A Functional Medicine Guide To Calming Inflammation
You may have heard the world inflammation before; most likely in the context of chronic disease, a certain food group (ahem, gluten), or lifestyle practice. In our modern lives, there are so many factors contributing to inflammation that helping my patients identify and combat them is a major part of what I do as a functional medicine practitioner.
But how do you know if you have inflammation? What does it really feel like? Read on for the full intel on inflammation, it’s symptoms, and what it feels like to suffer from a chronically stimulated inflammatory response.
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What is inflammation?
Inflammation is an important bodily process that, when triggered by factors like an unhealthy lifestyle, stress, and toxic exposures, can spin out of control. When inflammation is allowed to run wild, it can damage the body by creating too many pro-inflammatory cells and molecules, such as tumor necrosis factor (TNF), interleukins (ILs), nuclear factor-kappa B (NF-kB), prostaglandins, and free radicals. Having too many of these pesky pro-inflammatory substances being produced can cause damage to the body, leading to inflammation-related health issues and conditions, such as autoimmune disease.
Unfortunately, we don’t always know this is happening at the time. Inflammation is insidious, and it starts brewing in the body long before a specific disease becomes noticeable, not to mention diagnosable. By the time a health problem is advanced enough to be officially diagnosed by your primary care doctor, there’s a good chance that chronic inflammation has already done some damage to the body. In one good example, close to 90% of your adrenal glands have to be destroyed before you are “officially” diagnosed with Addison’s disease. In this case, inflammation has been brewing for years, with the gradual build-up of symptoms a siren call for help, before it destroys enough to warrant a diagnosis.
Right now we all exist somewhere on an inflammation spectrum, from no inflammation to mild to moderate to diagnosis-level inflammation that has resulted in a disease state.
What does inflammation feel like?
Acute inflammation is characterized by obvious symptoms like redness, pain, and swelling in the area. You’ve probably experienced this when you’ve suffered a minor injury, like a burn, bruise, or scrape. The symptoms of chronic inflammation, however, are a little more elusive, which is why many people suffer from it for years without being able to identify exactly what’s going on with their health.
Here are a few ways chronic inflammation can manifest itself in the body:
Inflammation affects your entire body—and that includes the brain. In fact, the brain might be particularly at risk since an overload of inflammation can trigger an inflammatory-autoimmune response against your brain and nervous system. The consequence of this is often an erratic mood or feelings of anxiety and depression.
Inflammation can also damage your blood-brain barrier, which can lead to something called “leaky brain” and oxidative stress in the hypothalamus, which is the part of the brain responsible for regulating appetite and weight, body temperature, emotions, behavior, memory, growth, salt and water balance, sex drive and your sleep-wake cycle. (Is that all?) Needless to say, the consequences of this, which include brain fog, concentration, and attention issues, are something you want to avoid.
Inflammation and pain are intricately related. In just one example, many inflammatory and autoimmune conditions—such as arthritis or fibromyalgia—have pain as their primary symptom. If your joints are constantly stiff and achy, it’s a good sign that your inflammation levels are higher than they should be.
Inflammation creates pain as a way to communicate to the body that there’s a problem that needs attention. It’s your job to listen and make appropriate changes in your lifestyle that decrease both inflammation and pain.
Chronic inflammation messes with the way your body responds to stress; more specifically, it messes with your hypothalamic-pituitary-adrenal axis, which is the signaling cascade that tells your body to produce cortisol and other stress hormones. The result of this is chronically high cortisol, which can leave you with fatigue during the day, muscle weakness, low blood pressure, and trouble sleeping at night.
When this happens, it makes sense that your body would rather have you take it easy than hit Soul Cycle at six in the morning. Many people try to push through by pumping their bodies full of caffeine, but this only further triggers the adrenals and inflammation, and ultimately exasperates the problem.
How do you diagnose inflammation?
As a functional medicine doctor, I typically diagnose inflammation by way of a detailed medical history and talking to a patient about their symptoms. That said, there are also a few lab tests I frequently run to check for unhealthy levels of inflammation, including:
CRP: C-Reactive Protein is an inflammatory protein and the test measures it along with IL-6, (1) another pro-inflammatory protein. They are both linked to chronic inflammatory health problems.
