Fighting Inflammation, the Body’s Hidden Killer

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Illustration by Bryan Christie

Cancer. Stroke. Alzheimer's. Heart disease. Depression. What do all these conditions have in common? They've been linked to chronic inflammation. It seems impossible that one thing can be responsible for so many problems. But a growing body of medical research is revealing that inflammation — not the kind you get when you sprain an ankle, but the long-term, systemic inflammation that occurs when your immune system goes into overdrive, sending out cells that attack healthy tissues along with the unhealthy — may be at the root of many of our most prevalent diseases. The science also suggests that much of what we thought we knew about chronic inflammation, from why it increases as we age to where it begins in our bodies, and even what kind of drugs fight it, could be wrong.

At the same time, we're learning more about how to combat chronic inflammation with just a handful of simple lifestyle and diet steps that can lower your risk of future diseases. And once people begin taking them, most see positive effects almost immediately, says New York City physician Joseph Raffaele. "Mood is often lifted when you get inflammation under control, you're not chronically tired, you have less indigestion, you're able to really progress in workouts, even headaches can go away," says Raffaele. "Those changes in your body can just make you feel generally better."

So what is inflammation? In simplest terms, it's the body's first line of defense against injury or infection. But our immune system has two kinds of inflammatory responses: acute and chronic. The former kicks in to protect us if we get hurt or fall ill; the latter drags us down as we get older, helping to usher in that host of dangerous, even life-threatening diseases.

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To understand how our immune system can turn on us, it's best first to have a clear picture of what happens during the acute phase. Back to that sprained ankle. When the body senses the sprain, the immune system immediately sends out a team of first-responder chemicals called cytokines; they prompt the body to wall off the affected area. Damaged cells flow out, oxygen and nutrients flow in, and healing begins. If there's infection (maybe you scraped your foot in the same accident and some nasty bacteria crept in), the system will create antibodies to fight it. If the inflammatory response gets too enthusiastic, we rein it in: ice for the swelling that follows a sprain; aspirin for the fever that spikes too high. Usually in a matter of days or weeks, the body has cleaned up the damage and life goes back to normal.

Chronic inflammation occurs when the immune system continuously pumps out the cytokines. The chemicals keep circulating in our bodies, causing tissues to be constantly inflamed. This happens more and more as we age, a team of European researchers discovered during a study a year and a half ago. The researchers looked at the blood work from more than 3,000 middle-aged British civil servants during a 10-year period and found that those with high levels of inflammation had one and a half times the odds of having a cardiovascular problem such as heart disease and were 50 percent more likely to have died from a major chronic disease. That's because as we age our immune systems go downhill with us, giving us an ever-smaller reservoir of capable cells to respond to an increasing amount of damage inside the body and tissues growing old. It's a sad story. The body is hurting itself by trying to fix problems that it can't.

The prime example of this is the heart. Over time, the cells in our coronary arteries get banged up from the constant pounding of pumping blood. Little cracks form. The body interprets these cracks as wounds that need healing, and, signaled by the cytokines, the immune system sends cells to repair the damage. But in the narrow confines of the arteries, these cells just make the problem worse, setting in motion the creation of plaques that can cause heart attacks.

Christiaan Leeuwenburgh, chief of the Division of Biology of Aging at the University of Florida, explains that our aging cells have a nasty habit of turning senescent, which means they're no longer capable of doing their jobs and they begin spitting out their own inflammatory chemicals. Consider it a farewell "screw you" to the body. "Fat cells are the real culprits," Leeuwenburgh says. Even before they become senescent, some fat cells will secrete hormones called adipokines, contributing to bodywide inflammation, and with age they only get crankier. These adipokines can, for instance, push the body to store more fat. This leads to weight gain and puts us on the path to Type 2 Diabetes. In fact, many experts believe that as few as five surplus pounds spell trouble, even for those who exercise regularly.

While we know that some amount of chronic inflammation is inevitable with age, we can help influence how much we have by the lifestyle choices we make. Again, the heart is a great example. Wear and tear in the pipes is inevitable, but the lower we can keep our resting heart rate and blood pressure, the fewer cracks there will be and the fewer cells called in for that quick and dirty repair job.

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According to new thinking, there's one place you should focus on first when making changes. "The most common cause of chronic inflammation is probably the gut," Manhattan integrative physician Frank Lipman says. This idea of gut inflammation entered the medical mainstream thanks in good measure to Massachusetts General gastroenterologist Alessio Fasano, who made a convincing case 15 years ago that sensitivity to a common food protein found in wheat and other grains — gluten — can turn the gut "leaky." The theory: Gluten causes the lining of the gut wall to grow porous, creating microscopic leakage into the bloodstream and lymph system, which in turn triggers a systemwide inflammatory response. The cytokines go on a rampage, setting off symptoms from anxiety and fatigue to skin irritations and insulin resistance.

A host of common things can eat away at the all-important gut lining, says prominent UCLA gastroenterologist Kirsten Tillisch: too much stress and alcohol, processed foods, excessive exercise, and overexposure to antibiotics and common NSAID drugs like aspirin and ibuprofen. That anti-inflammatories made the list may seem incredible — after all, these drugs are designed to ease acute inflammation when we bang up muscles or joints. The problem? "It's easy for people to take them like candy," says Tillisch. Using NSAIDs to treat every ache and pain can rip the stomach lining and gastrointestinal tract, contributing to chronic inflammation, explains Tillisch. "I try to get patients off them just like any medicines that people don't need. I say, 'I know it feels better now, but in the long run you're actually causing more inflammation.' "

A body on inflammatory high-simmer can cause problems anywhere, including the mind. The current hot theory is that depression may be caused by cytokine-driven inflammation in the brain. This January, a study published in JAMA Psychiatry found that people with clinical depression had levels of brain inflammation 30 percent higher than those in a control group. The study authors suspect this could be one reason why half of clinically depressed people don't respond to antidepressants — those pills don't tackle inflammation levels. The evidence is solid enough that Big Pharma is now investing millions to develop a new generation of drugs that will. Why does brain inflammation spike in the first place? Experts like Tillisch suspect that the reason may tie right back to a leaky gut. The nervous system's connection between the brain and the gut is one of the strongest in the body; if inflammation goes up in the gut, it could rise in the brain.

While the biochemistry of chronic inflammation is complex, protecting yourself from it is simple. Follow the rules above to control your immune system. Sticking to the plan won't be hard. These are the kinds of choices that upgrade every aspect of your life — along with the health of your insides.

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