Turning the heat down: Solutions for reducing chronic inflammation in our patients' bodies
By Dorothy Garlough, RDH, MPA
As health professionals, we know that inflammation is the first response by the immune system to infection, irritation, or damage. The body reacts immediately to acute trauma by stimulating swelling, redness, pain, and heat. This, in turn, prevents its host from doing further damage to the site. Inflammation plays an important role in keeping your body safe and healthy through the actions of your immune system. However, inflammation should not be a constant in the homeostasis of the body. The goal is to keep inflammation in check.
Chronic inflammation, however, is like a fire in your body that you cannot see or feel. Andrew Luster, MD, PhD, director of the Center for Immunology and Inflammatory Diseases at Harvard-affiliated Massachusetts General Hospital, says, "It's (inflammation) a smoldering process that injures your tissues, joints, and blood vessels, and you often do not notice it until significant damage is done."
Chronic inflammation has the same reaction as acute inflammation, except now the flame persists. As white blood cells flood the problem area, they attack the tissues, organs, and even healthy tissues. This process usually occurs as a response to prolonged acute inflammation or repetitive injuries, and it can lead to necrosis (tissue destruction).1
The body's healing response depends on many factors, including the absence of persistent infection, foreign materials, viruses, bacteria, parasites, adequate blood supply, irradiation, and locally applied drugs such as corticosteroids. Other systemic factors include age (healing is slower as we age); deficiencies in nutrients, such as vitamin C, zinc, and protein; chronic food allergies; metabolic diseases; and other degenerative states.2
Seven out of every 10 deaths are attributed to chronic diseases. According to the Centers for Disease Control and Prevention, the three leading diseases that cause illness and death are cancer, diabetes, and cardiovascular disease. The likelihood of a low-grade level of inflammation is high among people who suffer from these diseases, as well as a multitude of other diseases and conditions, such as arthritis, periodontal disease, Crohn's disease,3 kidney dysfunction, atherosclerosis, and osteoporosis. Inflammation is even being linked to dementia and Alzheimer's.4
Link to brain health
The result of progressive inflammation in the central nervous system results in degeneration of nerve cells thought to play a role in the development of dementia.1 Epidemiologic studies suggest that people with high levels of systemic inflammatory markers, such as C-reactive protein and pro-inflammatory cytokines, are at higher risk of dementia than those with lower levels. There are many potential sources of chronic inflammation, including periodontal disease.5
Dental professionals recognize periodontal disease as one of the most prevalent diseases affecting the population. Among adults, 75% have a mild form (gingivitis), and approximately 40% have moderate or severe periodontitis.
The chronic condition of periodontitis exposes the patient to pro-inflammatory factors over the long term.6 The pathogens in plaque secrete lipopolysaccharide, an endotoxin that activates macrophages to produce pro-inflammatory cytokines. These cytokines then enter the circulation of people with periodontal disease and induce a negative host response. The bacteria themselves and their components can also gain access to the systemic circulation and invade non-oral tissues. Thus, bacteria and inflammatory mediators that originate in the oral cavity may contribute to and enhance inflammatory processes in the brain that increase the risk of dementia.7
New research suggests that omega-3s can cross the blood-brain barrier and may help lower inflammation that may contribute to Alzheimer's disease. In fact, a study in the May 21, 2015, issue of Frontiers in Aging Neuroscience examined 40 adults at risk for late-onset Alzheimer's and found that those who consumed more omega-3s performed better than their peers on tests measuring cognitive flexibility (the ability to switch between tasks). Also, a review of 185 studies published in the journal Circulation showed an association between higher amounts of omega-3s in blood levels as protection against conditions that can lead to a ministroke or full stroke.
Link to aging
Human aging, as well, is characterized by a chronic, low-grade inflammation, a phenomenon known as "inflammaging." Inflammaging is a highly significant risk factor for both morbidity and mortality in the elderly, as most if not all age-related diseases share an inflammatory pathogenesis.8
One source of inflammaging could be the damaged macromolecules (self-debris) that accumulate with age due to increased production and/or inadequate elimination. Toxic substances that have been accumulating over a lifetime are not eliminated, and there is evidence that this debris can clog our bodies at a cellular level.
Inflammation and cells
Inflammation happens at a cellular level. Most risk factors for diseases can stimulate the release of various inflammatory promoters, reactive oxygen species (free radicals), nitric oxide, and immune cells as a result of tissue injury. Microdamage to tissues or repetitive stress on certain tissues can promote tissue injury, which results in an inflammatory reaction of the immune system. In turn, prolonged inflammation puts people at risk for disease.9 This creates a vicious cycle. For instance, many risk factors for heart disease increase inflammation, and-in turn-low-grade inflammation increases the risk for heart disease.
