Inflammation: The Silent Killer – Unveiling the Hidden Dangers

Dr. Liz Bartman

Inflammation is a natural process that occurs in the body as a defense mechanism against harmful stimuli, such as injuries or infections. It is an essential part of the body’s immune response, helping to heal damaged tissues and fight off pathogens. However, when inflammation becomes chronic and persists over time, it can turn into a silent killer, contributing to the development of numerous diseases including insulin resistance, metabolic syndrome, mood disorders, joint inflammation and cardiovascular disease, to name just a few. In this blog, we will explore the dangers of chronic inflammation, its causes, and how to prevent or manage it effectively.

The Dangers of Chronic Inflammation

Chronic inflammation has been linked to a wide range of health problems, earning it the reputation of a silent killer. Here are some of the diseases and conditions associated with chronic inflammation:

• Cardiovascular Diseases: Persistent inflammation can damage blood vessels, leading to the development of atherosclerosis (hardening of arteries) and increasing the risk of heart attacks and strokes.
• Autoimmune Diseases: Conditions like rheumatoid arthritis, lupus, and inflammatory bowel disease are caused by an overactive immune system, resulting in chronic inflammation that attacks healthy tissues.
• Type 2 Diabetes: Inflammation interferes with insulin signaling, contributing to insulin resistance and the development of diabetes.
• Neurodegenerative Diseases: Chronic inflammation in the brain has been linked to neurodegenerative disorders such as Alzheimer’s and Parkinson’s disease.
• Obesity: Fat cells release inflammatory chemicals, and excess body fat promotes a state of chronic low-grade inflammation, which can lead to insulin resistance and metabolic dysfunction.

Sources of Chronic Inflammation

Understanding the causes of chronic inflammation is crucial for prevention and management. Several factors contribute to its development:

• Unhealthy Diet: Diets high in processed foods, refined sugars, unhealthy fats, and low in fruits, vegetables, and whole grains can promote inflammation. Alcohol consumption will also contribute to inflammatory activity by increasing sugar levels, altering gut microbiome and stressing liver detoxification pathways. 
• Sedentary Lifestyle: Lack of physical activity contributes to chronic inflammation by affecting metabolism and promoting weight gain.
• Chronic Stress: Prolonged stress triggers the release of stress hormones that can cause systemic inflammation.
• Smoking: Cigarette smoke contains harmful chemicals that can induce inflammation and damage the lining of blood vessels.
• Environmental Factors: Exposure to pollutants, toxins, and certain infections can trigger chronic inflammation .
• Obesity: Visceral adiposity, the white fat around the midsection, acts as its own endocrine gland. Visceral fat produces two inflammatory cytokines, called IL-6 and TNF-a. When there is excess adipose tissue, the patient will be in a low-grade state of inflammation. Visceral fat can also trigger gluconeogenesis for sugar production and will metabolize sex hormones and cortisol to help promote its own growth and survival . 
• Gut dysbiosis or dysfunction: Our gut regulates around 70% of our immune activity and can be a big source of inflammation. Low-grade dysbiosis, malabsorption, food sensitivities, and environmental factors can all influence our gut’s ability to regulate and support immune health, leading to a chronic, low-grade inflammatory state. 
• Poor oral hygiene: Gingivitis and periodontitis, are caused by bacteria triggering a low-grade, chronic inflammatory response within the gums. This can be associated with elevated hs-CRP levels. There is a well-established risk between gum disease and cardiovascular disease, attributed to this chronic, low-grade up-regulation of hs-CRP.

Prevention and Management Strategies

The good news is that we can support our clients to take steps that help prevent and manage chronic inflammation, including: 