Optimal Range: < 0.5 mg/L
Optimal Range: < 7 Umol/L
Ferritin: Normally used to check for stored iron levels in cases of suspected anemia, it is also considered to be an acute phase reactant, and when high, it’s a sign (3) of inflammation.
Optimal Range: Men: 33-236 ng/mL; Premenopausal women: 10-122 ng/mL; Postmenopausal women: 10-263 ng/mL
Once you get a baseline for what your inflammation levels look like, I recommend investigating why you have chronic inflammation in the first place. Consider these additional labs, which could help narrow down the culprits:
Methylation gene testing: Methylation is a complex biochemical process responsible for many important process in your body such as maintaining a healthy brain and gut, protecting our DNA, and detoxing our bodies. Gene mutations such as MTHFR polymorphism can inhibit your body’s ability to bring down inflammation levels, such as homocysteine, and knowing this can help your doctor prescribe appropriate measures.
GI labs: Your gut is the foundation of health. By running labs it allows your doctor to either rule out or confirm underlying gut problems like leaky gut syndrome and the presence of inflammatory gut proteins, such as calprotectin. It’s also a good idea to test for microbiome dysfunctions like SIBO and candida overgrowth, to better understand all potential sources of inflammation.
White blood cell count: Immune labs, like white blood cell count, (4) look for underlying low-grade infections that can fuel inflammation.
How food contributes to chronic inflammation
This type of sustained, chronic storm of low-grade inflammation is triggered by a range of factors, including medications, toxin exposure, stress, how much we move our bodies, and most importantly, the foods we eat. This is actually good news because it means we have a say in how much inflammation our bodies experience. In fact, studies estimate that close to 77% of inflammatory reactions are determined by factors over which we have at least some control — including our diets — with the remainder determined by genetics.
Food is so important because the foods we eat send our body signals; in fact, every single bite of food we eat influences how we feel on a daily basis — and in the long-term can make the difference between us being healthy or not.
That said, there is no one universally healthy diet. The foods that work well for someone else may not be right for you and your unique biochemistry. It’s important to find out what foods YOUR body loves and what food it hates in order to drive-down inflammation. You can start this process by trying an elimination diet, which will help you pinpoint food sensitivities and find out which foods work for you.
When you’re able to start cooling inflammation it opens up the opportunity for your body to address health imbalances that have been caused by it. Inflammation gets in the way of the body’s natural ability to heal.
To better understand how much inflammation is impacting your health and what you can do about it, pick up a copy of my book The Inflammation Spectrum. In it, I teach you to recognize how inflammation is manifesting in your body and then guide you through an elimination diet so you can develop a dietary plan that works for you.
How do you decrease the symptoms of inflammation?
Now that we know what inflammation is, what it feels like, and how it’s diagnosed; How do we fend it off? These are my favorite tips for fighting inflammation:
1. Find the foods that work best for your body
Many of you probably already avoid junk foods, but that doesn’t mean every food you think is healthful is actually right for you. I’ve seen many foods – even healthy ones – cause inflammation flare-ups, and uncovering food intolerances and sensitivities is an important part of winning the inflammation battle. Remember that there’s no one right diet for all people – we are all genetically and biochemically unique. I recommend doing an elimination diet, the gold standard for discovering which foods are not working for you.
2. Start meditating
Meditation is one of the easiest ways to tackle chronic stress, which can contribute to unnecessary inflammation in the body. And I’m not talking about 30 minutes a day, either. Even five minutes will make a difference. Research has shown that a meditation practice can help decrease pro-inflammatory cytokines such as TNF-a and IL-6.
3. Try CBD
CBD interacts with a larger system in the body called the endocannabinoid system, which is intricately involved in the inflammatory response and the immune system. CBD can be taken daily as a sublingual oil or supplement capsule (if you want to learn more about how it fights inflammation, check out my article on the topic). If you’re looking for a little extra anti-inflammatory support, it’s a great place to start.
