Inflammation sends the body off balance, which is something that all of us should be concerned about. And as scientists investigate the cause of dangerous and deadly diseases, there is one common factor in almost all of them – chronic inflammation.
To understand inflammation, it is important to know that inflammation is a natural response to injury or infection. Inflammation is the body’s way of protecting itself from infection and other threats. It is both a healthy and necessary function in the body.
However, if inflammation persists for a long time, it can cause havoc and contribute to chronic disease. It can target and attack healthy cells and organs, essentially turning the body against itself. Inflammation-related disorders (heart disease, metabolic disease, cancer, Alzheimer’s disease, autoimmune disease, and neurological disease) account for more than half of all fatalities worldwide.
In short, it’s the body’s defence system.
The immune system is activated when the body is injured or comes into contact with a virus, bacteria, or toxic substance. The role of inflammation is to fight against things that pose a threat and cause harm, to eradicate the source of the threat, remove damaged tissues, and to begin the healing process.
The immune system sends out an army of chemicals, called pro-inflammatory cytokines, to attack and trap the bacteria, clean up the area, promote healing, and then assist in returning levels to normal. They get the job done and are ready to act again when the next threat is detected. This is a normal healthy response, but if inflammation persists and the body continues to send out inflammatory cells even though there is no longer a threat, the immune system remains activated, and inflammatory cells continue to be released and circulated, resulting in chronic inflammation.
With the body in a constant state of high alert, this can lead to long term damage to cells, tissues, and organs and is more evident in obese, sedentary, and older people, often caused by weak immune systems, chronic infections, poor diet, and sedentary behaviour.
Acute inflammation occurs when the immune system responds to sudden damage, such as a cut. The immune system is activated and inflammatory cells are directed to the damage to begin the healing process. The cells release chemicals that cause blood vessels to dilate, allowing more blood to flow into the area, bringing more nutrients and repairing cells with it. The increased blood flow creates noticeable symptoms – redness and warmth, as well as swelling from the extra cells and fluid.
Chronic inflammation occurs when the immune system sends inflammatory cells when they are not needed. Unlike acute inflammation, chronic inflammation can cause some more subtle symptoms which can last months – years.
- Joint pain or stiffness (e.g., rheumatoid arthritis)
- Muscular pain
- Abdominal pain
- Chest pain
- Persistent infections
- Tiredness
- Depression
- Fever
- Weight gain / weight loss
- Skin rash (e.g. psoriasis)
- Constipation or diarrhoea
What causes chronic inflammation?
- Untreated acute inflammation from an infection or injury
- Exposure to toxins (industrial chemicals, pollution)
- An autoimmune disorder where your body attacks healthy tissue (e.g., lupus)
Lifestyle factors
There are so many controllable lifestyle factors that contribute to inflammation. Research suggests that if you fall into one of the categories below, then you are more at risk of developing long-term chronic inflammation.
Being overweight increases inflammation. Overeating changes how the body recognises and defends itself against bacteria and viruses. The immune system believes it needs to respond and sends out inflammatory cells.
Additional immune cells enter the fat cells, muscles, liver, and pancreas, which activates the immune system further. This increased immune response causes the body to generate excessive inflammation.
Unlike the acute inflammatory response, which fights off infection/injury and then returns the body to normal, the inflammatory response caused by obesity does not resolve itself and so chronic inflammation kicks in. Inflammation increases as weight is gained. The more inflammation, the greater the risk to health.
Inflammation essentially knocks the body out of balance, including our hormones.
The hormone leptin is produced by fat cells, so it stands to reason that the more fat cells present, the more leptin will be produced. However, with obesity, leptin does not perform as it should, it does not send out the signal of feeling full after a meal, which then leads to overeating and then more weight gain.
Insulin signals become lost with obesity, and glucose levels are no longer controlled, leading to diabetes.