Blood and lymph are responsible for bringing nutrients to the cells and removing the waste. When nutritional deficiencies fuel cell metabolism, disease can occur. A diet that is inadequate, unbalanced, or polluted may have low-quality nutrients. How the antibiotics and hormones fed to animals that we consume, along with chemicals sprayed on our foods (herbicides, fungicides, and insecticides), and the safety of GMO (genetically modified organisms) foods affect us on a cellular level are the subjects of ongoing studies. Could toxin accumulation from the quality of the food we eat become pathogenic? One fact is known: Toxins support cellular degeneration, rather than supporting regeneration for healing.10
Homeostasis
The Western approach to the treatment of diseases recognizes that an unhealthy lifestyle is a major contributing factor to disease. Currently, our health-care systems are therapeutic and mechanistic in their approach to treating disease, but some experts are looking at other approaches to inflammation. One such approach is to maintain homeostasis within the body to stimulate patients' healing. The goal is to help the body rebalance. Some schools of thought suggest that disease merely indicates the existence of an imbalance, and the preventive method is to strive to find and remove the root cause of disease. When a body is no longer in homeostasis for any reason-for example, improper diet, smoking, genetic family history, chronic emotional stress, environmental toxin overload, or sedentary lifestyle-it becomes weaker, rendering it less able to defend itself against certain microorganisms.10
According to René Dubos, MD, PhD, a microbiologist at the Rockefeller Institute for Medical Research, "Viruses and bacteria are not the cause of the disease: there is something else. Most human beings carry through life a variety of microbial agents potentially pathogenic. Only when something happens which upsets the equilibrium between host and parasite does infection develop into disease."
pH levels-Much research today is being done on the optimum pH level within our bodies. It is agreed that we are healthiest with a slightly alkaline pH of 7.34,11 yet much of our diet results in an acidic pH. When our bodies are too acidic, inflammation occurs and destruction begins.12 A practice of many long-lived people of past generations was to drink two tablespoons of fresh lemon juice in a glass of water daily. This practice, as it turns out, was helpful in reducing acidity within their bodies.
Prostaglandins-Prostaglandins are fatty acids that control inflammation, tissue swelling, allergies, and fever. There are three different families of prostaglandins that serve three different functions in the body:13
• PGE1 helps to promote an immune response by reducing allergies, preventing inflammation, and increasing mucous production in the stomach. It also decreases blood pressure and improves nerve function.
• PGE2 suppresses the immune function by stimulating the allergy response and promoting inflammation. There is a rise in platelet aggregation as well as an increase in smooth muscle contraction.
• PGE3 promotes the immune function by releasing pro-inflammatory prostaglandins, and decreases platelet aggregation.
In short, PGE1 and PGE3 are good prostaglandins, while PGE2 is pro-inflammatory. Certain foods promote production of prostaglandins. Linoleic acid (from safflower oil, sunflower oil and seeds, sesame oil and seeds) is converted to PGE1. Arachidonic acid (from meats and dairy produce) is converted to PGE 2 and alpha-linolenic acid (from pumpkin seeds, flaxseed, walnuts, soybeans) is converted into PGE 3. Also cold-water fish (such as salmon, mackerel, sardines, and trout) produce PGE3s, thus helping to reduce inflammation.14
"Western-like" patterns tend to raise the risks of inflammation.15 A diet high in sugar and saturated fat and low in fruit and vegetables, being overweight or obese, and low exposure to sunlight are some of the biomarkers of people living in an industrialized country. Eating C-reactive proteins (meat) can be pro-inflammatory, while vegetable- and fruit-based diets tend to be inversely associated to inflammation. Science has long touted the inflammation-fighting benefits of a healthy diet, one low in saturated fats and added sugars and high in fruits, vegetables, lean protein (such as omega-3-rich wild salmon), and whole grains.16
Inflammation and arthritis
An interesting study in 2010, reported in the Journal of the American Arthritic Association, reported findings of researchers who observed 53 arthritic participants in a study for three-and-a-half months. The patients followed a vegan diet for three-and-a-half months and experienced significant improvement in tender and swollen joints, pain, duration of morning stiffness, and grip strength compared to the people in a control group who consumed an ordinary diet. The vegan group transitioned to a lacto-vegetarian diet for nine months. At the one-year follow-up, they continued to have improved symptoms compared to the control group.
In another study published in Arthritis Research and Care in 2008, 30 patients with active rheumatoid arthritis who followed a gluten-free vegan diet for three months experienced reduced inflammation. This same study also saw reductions in body mass index and cholesterol.
But there are also potential pitfalls. Vegetarians, and especially vegans, have low blood levels of vitamin B-12 and D, calcium, and essential fatty acids, according to Duo Li, PhD, MSc, 17,18 With these diets, it's not just about what you're not eating (meat, eggs, and dairy). These healthy alternatives are packed with phytochemicals (plant-based compounds) that include antioxidants, flavonoids, and carotenoids, all of which help reduce inflammation and protect the tissues from oxidation, which can damage them. It is recommended to seek the advice and direction of your doctor before adopting a vegan or vegetarian diet, as there are potential pitfalls with low blood level of vitamins B-12 and D, calcium, and essential fatty acids.