• Helping our patients optimize a Healthy Diet: Include a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats. Minimize processed foods, hydrogenated oils, sugary beverages, and excessive alcohol consumption.
• Encourage Regular Exercise: Engage in moderate-intensity aerobic exercise and strength training regularly. Exercise helps reduce inflammation and improve overall health.
• Support Stress Management: Practice stress-reducing techniques such as meditation, deep breathing exercises, yoga, or engaging in hobbies that bring them joy.
• Help your patients Quit Smoking and avoid Secondhand Smoke: Quit smoking and avoid exposure to secondhand smoke as it can exacerbate inflammation.
• Help them Maintain a Healthy Weight: Excess body fat contributes to inflammation, so aim to achieve and maintain a healthy weight through a balanced diet and regular exercise.
• Support Their Sleep: Prioritize quality sleep to allow your body to repair and recover. Aim for 7-8 hours of uninterrupted sleep each night.
• Encourage Optimal Hydration: A study out of the journal Nutrients highlighted a great goal for water consumption that is based on age, weight, and metabolic activity. They recommend that a patient get their Basal Metabolic Rate in mL of water per day to achieve adequate cellular hydration. 
• Manage Underlying Conditions: If your patient struggles with a condition like diabetes, high blood pressure or an autoimmune disorder, work closely with them to ensure treatment is supporting both their condition and any underlying inflammation resulting from the condition. 
• Increase fiber: high fiber diets (30-50 g per day of mixed soluble and insoluble fibers) are associated with lowering levels of Il-6 and TNF-a. 
• Increase green tea: green tea polyphenols are associated with a reduction in CRP in human clinical studies. 
• Micronutrients and spices: Magnesium, vitamin D, vitamin E, zinc and selenium are all linked to lower levels of inflammation. Magnesium is listed as one of the most anti-inflammatory dietary factors, and its intake is associated with the lowering of hsCRP, IL-6, and TNF-alpha activity. Vitamin D exerts its anti-inflammatory activity by suppressing inflammatory mediators such as prostaglandins and nuclear factor kappa-light-chain-enhancer of activated B cells. Vitamin E, zinc, and selenium act as antioxidants in the body. Curcumin as a spice can help lower hsCRP, and is associated with improvement in inflammatory conditions in animal models . 
• Increasing fish oils: Fish oils are the richest source of omega-3 fatty acids. Higher intake of omega-3 fatty acids is associated with lowering levels of TNF-alpha, CRP, and IL-6.

Looking at lab markers, we can identify whether there may be concern for inflammation, or not. The following labs can help uncover hidden inflammation:

• Elevated Androsterone, DHT or 5a-Androstendiol: These are the 5a-reductase metabolites measured on a DUTCH sex hormone panel. 5a-reductase elevates in response to high insulin levels or underlying stressors that drive up blood sugars, as well as hypo-thyroid. When 5a-reductase metabolites are elevated, it is important to assess for any underlying inflammatory culprits, especially blood sugars. 
• High metabolized cortisol on the DUTCH adrenal profiles. Elevated cortisol metabolism suggests that the body is “on fire.” Metabolized cortisol elevates in response to inflammation, blood sugar dysregulation, high physical or mental stress, and hyper-thyroid. 
• Low 2-methoxy E1 levels. When 2-methoxy-E1 is low in comparison to 2-OH E1 and total estrogens, it suggests that there is poor methylation. Methylation is suppressed when the body is inflamed, and can actually become a vicious cycle, as inflammation suppresses methylation, and then poor methylation can increase homocysteine, which is a pro-inflammatory intermediate of our methylation cycle.
  • When you see a low methylation index indictor on the DUTCH test, it is a good idea to screen your patient’s homocysteine levels to determine the degree at which their methylation is problematic. 
• Serum markers for inflammation: 
  • Fibrinogen– a blood clotting protein that will increase with tissue inflammation or tissue destruction. 
  • Hs-CRP– a marker made in the liver in response to increased levels of IL-6 and specifically representing the degree of endothelial inflammation in the body. Of important note, this marker can elevate with abdominal obesity, periodontal disease, high blood pressure, oral contraceptive pills, Premarin, and smoking. 
  • Homocysteine– a marker of incomplete methylation of methionine. Homocysteine, when elevated, can damage endothelial tissue and increase the risk for stroke or heart disease, as well as cancer, depression, and inflammatory bowel disease.  
  • ESR– this is a very rudimentary test, but can help identify inflammation in the body in a minimally invasive, low-cost way. This test is monitoring Erythrocyte sedimentation rate (ESR). If we are inflamed, our red blood cells become “sticky” and can slow how rapidly they settle to the bottom of a test tube. A lab will quantify the rate of sedimentation, with a slower (higher) rate of sedimentation associated with inflammatory risk, including autoimmune disorders, viral or bacterial infections, and chronic low-grade stress on the body. 
• Additional testing: Food sensitivity testing, Environmental screenings including both organic and inorganic sources of tissue burden, and GI testing are all tests that could be considered depending on the patient and your concerns. 

Remember, while inflammation is a necessary response for our body’s defense mechanism, chronic inflammation can silently wreak havoc on our health. By adopting a healthy lifestyle, including a balanced diet, regular exercise, stress management, and avoiding harmful habits, we can help our patients combat chronic inflammation and reduce the risk of associated diseases.