Body fat distribution plays an important role in the development of obesity related health conditions. Fat stored around the tummy (visceral fat) is far more dangerous than fat stored around the hips and thighs. Sex hormones, oestrogens (made in the ovaries) and androgens (produced in the testes), help to determine the distribution of body fat and provide some protection against disease. Women of childbearing age are more likely to store fat in the lower body (pear shape).
As we age, women’s ovaries and men’s testicles do not produce as much oestrogen. This is why we see a shift in fat distribution towards the tummy. The fat cells take over production (albeit at a much lower rate). The more fat cells present, the more oestrogen is produced, which can aid in the development of hormone-receptive positive cancers.
Hormones do an awful lot for us in the background, so it pays to keep them on side!
Fight or flight – we’ve all heard of it, but how does it cause inflammation?
The body releases the stress hormone cortisol. Cortisol basically shuts down the “nonessential in an emergency” functions like digestion and immune response (you don’t need to digest food or fight a cold if you’re in a fight or flee situation, right?!) Cortisol boosts the production of blood sugar to boost energy and sends it to the larger muscles. The arteries are narrowed, which makes the blood pump harder. Adrenaline (another hormone) is released, which increases the heart and breathing rate, pushing more oxygen to the muscles. This would all be super helpful if you needed to be ready to fight or flee, and it is meant to be temporary. After that, your normal bodily functions return to normal.
But if you are in a chronic state of stress, then the immune system does not function as it should (it’s too busy getting ready to fight), it continues to send out pro-inflammatory cytokines, and inflammation is increased.
Inadequate sleep, both in terms of quality and quantity, can stress your system and increase inflammation.
Sleep, the immune system, and inflammation are all regulated by circadian rhythms. I spoke about this in Why Sleep is Essential for Good Health. In a nutshell, the circadian rhythm controls hormones and bodily processes that allow humans to cycle through sleep and wakefulness over a 24-hour day. Circadian rhythms also regulate our immune system as well as our levels of inflammation, so when the circadian rhythm is disrupted, so is normal immune function. This increases the likelihood of chronic inflammation.
Do not be fooled into believing that it takes severe sleep deprivation to raise inflammation. Studies have shown that even one night of poor sleep can raise levels. And partial sleep deprivation (basically insufficient sleep, which so many of us encounter night after night) also elevates levels.
Flip it the other way and get too much sleep. This will also lead to inflammation. Most adults need between 7 – 9 hours.
A small amount of alcohol can reduce inflammation. However, excessive alcohol intake can not only cause inflammation, but it can also impair your body’s ability to regulate inflammation. Over the long term, this inflammation causes organ dysfunction throughout the body, especially in the liver, intestines, and brain.
Alcohol disrupts the balance between good and bad bacteria in the gut, as well as promotes the overgrowth of bacteria, which further disrupts gut health. This activates immune cells, which promote inflammation.
The intestinal walls act as a barrier to the good and bad. It allows the good stuff to be absorbed and blocks the bad stuff from being absorbed. Too much alcohol and this barrier is no longer able to do its job, meaning bacteria and toxins are now able to leave the gut, enter the bloodstream, and travel around the body.
Alcohol inhibits the body’s immune system and the support that the organs lend it.
Sedentary behaviour has been linked to low-grade inflammation. You can train 2, 3, 4 or 5 times a week and still lead a sedentary life. Exercising for 30 minutes several times a week will not undo the effects of sitting at your desk for 8 hours per day and then sitting in the evening with your family. As a result, despite your gym sessions and being at a healthy weight, low-grade inflammation may be present.
Sitting is thought to slow the metabolism. This affects the body’s ability to regulate blood sugar, blood pressure, and break down body fat, which in turn leads to a number of health conditions, which bring with them,… You guessed it: inflammation.
Movement has anti-inflammatory effects. Think about it: when you move, your heart rate is elevated. If your heart is beating at a higher rate, with every beat your heart sends more blood cells (carrying oxygen and nutrients around the body). When we are moving the body releases yet more hormones into the blood stream which activates receptors of the immune cells which help to control inflammation.