Any diet-including a vegan or a vegetarian one-can reap the anti-inflammatory benefits by adding certain oils. Kim Larson, RDN, CD, CSSD, national spokesperson for the Academy of Nutrition and Dietetics, says that extravirgin olive oil helps reduce inflammation and can have a similar effect to ibuprofen. However, she advises using it at low temperatures because high heat destroys its beneficial compounds, called polyphenols.
Altering your diet
In terms of diet, you want to subtract and add. Cut back or eliminate simple sugars (such as soda and candy), beverages that contain high-fructose corn syrup (such as juice drinks and sports drinks), and refined carbohydrates (such as white bread and pasta). "Not only are these types of foods empty calories, but overindulging in them can contribute to easy weight gain and thus trigger inflammation," says Dr. Andrew Luster of the Center for Immunology and Inflammatory Diseases.
You want to add foods rich in antioxidants, known as polyphenols. Studies have shown that these antioxidants have many anti-inflammatory properties. Which foods are considered the best? A study in the May 2016 British Journal of Nutrition found that polyphenols from onions, turmeric, red grapes, and green tea lowered a marker for inflammation in the body. All types of berries are also rich in polyphenols, as are cherries and plums, as well as dark green leafy vegetables, such as spinach, kale, and collards. Olive oil, flaxseed oil, and fatty fish-such as salmon, sardines, and mackerel-offer healthy doses of omega-3 fatty acids, which have long been shown to reduce inflammation.
Managing your diet and lifestyle are the two best ways to keep chronic inflammation under control. As mentioned, excess weight is a frequent cause of inflammation, so losing extra pounds, especially around the abdomen, can lower inflammation levels.
Longevity hotspots
Perhaps we can gain insights by looking at Blue Zones throughout the world, where people live abnormally long life spans. These zones include Okinawa, Japan; Sardinia, Italy; Loma Linda, California; Nicoya Peninsula, Costa Rica; and Ikaria, Greece.
Identified by Dan Buettner through his work with National Geographic, he says, "When it comes to diet, they have three key things in common. Ninety percent of their calories come from plants, 65% of their diet is complex carbs, and the third thing-and this is a supplement everyone should run out and buy-is beans. A cup of beans a day for longevity." In addition to beans, the people living in these zones will only have meat about five times a month, very little cow dairy, a handful of nuts a day, and absolutely no soda.19
Benefits of lifestyle changes
In July 2003, the Journal of the American Medical Association found that adding soy protein, viscous fiber, and nuts could be as effective for lowering cholesterol as adding a prescription statin medication to a low-saturated-fat diet. Isn't that amazing?
Additionally, in 2002, the New England Journal of Medicine stated that diet and exercise might be more effective than pharmacologic therapy in defending against cardiovascular disease in patients with glucose intolerance. After three years of making diet and lifestyle changes, patients decreased their risk of developing diabetes by 58%. In contrast, those taking metformin, a common pharmaceutical prescription for diabetics, reduced their diabetes risk by only 31%. In addition, adapting healthy lifestyle changes had a significant reduction in C-reactive protein (CRP), which is an indirect marker of subclinical inflammation.
Do you suffer from chronic inflammation? A simple blood test from your doctor may tell you. It measures a liver chemical, C-reactive protein (CRP), which rises in response to inflammation. Often a CRP level of 1 to 3 milligrams per liter (mg/L) signals a low, yet chronic degree of inflammation. Levels higher than 3 mg/L indicate a high risk of inflammation. The result can help your doctor devise a strategy to lower your levels.
Another risk is visceral fat cells-the kind of fat that builds up in your abdomen and surrounds your organs. The immune system sees those fat cells as a threat and pumps out more white blood cells. The longer you stay overweight, the longer your body remains in a state of inflammation. The fire just keeps burning.
Fighting periodontal disease, treating high cholesterol, and quitting smoking (with the subsequent toxins) are other recommended safeguards against developing chronic internal inflammation.
