I recently attended a Metagenics seminar on Resolving Chronic Inflammation and it deepened my understanding of the important role that inflammatory processes play in our bodies. Inflammation often gets labelled as harmful, causing symptoms such as pain, reduced function and fatigue. However, without inflammation, our bodies would not be able to heal from injury or infection. The key is how our body recovers after the inflammatory process is triggered; when inflammation fails to resolve, chronic illness can ensue. This includes cancer, depression and autoimmune inflammatory disease, such as rheumatoid arthritis and inflammatory bowel disease.
As an integrative GP, whenever a patient presents with symptoms that are inflammatory in nature, one of the first steps I take is to try and identify the underlying drivers for the inflammation. There are a number of important and common causes for chronic inflammation, including
Gut dysbiosis
Metabolic syndrome
Infection
Tissue damage
Chronic stress
Medications
Persistent allergens
Taking a thorough history, performing a physical examination and arranging appropriate investigations will generally uncover a number of potential inflammatory triggers, which can then guide management. However, there are also a number of treatments that can be employed to assist with reducing and resolving inflammation without knowing the precise diagnosis. Healing the gut and reducing metabolic inflammation are two key strategies that I will explore below.
1. Gut dysbiosis
This is a very common condition for anyone living a busy modern lifestyle. The gut microbiome is sensitive to poor dietary choices, excessive alcohol consumption, inadequate sleep, medications and insufficient physical activity. When our gut bacteria are not provided with the healthy conditions they need to thrive, the microbiome becomes dysbiotic, or out of balance, which leads to reduction in immune tolerance and increases inflammation of the gut lining. Once inflammation takes hold, gut function can be significantly affected, leading to symptoms such as constipation.
Constipation is a problematic condition as it can cause pain, bloating and cramping but also has significant social and professional effects that reduce quality of life. Constipation can also be a symptom of underlying disease, such as hypothyroidism, diabetes, Parkinson’s Disease, depression and bowel obstruction, so a thorough clinical assessment is warranted when constipation is a chronic problem.
Having said this, there are a number of first line treatments that can be trialled to manage chronic constipation. These include
2. Metabolic syndrome
Obesity, or excessive adipose tissue, is associated with chronic, low-level, non-infective inflammation. When we over-eat, the higher levels of nutrients in our system stimulate inflammatory pathways in our cells, deceiving the body into recognising the oversupply of nutrients as pathological. Adipose cells produce macrophages that control whether inflammation is promoted or reduced. When there is an excess of adipose cells, as is the case with obesity, the macrophages tend to promote inflammation. This in turn affects our endocrine system, stimulating insulin-resistance, which is the underlying pathology of type 2 diabetes. Both obesity and type 2 diabetes increase the risk of developing osteoarthritis, not only due to the increased mechanical load on the joints, but also as a result of the release of excess adipokines from the adipose tissue into the blood stream and into the joints, where they cause cartilage destruction.
Consequently, weight loss, even in modest amounts, is key to reducing inflammation and improving insulin sensitivity. A nutritionally balanced diet combined with regular physical exercise and effective stress management are vital components of effective weight loss programs. This can be difficult to achieve on your own, especially when we live in such an obesogenic environment. There is evidence to suggest that employing a health coach, either in-person or via an online interface, to support you with implementing these strategies over a sustained period of time can improve outcomes (3). Consequently, I regularly refer my patients who need to lose weight to a health coach for this purpose.
Resolving inflammation
Although modifying inflammatory drivers is important, it is also worthwhile considering the effect of supporting the immune system to switch from a pro-inflammatory state to an anti-inflammatory state. This occurs when pro-inflammatory immune cells receive the message that it’s time to change mode to achieve resolution. You might be curious to hear that COX-2 inhibitors such as ibuprofen can in fact prolong the inflammatory response when used long-term as they suppress the immune system such that the inflammatory process cannot transition to the resolution phase.
Alternatively, there are nutrients that can be employed to support the body’s transition to the pro-resolution state. They come in the form of omega-3 fatty acids EPA and DHA. These omega-3s are precursors to important metabolites known as specialised pro-resolving mediators (SPMs) that are responsible for a range of actions that result in the cleaning up of inflamed tissue, inhibiting pro-inflammatory factors and increasing anti-inflammatory mediator production without suppressing the immune system. Further to this, SPMs can improve the effectiveness of antibiotics when treating bacterial infections (4).