I almost didn’t want to cover smoking in this article because smoking is bad. End of. Nothing good ever came of smoking, but we all know that, yet there are still plenty of smokers out there. And yep, I’m one of those ex-smokers who may at times be a little preachy about the subject (not sorry!)
Nicotine activates certain white blood cells, which release molecules that lead to an increase in inflammation.
Smoking impairs the immune system, which means more risk of infection. Smoking has also been known to make pain worse (more research needed here). Smoking impairs the delivery of oxygen and nutrients around your body, causing more pain, degeneration, and ill health.
Smoking is linked to the development of rheumatoid arthritis, (an inflammatory disease where the immune system attacks healthy cells). Smokers are more likely to get severe rheumatoid arthritis and are less likely to experience remission. As well as this, smoking decreases the effectiveness of some of the drugs used to treat it. The pain of arthritis becomes a barrier to engaging in exercise, which is known to help relieve symptoms. The reason is not clear at this stage, but it is believed that smoking triggers a faulty immune system response.
As with obesity, smoking alters the bacteria in the gut, and along with the changes in the immune system, this can make you more susceptible to Crohn’s (an inflammatory disease where the immune system attacks healthy cells).
Another one which I was a little reluctant to cover because the last thing I want to do is to put anyone off exercising! Please be reassured that if you are doing personal training with me, I will always be looking at your training as a whole. What have you done the previous day, week, or month? On top of this, I will look at your stress levels. I will be interested in how you are sleeping. I will pull you back if that is the right thing to do, and if you are training with me 2 days in a row, then I will be looking at that and adjusting your training accordingly.
Exercising to the point where you are exhausted, and your muscles are sore. We’ve all been there where we pushed a little too hard and suffered as a result. Listen to your body. It’s telling you that it’s in recovery mode. When we exercise, the muscles contract and relax. Under heavy load, this causes the muscle fibres to break down. During recovery, the body repairs them, and when they grow back, they are stronger and bigger. There’s some inflammation going on here. But that’s normal.
To aid in the repair and regrowth, the immune system sends in the team to do their jobs! Increased blood flow, bringing with it more oxygen and nutrients. The waste is cleared away and the repair process begins. Inflammation is a good thing here because it signals the immune system to repair. However, if you are exercising at a high intensity without allowing time for the body to recover and repair, then it will remain in this heightened state of inflammation.
The body likes balance and moderation.
Diet and inflammation
The food that you eat can significantly affect inflammation in your body. There are foods that are known to have anti-inflammatory properties and there are foods that are known to increase inflammation (you can probably guess the ones you should avoid!)
I know, it’s so yummy, but it really is at the top of the list when it comes to inflammation. When we eat/drink too much sugar, our bodies release insulin and stress hormones, which in turn can trigger inflammation. Inflammatory markers spike in as little as 30 minutes and remain elevated for over 2 hours. When there’s too much sugar at one time, insulin tries to store the excess in your fat cells, which causes them to get larger. As a nation, we tend to drip feed ourselves throughout the day as we eat as often as every few hours, so this inflammatory reaction caused by food happens fairly regularly throughout the day and becomes a chronic inflammation.
Sugar is sugar…. No, it’s not. Added sugar has been removed from its original source and added to foods and drinks to make them taste nicer and increase their shelf life. A chocolate bar will last a lot longer than an apple (in that it has a much longer shelf life!) Natural sugars have not been linked to inflammation because they act differently when eaten and digested. As many of these whole foods are eaten with other foods (protein, fibre), the sugar is absorbed more slowly and this slower absorption prevents the spike in blood sugar that added sugar causes. Many foods containing natural sugars are anti-inflammatory.
Trans fats are found in fried foods (chips, doughnuts, margarine, biscuits, cakes, pasties, and processed snacks). Refined carbohydrates (white bread, pasties, sugar). Fats are not bad for you, but, trans fats are (if you missed it, you can read about fats, the good ones and the bad ones, in my earlier blog – Fat. What it is & why you need it). Hydrogen is added to vegetable oil, which causes the oil to become solid at room temperature. This gives the food a longer shelf life.