Pro-inflammatory milieu is one mechanism through which unhealthy diets are linked to a multitude of diseases. In practical terms, fully understanding the link between diet and inflammation holds the promise to educate us on the mechanisms by which dietary patterns improve health. Although none of us can predict if we will become diseased, creating a healthy lifestyle is the best preventive measure we can take. Ann Wigmore, founder of the Hippocrates Health Institute in West Palm Beach, Florida, said, "The food you eat can be either the safest and most powerful form of medicine or the slowest form of poison." As it turns out, "We are what we eat!" RDH
Dorothy Garlough, RDH, MPA, is an innovation architect, facilitating strategy sessions and forums to orchestrate change within dentistry. As an international speaker and writer, Dorothy trains others to broaden their skill-set to include creativity, collaborative innovation, and forward thinking. She recognizes that engagement is the outcome when the mechanisms are put in place to drive new innovations. Connect with her at [email protected] or visit engagingteams.com.References
1. Reference terms: Necrosis. ScienceDaily. https://www.sciencedaily.com/terms/necrosis.htm. Accessed November 15, 2016.
2. Black JK. The anti-inflammation diet and recipe book: protect yourself and your family from heart disease, arthritis, diabetes, allergies-and more. ISBN-10: 0897934857. Alameda, CA: Hunter House Inc; 2006:7.
3. Crohn disease. University of Maryland Medical Center website. http://umm.edu/health/medical/altmed/condition/crohns-disease. Accessed November 15, 2016.
4. Akiyama H, Barger S, Barnum S, et al. Inflammation and Alzheimer's disease. Neurobiol Aging. 2000;21(3):383-421. https://www.ncbi.nlm.nih.gov/pubmed/10858586.
5. Kaye E. Periodontal disease and impaired cognition. DentistryIQ.com. http://www.dentistryiq.com/articles/2010/06/periodontal-disease-and-impaired-cognition.html. Published June 2010. Accessed November 15, 2016.
6. Kamer AR, Craig RG, Dasanayake AP, Brys M, Glodzik-Sobanska L, de Leon MJ. Inflammation and Alzheimer's disease: possible role of periodontal diseases. Alzheimers Dement. 2008;4(4):242-250. doi: 10.1016/j.jalz.2007.08.004.
7. Abbayya K, Puthanakar NY, Naduwinmani S, Chidambar YS. Association between periodontitis and Alzheimer's disease. N Am J Med Sci. 2015;7(6):241-246. doi: 10.4103/1947-2714.159325. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488989/.
8. Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci. 2014; 69(Suppl 1):S4-S9. doi: 10.1093/gerona/glu057. http://biomedgerontology.oxfordjournals.org/content/69/Suppl_1/S4.full.
9. What you eat can fuel or cool inflammation. Harvard Health Publications. Division of Harvard Medical School of Harvard University. http://www.health.harvard.edu/family-health-guide/what-you-eat-can-fuel-or-cool-inflammation-a-key-driver-of-heart-disease-diabetes-and-other-chronic-conditions. Published September 2005. Updated February 2007. Accessed November 15, 2016.
10. Black JK. The anti-inflammation diet and recipe book: protect yourself and your family from heart disease, arthritis, diabetes, allergies-and more. ISBN-10: 0897934857. Alameda, CA: Hunter House Inc; 2006:6.
11. Schwalfenberg GK. The alkaline diet: is there evidence that an alkaline pH diet benefits health? J Environ Public Health. 2012;2012:727630. Published online October 12, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195546/. doi: 10.1155/2012/727630.
12. Gordon G. Chronic pain, inflammation, and acidity. Gordon Research Institute. http://gordonresearch.com/chronic-pain-inflammation-and-acidity/. Published November 24, 2015. Accessed November 15, 2016.
13. Black JK. The anti-inflammation diet and recipe book: protect yourself and your family from heart disease, arthritis, diabetes, allergies-and more. ISBN-10: 0897934857. Alameda, CA: Hunter House Inc; 2006:13-14.
14. Dr. Weil's anti-inflammatory diet. Weil Lifestyle. DrWeil.com. http://www.drweil.com/health-wellness/health-centers/aging-gracefully/dr-weils-anti-inflammatory-diet/. Accessed November 15, 2016.
15. Manzel A, Muller DN, Hafler DA, Erdman SE, Linker RA, Kleinewietfeld M. Role of "Western diet" in inflammatory autoimmune diseases. Curr Allergy Asthma Rep. 2014;14(1):404. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034518/. doi: 10.1007/s11882-013-0404-6.
16. Barbaresko J, Koch M, Schulze MB, Nöthlings U. Dietary pattern analysis and biomarkers of low-grade inflammation: a systematic literature review. Nutrition Reviews. 2013;71(8):511-527. doi: 10.1111/nure.12035. http://nutritionreviews.oxfordjournals.org/content/71/8/511.abstract.
17. http://www.j-avu.com/uploads/130505/VNJ20142(1)/Zheng%20et%20al%20VNJ%202014%202(1).pdf
18. http://vegan-in-graz.at/wp-content/uploads/Health-effects-of-vegetarian-and-vegan-diets.pdf
19. What the world's longest-living people eat (and avoid). Yahoo Health. Yahoo.com. https://www.yahoo.com/beauty/what-the-worlds-longest-living-people-eat-and-118883344447.html. Published May 14, 2015. Accessed November 15, 2016.
