eicosanoids were the first hormones developed by living organisms and are produced by every cell in your body. Although they might be considered primitive hormones, they control everything from your immune system to your brain to your heart. There are two kindsof eicosanoids, those that promote inflammation (pro-inflammatory) and tissue destruction and those that stop inflammation (anti-inflammatory) and promote healing. You require a balance of both pro-inflammatory and anti-inflammatory eicosanoids to maintain wellness. Unfortunately, most of us produce too many pro-inflammatory eicosanoids, which leads to increasing levels of silent inflammation and eventually chronic disease. The Zone Diet was developed primarily to put these hormones back in proper balance.

Eicosanoids form the command center of your immune system. Knock them out completely, and the immune system goes with them. Eicosanoids can also initiate a military coup on the immune system. Like rogue soldiers, if the pro-inflammatory eicosanoids aren’t called back to the barracks, inflammation runs amok and your immune system starts attacking your body. Autoimmune illnesses can occur when there’s too much “friendly fire” from the immune system.

You can tip the balance back toward producing anti-inflammatory eicosanoids in a number of ways. First and foremost, you have to modify what you eat. Anti-inflammatory eicosanoids—which we refer to as the “good” ones—come from eating a diet rich in long-chain omega-3 fatty acids (found in fish oil) while reducing the intake of omega-6 fatty acids (found in vegetable oils like corn, soybean, sunflower, and safflower). This is because long-chain omega-3 fatty acids reduce pro-inflammatory eicosanoids, whereas omega-6 fatty acids increase the production of pro-inflammatory eicosanoids.

Until about eighty years ago, our population ate a 2:1 ratio of omega-6 to omega-3 fats. We ate a lot more fish back then, and many of our grandparents took a daily dose of omega-3-rich cod liver oil. Furthermore, the consumption of refined vegetable oils was a very small part of our diet. Now all of that has changed. We’re eating a lot more omega-6 fats and far fewer long-chain omega-3 fats, with the ratio of these two groups of fatty acids now closer to 20:1. With such a dramatic increase in omega-6 fatty acids in our diet, the levels of silent inflammation in our society have correspondingly increased. Heart disease, diabetes, and cancer are all on the rise because they are initiated by silent inflammation, which comes from the chronic overproduction of pro-inflammatory eicosanoids.

How can the type of fat you eat cause silent inflammation? It turns out that certain pro-inflammatory eicosanoids are derived from arachidonic acid (AA), a long-chain omega-6 fatty acid. Prostaglandins and leukotrines are the usual suspects when you have screaming pain, and they are also the cause of silent inflammation. This is why every anti-inflammatory drug works to stop the overproduction of these particular eicosanoids.

To call off these storm troopers in your inflammatory army derived from AA, you need to increase the “good” anti-inflammatory eicosanoids. These are derived from long-chain omega-3 fatty acids, such as eicosapentaenoic acid (EPA). Ultimately, the balance of AA to EPA in your blood determines the levels of silent inflammation in your body. The ratio of these two fatty acids (AA/EPA) measures your current state of wellness and the potential for future heath risks.

INSULIN

Simply consuming a lot more fish oil and a lot less vegetable oil will help reverse silent inflammation. Changing your dietary habits by following the Zone Diet can also have an immediate impact, because that will reduce the levels of the hormone insulin, which indirectly affects silent inflammation. This is because increased insulin levels increase the production of AA, the building block for all pro-inflammatory eicosanoids. By simply following the Zone Diet you can see a difference in your insulin levels within seven days. In fact, studies at Harvard Medical School have shown that even one meal can reduce insulin levels and begin to drive you back to a state of wellness. You’ll notice it right away in terms of your energy level and overall well-being. Of course, the opposite is also true: one meal that increases insulin levels can begin to drive you out of the Anti-Inflammation Zone.

You may hear a lot about insulin today, but still may not know exactly why it is important. To start with, insulin is the storage hormone that drives nutrients into cells. It is vital for your survival, since it allows cells to either store nutrients or immediately use them for energy. Without adequate levels of insulin, your cells would literally starve to death. This is exactly what happens in type 1 (childhood-onset) diabetes, in which a person is producing no insulin. (In fact, only a small percentage of diabetics have this type of diabetes.) But most of us are much more likely to have the opposite problem: we make way too much insulin. This is bad news, since it is excess insulin that makes you fat and keeps you fat. And it is also excess insulin that increases silent inflammation levels.

As you age, your cells become less responsive to insulin, and your pancreas needs to continually churn out more and more insulin to get the message through to the cells in the liver and the muscles that incoming dietary nutrients (primarily sugar and amino acids) need to be taken up by the cells. This is called insulin resistance.

In general, the more excess body fat you have, the more insulin resistance you have, and the more insulin your body needs to produce in order to overcome this resistance. This means an increase in the levels of silent inflammation and a much higher risk for the development of chronic disease.

Excess insulin’s link to silent inflammation stems from the fact that it increases the production of AA. And if that isn’t bad enough, recent research shows that insulin induces inflammation by increasing the production of Interleukin-6 (IL-6), a pro-inflammatory cytokine that causes the formation of CRP, another marker for silent inflammation. The bottom line: controlling insulin is essential if you want to reverse silent inflammation and move toward a state of wellness.

A quick and easy way to tell if you’re making too much insulin is to stand naked in front of your and ask yourself two questions. First, are you overweight? Second, is much of the excess fat located around your abdomen (i.e., are you apple-shaped)? If the answer to both questions is yes, then it’s a pretty good bet that you have insulin resistance. Insulin resistance is a precursor to type 2 diabetes. In type 2 diabetes, the pancreas eventually begins to fail since it can no longer continue to pump out the megadoses of insulin (hyperinsulinemia) needed to push glucose into the cells. Without this excessive output of insulin to keep blood glucose levels under control, they now rise to dangerous levels. The Zone Diet was developed specifically to reduce excess insulin production, and as a result the Zone Diet also reduces silent inflammation.

Eicosanoids and insulin are intricately linked. They both trigger silent inflammation if they’re out of balance. They both reduce silent inflammation when they’re brought back into balance. Neither operates in a vacuum, since they are interrelated. The bad news is most of us have both systems out of balance at the same time, and it only gets worse as we age. The good news is the Zone Diet can normalize both systems, which is why it’s the ultimate antidote to silent inflammation.