Inflammation

Dr Stacie Stephenson & Dr Oz standing in front of an inflammation graphic

Dr Stacie Stephenson and Dr. Oz

Quiz: How Inflamed Are You? Take the Quiz (3 mins)

Inflammation 101

Inflammation: It’s a trendy word in the health news, but it’s a complex concept. Maybe you’re wondering what it is, how it works, why it happens, whether you should worry, and what you can do about it if you have it. Look no further! It’s my mission, as the Vibrant Doc, to give you the information you need to live your most vibrant life, and inflammation is definitely not vibrant. It is, however, something you can influence. Inflammation is highly responsive to lifestyle and environment, and those are things you have control over, for the most part. In this Inflammation Kit, I’m going to show you exactly what you can do to reverse or prevent chronic inflammation. But first, just what is it?

There are two types of inflammation: acute and chronic. Acute inflammation is a good thing. It is an important reaction by your own immune system to dangerous influences, like viruses (such as the flu), bacteria (such as salmonella), foreign objects (like a splinter), wounds (like a skinned knee), or internal injury (such as a broken bone). Your body senses an injury or invasion, mounts an immune response to protect you, and once the threat has passed—the infection is conquered, the foreign object is removed, the wound is healed—the inflammation subsides. 

Chronic inflammation is another story. With chronic inflammation, the body is constantly in an alert state—maybe not high-alert, like with a broken bone or a case of food poisoning, but low-alert, when the body determines that there is a threat, but it isn’t sure exactly what it is. 

This can happen if you live in a polluted environment, eat a lot of processed food, don’t exercise, or are under a lot of stress all the time. Your body is smart and this makes sense: If the air and water is dirty or has industrial chemicals in it (are you being poisoned?), if you are eating foods that your body doesn’t really recognize as foods (can’t you find real food?), if you aren’t moving around like the body thinks it’s supposed to (are you lying there because you are sick or injured?), or you are worrying, fretting, perseverating (is something threatening you?), your body will get the message that something is wrong. 

In response, to protect you, it will mount an immune response just in case something really bad happens. It’s like an early warning signal that never turns off because you haven’t sent the signal that it can turn off. 

On top of that, unhealthful lifestyle habits can cause actual physical conditions that will further encourage inflammation:

  • Arterial plaque: A poor diet high in sugar and unhealthful fat (like in fried foods and fatty meat) can lead to plaque build-up in the arteries, which can cause low-grade inflammation (and put you at risk for heart attack and stroke). 
  • Oxidative stress. A poor diet can also mean you don’t eat as many antioxidant-rich vegetables and fruits. We need these antioxidants! The natural process of metabolism, as well as exposure to pollution, processed food, UV radiation, radon, and other damaging substances, creates a by-product called free radicals. These are unstable molecules missing an electron. They tear through the body damaging cells and DNA, searching for an electron to “plug in” to the missing spot. This is what causes oxidative stress and inflammation. Foods with antioxidants donate an electron to these free radicals, essentially neutralizing them so they stop causing damage and inflammation. This is one very important reason why we need to eat vegetables and fruits!
  • Sedentary living. A lack of exercise can lead to atrophy of your muscles and reduce your cardiovascular function. It can also signal the mitochondria in your muscle cells that you don’t need as much energy, and so your cells will make less energy. 
  • Stress and sleep problems. Stress can shrink your brain and reduce your cognitive abilities, and can also keep you from sleeping well, which can further exacerbate inflammation. 

As you can see, lifestyle has a major impact on the cascade of processes that can lead to chronic inflammation. But it also has a major impact on the cascade of processes that can resolve and prevent future inflammation. Inflammation may be a risk factor for just about every common chronic disease afflicting people today, but what and how you eat, how much you move, how you manage your stress, how well you sleep, and even how well you connect with and feel supported by other people can all make a difference. To learn more about how to take inflammation into your own hands, see the sections on anti-inflammatory foods, supplements, and lifestyle.

Lab Tests That Detect Inflammation

Doctors test for inflammation using different kinds of tests for different kinds of situations. None of these tests can tell you exactly where your inflammation is, but will tell you if you have inflammation somewhere (or everywhere). I’m not going to list reference ranges her because different labs have different reference ranges, so go by the references ranges you get from the lab that does your test. Depending on your health and what conditions you are concerned about, your doctor may or may not recommend any of the following tests—and you can also do some of these on your own at home, with the rise of many different at-home testing companies:

