Inflammation: Friend or Foe?
For a long time, inflammation was only something that we thought about when we stubbed our toe or injured ourselves in some way. Now we know that this process in the body can be systemic and much deadlier than we could’ve ever imagined. Inflammation has become one of the new “big” issues in medicine over the last decade, with every disease being attributed to it and multitudes of different “anti-inflammatory” treatments popping up. While some of the inflammation hype may be overblown, there definitely is evidence that we live in a “pro-inflammatory” world and our health and performance are suffering because of it. We’ll dive into this issue and look at inflammation as our “foe”, and what we can do about it. You may be thinking, “But there are already hundreds of articles out there talking about the horrible nature of inflammation, so why write another?”
The answer is that, like with most things in life, inflammation isn’t a black and white issue, and to only proclaim it as this great killer and evil enemy is wrong. Inflammation ain’t all bad, and we also need to appreciate the good that it does for us and how it can be useful. The importance of inflammation and its ability to help people is starting to be understood, especially in the treatment of musculoskeletal issues. The path to healing for many people is through the controlled creation of inflammation. So, in addition to looking at the negative aspects of inflammation, we are going to be inflammation’s champion and explain how it can be used to optimize health and increase performance.
What is Inflammation?
How then can inflammation be simultaneously killing us, and be the answer to many of our musculoskeletal problems? The answer, like everything else in the world of health, lies in balance. When it comes down to it, inflammation is simply a process in the body. When this process is working correctly, and in a balanced state, it is positive to us and assists us in health. When inflammation gets out of balance, it can lead to a wide range of dis-eased states and ultimately, poor health and decreased quality of life.
The basic idea of inflammation is that when the body senses some sort of injury, irritant, pathogen, or other negative stimulus (all resulting in damaged tissue), it sends large amounts of blood (carrying various immune cells and clotting agents) to the area. The blood leaks out from the blood vessels out into the area of the damaged tissue. The body seals off the area to contain the pathogen/irritant and/or to prevent additional blood loss from injury. The clean-up crew cells then go to work. They secrete enzymes to break down the damaged tissue while other Pac-Man style cells eat up the resulting bits of biology. Other cells go to the area and release chemical “flairs” that tell the rest of the cells to come and help out. This process is repeated via a positive feedback loop until all of the damaged tissue is broken down and “phagocytized” (eaten up).
Assuming that there isn’t more trauma/stress/damage to the area, the cleanup crew picks up and leaves the area, removing the waste products (via a separate pathway- the lymphatics) and making way for the rebuilding process to begin. This inflammatory process usually takes between 48-72 hours in a healthy individual, but the overall healing process can take weeks, months, or even years depending on the severity of the damage and the body’s ability to rebuild.
Now this is a very simplified version of the inflammatory process, but it should give you a good idea of what’s going on. If you want a more in depth look at the physiology of inflammation, the link below takes you to a good presentation from John Hopkins University.
Chronic Inflammation: Killing Us from the Inside Out
As you may have gathered, the inflammatory response is designed to be very efficient- Get in, contain the area, break down the damaged tissue, remove the debris, and make way for the builders to come in and reconstruct the tissue. Within an unbalanced system, however, this process can be perpetuated at a low level indefinitely. This is where we see the issues. Chronic inflammation tends to destroy healthy tissues, leading to disease in the body. Researchers now believe that cancer, cardiovascular disease, Alzheimer’s disease, respiratory diseases, autoimmune diseases, bowel diseases, arthritis, depression, diabetes, and various neurological diseases all are either caused by chronic inflammation, or have chronic inflammation as a major side effect (and in many cases, both).
Besides playing a role in major disease processes, chronic low-level inflammation is also thought to be a major contributor to chronic symptoms such as allergies, food sensitivities, digestive issues, skin/hair issues, fatigue, and mental fogginess. Many people experience one or more of these symptoms on a daily basis. Out of control inflammation is a major problem in the body. So what exactly causes inflammation to be an ongoing process and not that speedy 48-72 hour process that it’s supposed to be?
There are two main issues that lead to chronic inflammation. If we think of inflammation as a fire (the name is from the Latin, īnflammō, meaning “I ignite, set alight”), there is the spark and the fuel. Both need to be present in order for the fire to continue. Just as with fire, the continual presence of the fire itself perpetuates the fire, so long as there’s an adequate fuel supply. The spark sets off the inflammatory response, and the fuel keeps it from ending, as it would in a normal response.
Let’s start by exploring some of the “sparks” for inflammation. Gross physical traumas, burns (including sunburns), frostbite, and infections are some of the obvious ones. There are also dietary sparks which tend to be more individualized depending on your own biochemistry and immune system, meaning that you may have one or more of them, or none at all. Some common dietary sparks include dairy (lactose), casein, wheat, alcohol, nuts, egg, soy, fish, and shellfish. There are also environmental sparks that many of us are barraged with on a daily basis. Some of them are caused by humans such as pesticides, heavy metals, air pollution, plastics, synthetic fibers, latex, and chemical adhesives. Others are part of the natural environment and can be found in, among other things, pollen, grasses, insects, & leaves.
