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Chronic Inflammation and Nutrition

Asthma, lupus, irritable bowel syndrome, Crohn’s disease, glomerulonephritis, allergies as well as other chronic conditions are all characterized by inflammation. Inflammation is a normal bodily response to protect us from trauma, toxins, heat, or infection from foreign organisms such as bacteria and viruses. The damaged cells release various chemicals including bradykinin (causes blood vessel dilation), histamine (causes contraction of smooth muscle and dilation of capillaries), and prostaglandins (causes inflammation, pain, and fever as part of the healing process).

The swelling caused by the dilation of blood vessels and capillaries is part of the immune system’s ability to sequester the foreign matter, thereby isolating it from further contact with other tissues. The chemicals released during an inflammatory response, signal and attract phagocytes (white blood cells) to the damaged cell site to start the healing process.

Acute inflammation is short-term and beneficial to the body as part of a normal healing process; however, chronic inflammation can be destructive to the body. Chronic inflammation occurs due to a malfunction of the immune system not turning “off” when it should. Chronic inflammation destroys healthy tissues and can play a role in the development of various diseases.

Chronic inflammation can occur anywhere in the body and is very damaging because it acts like a slow-burning fire that continues to stimulate pro-inflammatory immune cells.² Excess immune cells and their signaling molecules circulating in the body can damage blood vessel linings (in atherosclerosis), pancreatic tissue (diabetes), and joint tissue (in arthritis).² Chronic inflammation also occurs in autoimmune diseases such as lupus, asthma, inflammatory bowel disease and allergies.

Over time, chronic inflammation can cause changes in DNA and can lead to cancer. For example, people with chronic inflammatory bowel diseases, such as Crohn’s disease, have an increased risk of colon cancer. People who are overweight and/or obese also experience chronic inflammation which lends itself to weight gain, due to the water retention.

Inflammation can cause people to feel pain, stiffness, distress, discomfort and even agony depending on the severity. Inflammation primarily causes pain because the swelling pushes against nerve endings which sends pain signals to the brain. Living with chronic inflammation and pain can be debilitating and can lead to depression.

There are many treatment modalities for chronic inflammation.

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Non-steroidal anti-inflammatory drugs (NSAIDS

Non-steroidal anti-inflammatory drugs (NSAIDS) (i.e. Naproxen, Ibuprofen, Aspirin, etc.) counteract an enzyme that contributes to inflammation.

Corticosteroids

There are two types of corticosteroids used to treat inflammation. Glucocorticoids (i.e. cortisone, prednisone, triamcinolone, budesonide, etc.) are used to treat conditions such as systemic lupus, arthritis, dermatitis, allergic reactions, Inflammatory bowel disease (IBS). Glucocorticoids are offered in both oral and topical forms. Mineralcorticoids are used to treat salt imbalances in the body which contribute to inflammation.

Disease Modifying Antirheumatic Drugs (DMARDs)

DMARDs are a class of drugs that inhibit T cells and B cells and suppress the body’s immune and inflammatory responses. Common drugs in this category include methotrexate, sulfasalazine, and azathioprine.

Biologic Drugs

Biologic drugs such as Enbrel®, Stelara® and Humira® all work by targeting chemicals and cytokines such as necrotic tumor factor (TNF), interleukin 1 (IL-1) and interleukin 6 (IL-6) which all cause inflammation.

Many of these pharmacotherapy agents work very well in controlling inflammation, however many people experience side effects and these treatments can be expensive. Most common side effects include nausea, headache, dizziness, diarrhea, extreme weakness or fatigue and dry mouth. However, some medications can create severe side effects such as hepatic problems, blood disorders and even fetal harm in pregnant women.

Nutrition Therapy

The one treatment modality that has little to no side effects is…………….. diet. The typical American diet is very rich in pro-inflammatory fried foods and processed foods. The unhealthy food that people are eating affects the body in many ways and chronic inflammation is just one of them. We commonly hear about hypercholesterolemia, hypertension and atherosclerosis being associated with dietary intake, however just in recent years has diet been linked to chronic inflammation. Increasingly more research pertaining to chronic inflammation is proving that the body reacts to the types of foods we eat, whether healthy or unhealthy.

Foods that are pro-inflammatory include fried foods, red meat, processed meats (i.e. sausage, bacon, deli meats), snack foods, sugar sweetened beverages (i.e. soda, energy drinks, juices), baked goods, vegetable oil laden products, and refined carbohydrate foods. Omega-6 fatty acids are pro-inflammatory and are found in all kinds of foods that are fried. These products as well as highly processed foods contain high levels of AGEs (advanced glycation end products). AGEs are compounds produced in the body through an array of chemical reactions. These reactions happen when blood sugar levels are elevated. The danger of AGEs is that they can clog the microvascular system of eyes, heart, kidneys, and brain thus contributing to higher risks of complications of disease states like diabetes mellitus and heart disease.

Foods high in saturated fat are also pro-inflammatory. Although a moderate intake of yogurt with active cultures can be beneficial to the GI tract, dairy foods high in saturated fat can decrease levels of good gut bacteria which are crucial participants of the immune system in reducing inflammation. Saturated fats have also been found to inflame white adipose tissue; this type of tissue stores energy while brown adipose tissue is catabolic and burns energy. In addition to ingesting many saturated fat foods, if fat cells increase in size, through the intake of excessive calories of processed foods, they release pro-inflammatory mediators that provoke a systemic inflammation response as well. Therefore, staying at a healthy body weight or losing weight if overweight or obese also helps in managing chronic inflammation.

Although there is no set “Anti-Inflammatory Diet,” combatting chronic inflammation with nutrition is as easy as getting back to the basics. Consuming more fresh fruits and vegetables, choosing whole grains, nuts, omega-3 rich fish and healthy oils such as olive oil. Anti-inflammatory foods contain phytochemicals. Phytochemicals carry out healthy biochemical and biological activity at the cellular level which is beneficial for the body. The processing of foods can damage and destroy phytochemicals, therefore whole foods are advocated to ensure the best nutritional benefit is being consumed.

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Sources:

1. â•œFoods That Fight Inflammationâ•š Harvard Health Publishing, August 13, 2017.
2. â•œWhat Is Chronic Inflammation?â•š Dr. Amber Hayden DO, 2017.
3. Want X, et. al â•œInflammation Markers and Risk of Type 2 Diabetesâ•š Diabetes Care Vol. 36, January 2013.
4. Minihane A. et. al. â•œLow-Grade Inflammation, Diet Composition and Health: Current Research Evidence and Its Translation. British Journal of Nutrition 114 (999-1012) 2015.
5. Calder P. â•œLong Chain Fatty Acids and Gene Expression in Inflammation and Immunityâ•š  Current Opinion in Clinical Nutrition & Metabolic Care  16 (425-433) 2013.
6. â•œImmune Responseâ•š  Medline Plus www.medlineplus.gov/ency/article/000821.htm
7. Nordqvst C. â•œEverything You Need to Know About Inflammationâ•š  Medical News Today Nov. 24, 2017.
8. Rowe B. Davis L., â•œAnti-Inflammatory Foods For Health: Hundreds of Ways to Incorporate Omega-3 Rich Foods Into Your Diet to Fight Arthritis, Cancer, Heart Disease and More. 2008.
9. International Journal on Inflammation   https://www.hindawi.com/journals/iji/
10. The Journal of Inflammation  www.ncbi.nlm.nih.gov/pmc/articles/PMC1074343/

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