  • ESR (erythrocyte sedimentation rate): This is a general test that can indicate the presence of certain inflammatory disorders. It measures the rate at which red blood cells will fall to the bottom of a test tube. In the presence of inflammation, proteins in the blood can cause the cells to fall to the bottom faster, which raises the rate and the ESR number. This test is sometimes used when a doctor suspects an infection or certain autoimmune conditions such as rheumatoid arthritis or inflammatory bowel disease. It can also help to determine if antibiotics are working. Your doctor may order this test if you’ve had a persistent fever, joint stiffness or pain, anemia, or if you have lost your appetite and/or are losing weight with no apparent cause.
  • CRP (c-reactive protein): This test is useful if a doctor is trying to tell the difference between an inflammatory condition like rheumatoid arthritis and a non-inflammatory condition like osteoarthritis. Your liver produces c-reactive protein, and sends it into your bloodstream in the presence of information, to protect you from damage. This test measures the level of c-reactive protein in your bloodstream. It is more sensitive and specific than the ESR test, and your doctor may also order this test if they suspect you have an inflammatory condition such as an inflammatory autoimmune disease or other chronic disease, or if you have a persistent fever, chills, a high heart or breathing rate, or digestive symptoms like nausea and vomiting. CRP will also be high in cases of bacterial and fungal infections, but it is also sensitive enough to detect inflammation caused by inflammatory lifestyle habits like a junk food diet, a sedentary lifestyle, high levels of chronic stress, or heavy drinking or smoking.
  • hs-CRP (high-sensitivity c-reactive protein): This test also measures c-reactive protein, but at much lower levels. Doctors order this test specifically to check heart disease and stroke risk, because lower levels of inflammation result from damage to the arteries that lead to the heart and brain. When the arteries become inflamed by plaque formation, the body sends out c-reactive protein to try to help heal the inflammation, and this test measures the level of these proteins in the bloodstream. An above-normal hs-CRP doesn’t mean you have heart disease, but it does mean you are at a higher risk, as arterial inflammation is a serious risk factor for both heart disease and stroke. Some people think an elevated hs-CRP is a better measure of heart disease and stroke risk than high LDL (“bad”) cholesterol. A doctor may also order this test when an autoimmune condition is suspected.
  • PCT (procalcitonin test): This test measures the level of procalcitonin in the blood. High levels could signal a serious bacterial infection like sepsis or meningitis. A doctor may order it if you are experiencing a rapid heartrate, shortness of breath, low blood pressure, or other signs of a serious infection, such as sepsis from a urinary tract or skin infection. It’s not used as often for chronic inflammation—it’s typically reserved for more serious acute inflammation situations and their treatment (such as to determine whether antibiotics are working). This isn’t a test you can order to do yourself at home.

The Top Ten Anti-Inflammation Foods

Your food choices matter if you want to get a handle on inflammation. How you eat can heavily influence chronic inflammation, making it worse, making it better, or eliminating it completely. One of the best ways to deal with inflammatory oxidative stress and free radicals is with anti-oxidant, anti-inflammatory foods. These foods can neutralize the oxidative stress caused by free radicals, which protects you from tissue damage and inflammation. Here are my top ten favorite foods rich in antioxidants like vitamin C, resveratrol, flavonoids, lycopene, polyphenols, and more:

1.) Berries: All the brightly colored berries are rich in Vitamin C, anthocyanins, ellagic acid, and resveratrol, for superior damage control and an anti-cancer effect. They reduce inflammation, support immunity, and bonus: They can make your skin glow!

2.) Tomatoes: Fresh tomatoes as well as tomato products like sauce and paste are a particularly good source of lycopene, which among other great benefits may help protect your skin from sun damage. They are also a rich source of immune-supportive vitamin C, which is both a vitamin and an antioxidant.

3.) Pumpkin: Pumpkin, along with other bright-orange vegetables and fruits like sweet potatoes, mangoes, and carrots, are rich in beta-carotene, which is a precursor of vitamin A and is especially beneficial for protecting your eyes.

4.) Green tea: This flavonoid-rich and lower-in-caffeine comforting warm beverage contains polyphenol, including a powerful catechin called epigallocatechin-3-allate, or EGCG for short. Green tea may protect against many chronic diseases, like cancer and heart disease, through its anti-inflammatory and antioxidant action. It may also help with fat loss and improve brain function because of its caffeine and the amino acid L-theanine, which has an anti-anxiety effect. 

5.) Onions and garlic: These savory kitchen favorites contain allium sulphur compounds, which support the body’s natural detoxification processes and may suppress growth of tumor cells, which could make them cancer-protective. 

6.) Broccoli: Broccoli and other cruciferous veggies like cauliflower, cabbage, and kale, contain indoles, which also help to support detoxification and are also thought to be protective against breast, cervical, color, lung, and prostate cancer. Indoles may also help to relieve the stress of environmental estrogens (called xenoestrogens), improving estrogen metabolism.