Once the spark is lit, the body should then be able to mount a quick and effective response to neutralize the threat and then return us to a balanced and healthy baseline. But when there’s continual fuel that’s added to the fire, the inflammation persists. These fuels can be dietary. Increased sugar intake creates a surge in insulin which sensitizes the immune system and increases the production of pro-inflammatory mediators such as arachadonic acid. This chemical cog in the inflammatory wheel is also produced in higher quantities when we consume large amounts of omega-6 fatty acids and not enough omega-3 fatty acids. There are a number of other proposed dietary “fuels”, but just eating the wrong types of fat and too much sugar are enough to continually keep the fire burning.
Fuels can also come from stress- both short-term and long-term. Stress increases our circulating levels of the hormone cortisol, which actually is an anti-inflammatory. Sounds good then right? The problem is that cortisol suppresses the immune system, and high levels of it can leave us vulnerable to infections and disease. Also, chronically high levels of cortisol desensitize the body to its own effects, reducing its own ability to suppress inflammation. So even though cortisol’s job in the body is to regulate and suppress inflammation, chronic stress, and the accompanying high cortisol levels, actually over time causes the body to have more inflammation.
Another major fuel for inflammation is a lack of regular movement. Exercise regulates, and can normalize, the body’s hormones including cortisol. Exercise also stimulates the release of numerous anti-inflammatory molecules. Exercise physically modulates inflammation by pumping the lymphatics and increasing circulation. Exercise opens up the airways and stimulates the bowels, causing both systems to work more efficiently to remove irritants and reduce stagnation. None of this takes place when we sit all day and don’t exercise.
The quantity of movement is important, but the manner of movement can be equally important. Biomechanical issues can be both sparks and fuel for the inflammation fire. If the body lacks mobility or stability, it will invariably put stresses on the body that, over time, can cause tissue damage. Dysfunctional movement patterns or poor posture also put stress on the framework of the body and can lead to inflammation. Unless these issues are corrected, they will continue providing the stimulus (fuel) for inflammation. The result is often times chronic pain and degenerative changes, as well as a predisposition to injury.
The final fuel that we’ll address is a lack of good sleep. When we spend an adequate amount of time in the deeper, more restorative, stages of sleep (3 & 4), our immune system has a chance to rest and reset itself. When we don’t sleep enough, or deeply enough, we see a rise in pro-inflammatory cytokines. Getting good sleep is one of the most important tenants of good overall health, so it should be no surprise that it plays such a huge role in immune function and inflammation.
We’ve separated the components of chronic inflammation into the causes and the perpetuators, but in reality, it’s very hard to tease them apart. And on top of it, they all seem to work with a negative synergistic effect. If we have an inflammation response from air pollution, or being exposed to high levels of chemicals, it can then sensitize our bodies and cause us to have a hyper-reaction after ingesting gluten or breathing in pollen. Our chronic gut inflammation makes us unable to digest good fats that are needed to modulate inflammation. The examples and combinations are endless. Our bodies are constantly under attack from every angle, and we don’t have the ability/resources to fend them off.
Increasingly, we see people who are allergic to, or have sensitivities to, just about everything under the sun. As far as we know, more children have asthma and allergies (yes, part of that is because we have gotten better at diagnosing it) than at any other time in human history. In extreme (but also increasingly common) cases, people actually become sensitized/allergic to their own tissues, resulting in a myriad of autoimmune diseases. The bottom line is that we live in a pro-inflammatory world, and on top of it, we are not doing a great job of combating it with healthy behaviors/cultures.
A Simple Approach to Treating Chronic Inflammation
So what then is the solution? Well, in a nutshell, it’s to live as healthy of a lifestyle as possible and reduce your exposure to the “sparks”. There are countless numbers of articles, books, and podcasts out there on how to achieve this so for me to try to squeeze it all into a few paragraphs would be ridiculous. But why not give it a try…
Let’s begin by addressing diet because that seems to be the one people love to look at the most. Remember that diet is only one part of the puzzle so thinking that it’s the only factor that needs to be addressed in order to reduce chronic inflammation (or to be healthy) is ridiculous. That being said, diet is one of the big pieces of the puzzle, and certainly a necessary one to address. Here are some of the consensus ideas on using it reduce inflammation. Eat less refined grains and sugars. Eat more “good fats” (omega-3 containing) and less of the “bad fats” (omega-6 containing). I put them in quotes because neither is good or bad, it’s all about the ratio between them. Eat lots of vegetables. Eat a wide variety of foods. Put more spices on your foods as many spices have anti-inflammatory properties. Reduce alcohol intake. Increase water intake. Regularly supplementing with fish oils, vitamin D3, and a good multivitamin can also help to keep inflammation at bay.