4. Join a yoga studio
The list of yoga’s benefits is long. In fact, it’s practically endless and includes improved flexibility and reduced chronic pain as well as lower inflammation levels. One study even showed that men and women who practice yoga for an hour a day have significantly lower TNF-a and IL-6 levels. If you want to reduce inflammation and get in shape at the same time, yoga might be for you.
5. Get familiar with the vagus nerve
Also known as the “wandering nerve” the vagus nerve plays a major role in the communication between the gut, brain, liver, heart, and lungs. Stimulating this nerve—which you can do by slow breathing, singing, or deep humming—has been shown to lower a pro-inflammatory cytokine called TNF in patients with rheumatoid arthritis as well as alleviate inflammation-related health issues like depression and inflammatory bowel disease.
6. Drink red wine
Wine lovers, I have great news! Red wine is rich in polyphenols like resveratrol, which can reduce inflammation by lowering TNF-a and CRP. A glass of wine a day may give you some anti-inflammatory benefits, but if you really want to get the full benefits of resveratrol, it’s best to forego the alcohol (which can be inflammatory) and take it in supplement-form.
7. Get your full 8 hours
We all know that adequate sleep helps us feel optimal, but it also combats unhealthy levels of inflammation. In fact, a two-hour nap has been shown to significantly lower IL-6 levels that were elevated from lack of sleep the night before. If you want to fight inflammation you can start tonight by turning off all electronics 2 hours before bed. As an added bonus, adequate sleep can also help you maintain a healthy weight and reduce brain fog and fatigue. Sounds like a win-win, doesn’t it?
8. Hug it out
Did you know that physical touch can stimulate the release of oxytocin from your brain’s pituitary gland? It’s true. Oxytoxin is known as the “love hormone” and is released when we hug, kiss, cuddle, and yes—have sex. Research has shown that the love hormone lowers IL-6 and boosts T-regulatory cells, which can also help lower inflammation.
9. Try intermittent fasting
It’s common to talk about foods that help fight off inflammation, but not as many people talk about how not eating at all for periods of time can also benefit us. Intermittent fasting has been linked to a decrease in inflammation-related health conditions like asthma, lupus, and IBS.
Limiting your food intake for extended periods of time does wonders for lowering inflammation, by reducing pro-inflammatory cytokines. In fact, fasting has been linked to a decrease in inflammatory conditions such as asthma and autoimmune conditions like lupus. Start by simply leaving 14-hours between dinner and breakfast the next day and see how you feel.
10. Hit the gym
While exercise can actually trigger inflammation in the short-term, it can decrease it in the long-term. In fact, 20 minutes of exercise has been shown to suppress inflammatory markers. Anything that gets your heart rate up can be considered exercise, including walking, biking, and even gardening—but cardio exercises like HIIT training have demonstrated exta anti-inflammatory properties.
There are so many ways to fend off chronic inflammation, so just choose one (or a few) from the list above and kiss, exercise, sleep, or CBD your inflammation goodbye.
11. Get more PPARs
Studies suggest (5) that Peroxisome Proliferator – activated Receptors (PPARs) may help improve inflammatory conditions such as atherosclerosis, asthma, colitis, MS, and other autoimmune conditions. Some PPAR activators: wild-caught fish, (6) green tea, astragalus, ginger, (7) and sea buckthorn. (8)
12. Get better sleep
Research (9) has found that loss of sleep, even for a single night, increases inflammation in the body. Dealing with sleep disturbances, such as sleep apnea and adrenal fatigue, is essential to calming inflammation levels. Set up a calming before-bedtime routine for yourself if you have trouble falling or staying asleep.
13. Get more vitamin C
Several studies (10) have linked low vitamin C with inflammatory conditions. In one study (11) of 3,258 healthy 60 to 79-year-old men, vitamin C intake from fruits and vegetables was significantly and inversely associated with inflammatory CRP and t-PA.
14. Increase Nrf-2
A protein called Nrf-2 plays a role in regulating (12) antioxidant gene induction. Nrf-2 actually turns on genes that are responsible for antioxidant and detox pathways. When Nrf-2 is activated, inflammation decreases, and conversely, inflammation tends to be worse with lower levels of Nrf-2.