7.) Lentils: Legumes, especially lentils, are rich sources of isoflavonoids, which can also help to regulate estrogen and may improve PMS symptoms. They may also support immunity, brain health, heart health, skin health, bone health, and suppress the activity of cancer cells.

8.) Leafy greens: Spinach, kale, chard, collards, and the deepest green lettuces contain the antioxidant lutein, which is another carotenoid like beta-carotene that protects the eyes from age-related macular degeneration, which is the leading cause of vision impairment and blindness with age. It’s also beneficial for brain health. 

9.) Fish and shellfish: Zinc and manganese are minerals but they are also anti-oxidants that are rich in seafood. Zinc supports immune function and healing–I recommend upping zinc intake every winter, for cold and flu season. It also supports thyroid function, which is important for women as they get older. Manganese supports the body’s use of vitamins by improving metabolic activity and liver activity, and it helps with energy production. 

10.) Herbs and spices, especially turmeric: The “rumors” are true about turmeric. It really is one of the most powerful anti-inflammatory substances you can use in your kitchen, thanks to the antioxidant curcumin, which aggressively scavenges free radicals. But other spices and dried herbs, like thyme, oregano, lemon balm, sage, ginger, cinnamon, cloves, and allspice, are great sources of polyphenols, which keep blood vessels healthy and flexible, improving circulation. Polyphenols can also improve the health of gut bacteria by supporting beneficial bacteria and discouraging the bacteria that cause inflammation.

The Top Five Anti-Inflammation Supplements

Your food choices matter if you want to get a handle on inflammation. How you eat can heavily influence chronic inflammation, making it worse, making it better, or eliminating it completely. One of the best ways to deal with inflammatory oxidative stress and free radicals is with anti-oxidant, anti-inflammatory foods. These foods can neutralize the oxidative stress caused by free radicals, which protects you from tissue damage and inflammation. Here are my top ten favorite foods rich in antioxidants like vitamin C, resveratrol, flavonoids, lycopene, polyphenols, and more:

1.) Fish oil, or EPA/DHA: Fish oil (or krill oil or algae oil) is rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are powerful anti-inflammatory fats that affect the signaling between cells and have been shown to be powerful therapies for people who have inflammation from chronic diseases, like heart disease for autoimmunity. Countries with the highest fish consumption tend to have the lowest levels of both dementia and depression, but it can be hard to eat enough fish, and there are concerns too about mercury in fish. Purified mercury-free fish oil is a great way to get the benefits without the downsides.

2.) Vitamin D: It’s sometimes called the “immune vitamin,” and it is an essential immune support vitamin, but vitamin D is also anti-inflammatory. Vitamin D modulates the immune response, which is the cause of inflammation, so a sufficient vitamin D level in the blood (I recommend 50 ng/ml) can help the body be more intelligent about how it responds to threats. This may help inflammation subside when it’s no longer necessary.

3.) Curcumin (turmeric): I always recommend cooking with turmeric, but taking a curcumin supplement (curcumin is the active ingredient in turmeric) is a good way to get a higher dose without the taste, which some people don’t care for. Curcumin inhibits inflammatory pathways in the body and may be as effective as anti-inflammatory medications, such as ibuprofen. 

4.) Boswellia: This tree resin is also called frankincense, and it’s not just anti-inflammatory. It’s also analgesic (meaning it helps with pain) and anti-arthritic, which is why it is an ingredient in so many joint formulas. It reduces white blood cell count in join fluid, and inhibits substances released in people who have rheumatoid arthritis. Studies have shown that 8 weeks of treatment improve function in people with knee arthritis.

5.) Probiotics: Probiotics help support beneficial gut bacteria, and one of the effects of this is a reduction in the inflammatory process in multiple ways, including tightening up the network of cells in the gut lining (the endothelium) in ways that can prevent food particles leaking into the bloodstream and causing an immune system overreaction/inflammation, and also minimize the development o inflammatory biomarkers and the development of inflammatory cytokines.

Five Keys to Living an Anti-Inflammatory Lifestyle

What you eat may be your most important weapon against chronic inflammation, but many other aspects of your life can either support or interfere with your efforts to douse the flame of inflammation. Let’s take a closer look at five lifestyle changes you can make to live a less inflammatory life:

1.) Exercise More: It’s my answer to almost every problem, I admit, but research backs me up. Time and time again, studies have shown the health benefits of regular exercise, and a 2017 study showed that just a single 20-minute session of exercise stimulates the immune system to produce an anti-inflammatory response at the cellular level. Talk about good medicine! 