Next, living an anti-inflammatory lifestyle needs to be addressed. I doubt you smoke, but if you do, stop. Limit your exposure as much as possible to those man-made environmental triggers that were discussed earlier- pollution, heavy metals, synthetic fibers, latex, pesticides, and plastics. Get out of the office and into nature. Spend time exploring parks and getting fresh air. Have proper sleep hygiene and make getting the correct amount and quality of sleep a daily priority. There’s a lot of good information online recently on “sleep hacks” which can be beneficial. Exercise daily and vary the types of exercise you engage in. Find a way to not sit all day and to move as much as possible. Adopt correct postures, movement patterns, and learn how to breathe correctly. Deep, diaphragmatic breathing has been shown to regulate hormones and the stress response. Finally, and maybe most important of all, reduce stress in your life. Everyone has different ways that work for them, but some awesome (and constructive) stress reducers are mindfulness meditation and yoga. A daily mindfulness practice of some sort can decrease stress drastically, and has also been shown to increase and preserve grey matter in the brain.
Again, the goal of this article isn’t to address every possible way to reduce chronic inflammation, but instead to give some basic things that need to be addressed. As you may have noticed, most of these practices are not only about reducing inflammation, but really about increasing overall health in the body. By doing all of these things, the vast majority of people notice a decrease in inflammation-related disease and symptoms. And if you do all of these things and still notice that you’re suffering from chronic inflammation, the next step may be to find a good naturopath or functional medicine doctor who can look at your specific case and help you to find the missing link.
Inflammation as an Ally
We just finished thoroughly bashing inflammation and painting it as our mortal enemy. Now the job is to try to salvage its image and talk about the benefits of inflammation for health and recovery. As we said earlier, the process of inflammation is designed to be efficient and short-lived. It’s the first step in limiting damage to tissues and beginning the healing process. In many cases, inflammation needs to be present in order for tissues to remodel and grow.
We see this in the strength and conditioning world. During intense physical training of pretty much any type, micro tears are formed in the muscle and the only way to heal them and grow the body is through inflammation. Bodybuilders know this well and look to get a “pump” in at every training session. What the pump actually is, is simply an acute inflammatory response. Blood rushes into the tissues in order to not only provide nutrients and oxygen to the working tissues, but it also is beginning the healing process. Anyone who’s seen Pumping Iron knows how Arnold Schwarzenegger feels about the pump, and most other athletes share the same sentiment.
From a sports medicine approach, we now understand that one of the best ways to heal tissues, and normalize dysfunctional tissue, is through the creation of controlled localized inflammation. Soft-tissue instrument assisted practices, which are based on traditional Chinese medicine’s “gua sha”, aim to break down fascial adhesions. In doing so, an inflammatory response is created. Once the broken down tissue is removed by the cleanup crew, cells called fibroblasts, come in and begin laying down new connective tissue that is stronger and aligned in the correct patterns. Additionally, a substance called hyaluronic acid is secreted. This substance acts as a lubricant between layers of tissue and allows muscles, fascia, and skin to move efficiently and without pain.
This is the same idea that we see with Myofascial Release and Active Release techniques. Also the same idea behind some forms of acupuncture in which a needle is used to get into the deep layers of tissue in order to disrupt them and prompt an inflammatory/healing response. Shockwave therapy is an exciting new tool that utilizes high-frequency sound waves to do the same thing.
Medical doctors are also exploring this idea with Platelet-Rich Plasma (PRP) Therapy. The doctor will take blood from the patient, separate out the plasma component from the red blood cells, and inject it back into the patient at a sight of pain/injury. The goal is to stimulate an inflammatory response and create healing of the tissue. Multiple surgery techniques are designed to go into the damaged tissue and create micro trauma in order to induce inflammation and healing.
We also see this in mobility practices. The purpose of foam rolling, or using a lacrosse ball, is to break down abnormal tissues (particularly fascia), creating inflammation which induces remodeling of fascia and hyaluronic acid secretion. This has become an important part of most athletes’ daily lives and an incredibly beneficial tool for staying injury free and maximizing performance.
Bringing inflammation to an area is imperative for healing. Inflammation also serves to sensitize our nervous system, creating pain in the area. Now this may not sound great at first, but pain is incredibly important as it alerts us to injury within the body and tells us to stop doing the aggravating activity, thus limiting further damage.
I hope that the case has been made for inflammation not being such as bad thing. Or at least, now we can see that inflammation is just as much our friend as it is our foe. And if we can maintain balance and health within the body, inflammation will spend more time helping us than hurting us.
In our next article we’re going to explore the idea of helping acute inflammation to be an efficient, health-promoting, process. We are also going to be looking at the merits of icing (or lack thereof) and what else can be done to prevent chronic inflammation and swelling following injury. As always, if you have any questions or comments about this article, don’t hesitate to hit the “contact” link on the top of the page and send us a message!
Join Higher Performance Network!
Receive the latest news & exclusive content from HPN!