Many dietary sources of antioxidants have been found to activate Nrf-2 including:
- EGCG from green tea
- quercetin from apples
- curcumin from turmeric
- resveratrol from grapes
- rosmarinic acid from rosemary
- L-sulforaphane from broccoli
- thiosulfonateallicin from garlic
15. Decrease NF-kB
The inflammatory nuclear factor kappa B, or NF-kB for short, binds to your DNA and triggers a number of different inflammatory cascades in the body when activated. NF-kB has been implicated (13) in the pathogenesis of many chronic inflammatory conditions, but there is some exciting research going on focusing on finding ways to inhibit the expression of NF-kB to prevent or control the multitude of inflammatory-related diseases. I recommend focusing on these foods to help bring your NF-kB levels down.
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- Associations of Circulating C-Reactive Protein and Interleukin-6 with Survival in Women with and without Cancer: Findings from the British Women's Heart and Health Study Katriina Heikkilä, Shah Ebrahim, Ann Rumley, Gordon Lowe and Debbie A. Lawlor Cancer Epidemiol Biomarkers Prev June 1 2007 (16) (6) 1155-1159; DOI: 10.1158/1055-9965.EPI-07-0093
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- Kell DB, Pretorius E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics. 2014;6(4):748-773. doi:10.1039/c3mt00347g
- Farhangi MA, Keshavarz SA, Eshraghian M, Ostadrahimi A, Saboor-Yaraghi AA. White blood cell count in women: relation to inflammatory biomarkers, haematological profiles, visceral adiposity, and other cardiovascular risk factors. J Health Popul Nutr. 2013;31(1):58-64. doi:10.3329/jhpn.v31i1.14749
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- Li H, Ruan XZ, Powis SH, et al. EPA and DHA reduce LPS-induced inflammation responses in HK-2 cells: evidence for a PPAR-gamma-dependent mechanism. Kidney Int. 2005;67(3):867-874. doi:10.1111/j.1523-1755.2005.00151.x
- Biochem Pharmacol. 2014 Nov 1; 92(1): 73–89. doi: 10.1016/j.bcp.2014.07.018
- Pichiah PB, Moon HJ, Park JE, Moon YJ, Cha YS. Ethanolic extract of seabuckthorn (Hippophae rhamnoides L) prevents high-fat diet-induced obesity in mice through down-regulation of adipogenic and lipogenic gene expression. Nutr Res. 2012;32(11):856-864. doi:10.1016/j.nutres.2012.09.015
- Elsevier. (2008, September 4). Loss Of Sleep, Even For A Single Night, Increases Inflammation In The Body. ScienceDaily. Retrieved June 30, 2020 from www.sciencedaily.com/releases/2008/09/080902075211.htm
- Michel Langlois, Daniel Duprez, Joris Delanghe, Marc De Buyzere, and Denis L. Clement Serum Vitamin C Concentration Is Low in Peripheral Arterial Disease and Is Associated With Inflammation and Severity of Atherosclerosis Circulation 2001;103:1863–1868 doi:10.1161/01.CIR.103.14.1863
- Wannamethee SG, Lowe GD, Rumley A, Bruckdorfer KR, Whincup PH. Associations of vitamin C status, fruit and vegetable intakes, and markers of inflammation and hemostasis. Am J Clin Nutr. 2006;83(3):567-727. doi:10.1093/ajcn.83.3.567
- Rahman I, Biswas SK, Kirkham PA. Regulation of inflammation and redox signaling by dietary polyphenols. Biochem Pharmacol. 2006;72(11):1439-1452. doi:10.1016/j.bcp.2006.07.004
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BY DR. WILL COLE
Dr. Will Cole, IFMCP, DNM, DC, leading functional medicine expert, consults people around the world via webcam and locally in Pittsburgh. He received his doctorate from Southern California University of Health Sciences and post doctorate education and training in functional medicine and clinical nutrition. He specializes in clinically researching underlying factors of chronic disease and customizing a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. Dr. Cole was named one of the top 50 functional medicine and integrative doctors in the nation and is the best selling author of Ketotarian and The Inflammation Spectrum.