Trans fats have no health benefits whatsoever. They create inflammation, which is linked to heart disease, stroke, diabetes and other chronic conditions. Trans fats raise your bad cholesterol and lower your good cholesterol. Even a small amount of trans fat can dramatically increase inflammation.
Our food labels are not always to be trusted. Food labelling laws mean that food companies are allowed to round down their numbers, which can be incredibly misleading. It essentially means that products can have false claims of having zero trans fats. Look further than the front of the packet and check for partially hydrogenated oils in the ingredients list – this is what we are trying to avoid.
When it comes to meat, quality does matter. Processed meats are known to cause inflammation, but I’m loathed to label all meats as inflammatory (despite being a vegetarian myself!) Foods like sausages, bacon, ham, beef jerky, are not the same as a good cut of meat. In the same way that tomato ketchup is not the same as a tomato!
The way an animal is raised will make a difference to the quality of the meat. An animal that was pastured, fed a natural diet of grass, and had a lot of sunlight will produce meat that is quite different from one that was kept in a barn with little sunlight and fed a corn and soybean diet. This is due to the fact that an animal on a grass-based diet produces an omega-3-rich fatty acid profile that is anti-inflammatory in the human body.
When deciding whether or not to consume meat, keep in mind that quality and the amount of processing involved determine whether or not the meat you’re eating is likely to be inflammatory.
You can read more about carbohydrates here. Carbs are not all bad. In fact, there are a whole host of reasons why we should be eating carbohydrates, but there is a tendency to lump them all together in an anti-carb diet. When it comes to inflammation, it’s the refined carbs that we need to reduce or avoid (white bread, white pasta, cakes, biscuits, white rice, crackers).
All carbs provide energy, but their dietary value really depends on whether they are refined or unrefined. So how do we recognise which is which?
Refined carbs will,
- Contain processed, low-quality fats
- Contain excessive sugar (over 15g Per 100g)
- Contain no vitamins or minerals
Refined carbs have had most of their fibre removed. However, it’s the fibre that feeds the good bacteria in the gut, improves blood sugar control, and promotes fulness. Research suggests that refined carbohydrates encourage the growth of inflammatory bacteria in the gut. Refined carbs get broken down quickly, which causes a spike in blood sugar. Elevated blood sugar creates an inflammatory response as the body tries to remove the sugar from your blood.
Covered above, I’m sure you don’t want me to nag you twice about it!
What can you do to reduce inflammation?
It’s easy to see how chronic inflammation can occur. Life is busy. Work and family life can be stressful. We have deadlines to meet and a huge amount of juggling to do. This can lead to poor sleep. Throw into the mix a little too much wine as a reward for working so hard and some fast food to make life a bit easier. Too tired to exercise on top of that. Wow, already we’ve ticked five boxes. By now, your waistline may be suffering also. Hello, inflammation. But there is a lot that we can influence to claim back a bit of control here.
You don’t need to completely overhaul your diet but being mindful of what you put in your body is a must. Think colour. Whole, unprocessed foods are key. Foods that are as close to their natural state as possible are going to give you vitamins, minerals, and fibre.
Eat more;
- Leafy greens – spinach, kale (sorry!)
- Tomatoes
- Fatty fish (mackerel, sardines, salmon)
- Fruit (strawberries, blueberries, cherries, oranges)
- Nuts (almonds, walnuts)
- Olive oil
- Balance out your Omega 3 and Omega 6 intake – more Omega 3’s to balance out the Omega 6
- Replace refined carbs with whole grain alternatives (quinoa, brown rice)
- Go meatless 1 or 2 times per week, and when you are eating meat, choose cuts that have less than 4 grams of saturated fat per serving.
- Reduce your alcohol consumption.
If you are overweight, look to reduce your body fat. Use the calorie calculator here (insert link to calculator) as a starting point. When it comes to losing body fat, it’s energy in (food) vs energy out (movement).
- Move more – Break up your sitting hours
- Reduce stress
- Make sure that you are prioritising your sleep