Omega-3 fatty acids are typically consumed in the form of fish oil, however the body needs to convert EPA and DHA to SPMs in order to have an anti-inflammatory effect. This conversion process can be limited in patients with metabolic syndrome, obesity and hypercholesterolaemia. For these patients, it is now possible to prescribe SPMs to support resolution of their inflammation. SPMs are currently undergoing human clinical trials, but animal studies have demonstrated that SPMs are effective in reducing inflammation in a range of conditions, including osteoarthritis (5), fibromyalgia (6), allergies (7), inflammatory bowel disease (8), cancer (9) and endometriosis (10).
The Vagus Nerve
Another vital component of the body’s immune system is the vagus nerve. The vagus nerve contains parasympathetic motor nerves that connect the brain with a number of organs in the body, including the heart, lungs and gut. It is consequently involved with moderating our heart rate, breathing and digestion. Further to this, the vagus nerve is responsible for down-regulating inflammatory cytokine production by sending a message to the spleen, which is a key organ in the body’s immune system. The significance of this is that by activating the vagus nerve, we can regulate inflammation in the body.
There are number of simple ways to activate the vagus nerve. These include
Meditation
Deep, paced breathing exercises
Acupuncture
Taking tumeric, fish oil and magnesium
Exercise, especially yoga
In summary
Inflammation is a necessary physiological process for responding to injury and infection, however it can become a chronic problem when drivers such as gut dysbiosis and metabolic syndrome prevent resolution of inflammatory processes. Seeking support from an integrative health practitioner is vital to identify underlying causes for inflammatory symptoms and implement a management plan that targets these drivers. Further, SPMs are an emerging therapy for supporting resolution of chronic inflammatory diseases without suppressing the immune system. Finally, activating the vagus nerve is another simple and effective way of regulating inflammation.
If you are suffering with chronic inflammation and you’re ready to get to the root cause of your symptoms, I encourage you to find an integrative medical practitioner who can work together with you to complete of full and thorough assessment and prescribe a holistic management plan. If you live in the South West of Western Australia, you can book in for a consultation with me at Broadwater Medical Centre on 9751 0400.
References
1. Kapoor MP, Sugita M, Fukuzawa Y, Okubo T. Impact of partially hydrolyzed guar gum (PHGG) on constipation prevention: A systematic review and meta-analysis. Journal of Functional Foods. 2012 Jan; 4(1):398-402.
2. Ducrotté P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol. 2012;18(30):4012–4018.
3. Appel LJ, Clark JM, Yeh HC, Wang NY, Coughlin JW, Daumit G, Miller III ER, Dalcin A, Jerome GJ, Geller S, Noronha G. Comparative effectiveness of weight-loss interventions in clinical practice. New England Journal of Medicine. 2011 Nov 24;365(21):1959-68.
4. Chiang N, Fredman G, Bäckhed F, Oh SF, Vickery T, Schmidt BA, Serhan CN. Infection regulates pro-resolving mediators that lower antibiotic requirements. Nature. 2012 Apr;484(7395):524.
5. Sun AR, Wu X, Liu B, Chen Y, Armitage CW, Kollipara A, Crawford R, Beagley KW, Mao X, Xiao Y, Prasadam I. Pro-resolving lipid mediator ameliorates obesity induced osteoarthritis by regulating synovial macrophage polarisation. Scientific reports. 2019 Jan 23;9(1):426.
6. Klein CP, Sperotto ND, Maciel IS, Leite CE, Souza AH, Campos MM. Effects of D-series resolvins on behavioral and neurochemical changes in a fibromyalgia-like model in mice. Neuropharmacology. 2014 Nov 1;86:57-66.
7. Kim N, Ramon S, Thatcher TH, Woeller CF, Sime PJ, Phipps RP. Specialized proresolving mediators (SPMs) inhibit human B‐cell IgE production. European journal of immunology. 2016 Jan;46(1):81-91.
8. Bento AF, Claudino RF, Dutra RC, Marcon R, Calixto JB. Omega-3 fatty acid-derived mediators 17 (R)-hydroxy docosahexaenoic acid, aspirin-triggered resolvin D1 and resolvin D2 prevent experimental colitis in mice. The Journal of Immunology. 2011 Aug 15;187(4):1957-69.
9. Sulciner ML, Serhan CN, Gilligan MM, Mudge DK, Chang J, Gartung A, Lehner KA, Bielenberg DR, Schmidt B, Dalli J, Greene ER. Resolvins suppress tumor growth and enhance cancer therapy. Journal of Experimental Medicine. 2018 Jan 2;215(1):115-40.
10. Dmitrieva N, Suess G, Shirley R. Resolvins RvD1 and 17 (R)-RvD1 alleviate signs of inflammation in a rat model of endometriosis. Fertility and sterility. 2014 Oct 1;102(4):1191-6.