The word “Inflammation” is used to describe the symptoms of heat, swelling, pain, redness and disturbed function that is found when the body tries to repair damage or fight infection. This reflects activity of the immune system, and the body’s ability to maintain healthy tissues. When your body detects an injury or infection, your immune system sends out an army of white blood cells to deal with it. This is what is called “acute inflammation”: an event triggers an immune response designed to deal with the trigger, then it subsides when the triggering factor has been neutralised or removed.
Chronic inflammation, however, is different. Here the same reaction takes place, but instead of subsiding, it persists. The activated white blood cells can land up attacking nearby healthy tissues and organs which are then damaged in the process. The continued inflammatory process releases by-products which can also be carried into the circulation and cause problems elsewhere in the body. An example of this is abdominal obesity – fat inside the abdomen that surrounds and even invades you abdominal organs. These cells incite an inflammatory response, and the longer you remain overweight, the longer the state of inflammation persists. The inflammatory cytokines release by abdominal fat cells are carried in the circulation to all parts of the body, hence their effects on tissues outside of the abdomen.
Arthritis, heart disease and even Alzheimer’s have been linked to persisting (chronic) states of inflammation.
In most cases, chronic inflammation makes its presence felt – e.g. arthritis – but it can often be more subtle and insidious. A simple blood test can measure the level of inflammation present: this is a standard test and does not require any fasting. The relevance of this test is that chronic inflammation increases the overall risk for other conditions. The level of risk for heart disease shown by your cholesterol test will be multiplied in the presence of high levels of inflammation.
If your blood test shows high levels of inflammation, the logical next step is to find out why. Those who e.g. have obvious arthritis or an auto-immune condition will be very aware of flare-ups which increase inflammation. These conditions merit treatment in their own right, apart from their contribution towards chronic inflammation.
But very often chronic inflammation is like a smouldering fire which can lull you into a false sense of security, thinking that everything has died down, but it can flare up again at any time. There may be no gross signs, but the process causing damage is quietly going on. This is often the more significant form of inflammation – the “silent” type – and this is what the blood test can reveal.
Conditions such as arthritis are most often managed with anti-inflammatory drugs, the Non-Steroidal Anti-inflammatory Drugs (NSAIDs). These deal with the pain and the other aspects of inflammation. But they are not without possible side-effects and should only be used with appropriately, with caution, and preferably under guidance of your doctor. Many are available without prescription, and this is often where the most damage is done. The next post will outline factors to be considered when using NSAIDs.
Apart from medication, there are things you can do to reduce chronic inflammation, and these are aimed at the more common causes of inflammation.
Excess weight is a prime factor, especially weight around the belly as this type of fat is associated with inflammation. Losing excess weight will therefore help to lower inflammation.
Those with abdominal obesity often have raised cholesterol levels. Losing weight may help lower cholesterol, but a statin may be considered. Apart from their direct effect in lowering cholesterol levels, statins also have proven anti-inflammatory properties, so they can help in two ways. Using a statin is a personal decision, and is best discussed with your doctor.
Gum disease is also linked to chronic inflammation – bleeding gums caused by brushing or flossing is a sign of this. A visit to your dentist or oral hygienist will help to deal with this problem.
Quit smoking: apart from being sound advice in general, this will remove from your system the many toxins in cigarette smoke that promote inflammation, especially in the airways and lungs.
Changing your diet also helps. Apart from helping to lose weight (thereby reducing inflammation) you can also consider changing WHAT you eat. Sugars and processed foods contribute largely to weight gain, and have little nutritional value so can be safely be eliminated from your diet – or at least significantly reduced. Certain foods are rich in anti-oxidants such as polyphenols (e.g. green leafy vegetables, berries, grapes, turmeric) so increasing consumption of these may help reduce inflammation. Omega 3 fatty acids (found e.g. in fatty fish and olive oil) have been shown to reduce inflammation and are thought to have particular benefits in brain tissue.
Lifestyle and dietary changes are the first steps towards reducing chronic inflammation, but medication may also be needed. NSAID’s are drugs used to fight the symptoms/damage caused by excess or chronic inflammation. Most of them do so by blocking the effects of substances called prostaglandins, one type of which is produced during episodes of acute inflammation. But other types of these prostaglandins are beneficial, and inhibiting the effects of these can lead to many of the unwanted side effects of NSAID’s.
Most over the counter NSAIDs will affect both forms of prostaglandins, but two prescription NSAIDs are available which do not affect stomach prostaglandin and thus do not cause stomach irritation or bleeding.
Like all other medications, NSAID’s have therapeutic benefits and accompanying possible side effects, the four main concerns being effects on 1. The heart 2. The stomach 3. The kidneys. 4. Blood clotting. For more details on this see our MediChat Newsletter issue 54 – available on our website www.medichat.co.za
In general, medication should be used at the lowest effective dose for the shortest possible time and this is particularly applicable to NSAID’s because of their side effects. Anyone allergic to aspirin or who has significant asthma should avoid aspirin and only use NSAIDs with great caution. Before using any medication, always check the list of ingredients: many very effective combination painkillers contain an NSAID as one of their ingredients. If this is added to an NSAID you are already using, you will be overdosing on the ingredient present in both medications. If in doubt, please consult your doctor for advice. This is particularly important for people on any form of blood thinner.
Anti-inflammatories are effective and widely used for acute inflammation, but there is controversy over using them for chronic inflammation, mainly because continued use has its problems. For those who need long-term NSAIDs e.g. some forms of arthritis, it would be wise to check on kidney function at least once a year to ensure that there is no kidney damage which may become permanent if not spotted in time. Lifestyle changes (such as weight loss) remain an important part of combatting chronic inflammation even if NSAIDs are used as additional short-term aids.
Limited self-medication can be helpful, but if the condition persists beyond 7-10 days, please consult your doctor.