Regular, habitual exercise can have an even greater impact on inflammation, reducing inflammation and keeping it low, regardless of age or health status. The standard recommendation is to get 150 to 300 minutes of moderate-intensity exercise each week. That’s five 30- to 60-minute exercise sessions, but also remember that exercise is dose-dependent. A little exercise is better than none, and more exercise is better than less, up to a point. Over-exercising can add to stress and burnout, and experts say exercise begins to become detrimental if you are exercising for more than 2 hours every day (unless you are an athlete in training). 

I consider 300 minutes per week to be a good goal for health and maximum vibrancy, although it’s often a good idea to work up to that amount, to avoid injury. If you can commit to that hour of self-care on most days, you’ll enjoy a multitude of benefits.

2.) Stress Less: Some recent research has found inflammation is the one commonality between all the chronic diseases related to stress, and in fact, it seems like stress, inflammation, and chronic disease are a health-wrecking trifecta with multi-directional influences: stress contributes to inflammation, inflammation contributes to stress, stress contributes to chronic disease, chronic disease contributes to stress, inflammation contributes to chronic disease, and so on. The good news is that you can intervene into this multi-directional dysfunction at any point: Reducing stress can reduce inflammation and the risk of chronic disease, and reducing inflammation can reduce stress and the risk of chronic disease. 

One of my favorite ways to start managing stress to quell inflammation is to take up yoga. It may seem trendy, but this is a trend with legs, considering people have been doing yoga for tens of thousands of years. Yoga is a well-studied and meaningful stress management technique that can reduce stress and biomarkers of inflammation. You can learn yoga by taking a class (in person or online). People of any fitness level can benefit, and you’ll get added flexibility, mobility, and strength, too.  

3.) Make Meditation a Habit: Speaking of stress interventions, another of my favorites is also a super inflammation-fighter: Meditation. It’s as simple as sitting and breathing gently while tuning into all the details of your surroundings (mindfulness), or imagining peaceful, restorative environments (visualization). Just 5 to 20 minutes twice a day on a regular basis can make a profound difference in your stress, and can help to keep inflammation down. Mindfulness in particular has been shown to reduce inflammation in stressed-out adults. If that’s you, you might want to give it a try. I highly recommend it.

4.) Sleep Better: According to the Sleep Foundation, in 2021, about half of American adults report feeling sleepy during the day, over 35% say they sleep for less than seven hours per night (that goes up to over 42% in single parents), and over 32% of working adults say they slept fewer than six hours per night. Many also suffer from insomnia, sleep apnea, restless legs syndrome, narcolepsy, teeth grinding, hot flashes, and night sweats, and sleep deprivation is a known contributor to depression, anxiety, car crashes, lost work, work-related accidents, and medical errors in healthcare workers. On top of all that, sleep deprivation, sleep duration, and sleep disturbances all contribute to chronic inflammation and chronic disease risk. 

The key to resolving sleep problems is to improve sleep hygiene, which means improving your bedtime routine and sleeping environment. If you do the same thing each night before bed, winding down an hour or two before you hit the hay, your body will get the signal that it’s time to get sleepy. Turn lights low, don’t look at blue-light-emitting screens (so your brain can produce sleep-inducing melatonin), read, listen to music, meditate, write in your journal, have pleasant conversations with loved ones, take a warm bath or shower, and just generally get into a sleepy frame of mind. Go to bed at the same time (and wake up at the same time) on most nights, and make your bedroom into a peaceful haven for sleep.

An ideal sleeping condition is a completely dark, quiet, cool, clean bedroom. Remove all ambient light if possible, and all electronics. Even that little red light on your tv should be off or blocked (or get that TV out of the bedroom!). If possible, have quiet hours for the house. The ideal sleeping temperature is about 65 degrees F. A clean room decorated in a way that feels calm and peaceful is also useful. Making these sleep routine and environment changes can make a big difference in your sleep quality. Sleep tracking can be a good way to tell if your change are working. Many smart watches and other devices can tell you how long and how well you are sleeping.

5.) Connect: There is a lot of interesting research on the connection between connection and inflammation. They don’t seem to have much to do with one another, but it turns out that inflammation can lead to a higher sensitivity to negative and positive social experiences, which could lead to social withdrawal or to more social neediness, and that inflammation can also make people less able to interpret social cues appropriately. Going the other direction, people who are socially isolated show more proinflammatory activity than people who are more socially connected. 

What that means is that strong supportive relationships are good for you and can help to keep inflammation at bay, but that isolation, loneliness, or stressful relationships can increase the inflammatory response. So reach out. Nurture your relationships. Ask for support when you need it, and give support when the people who are important to you need it, too. Mutually supportive relationships are highly rewarding, and can help you feel better in many ways—physically, mentally, and emotionally, all of which can help to quell inflammation, and make your life more rewarding in the process.

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