Myths & Facts: Chronic Inflammation

“INFLAMMATION” IS A handy catchall for the visible and other tangible signs of the body’s immune response when injured or under attack from infectious agents. There is swelling, of course, and often redness, pain, elevated localized temperature and what patients often describe as a throbbing sensation. All of these symptoms are the result of the body’s immune system flooding the affected area with white blood cells, dilating blood vessels in the area to increase blood flow, and churning out prostaglandins (compounds with varying hormone-like effects) to help direct the healing.

In fact, while inflammation can be uncomfortable and patients often want to reduce the associated swelling and pain, both are evidence of the ongoing healing process. However, chronic inflammation is not a sign of healing. It is an immune system gone off the rails, rallying the body’s defenses to fight a nonexistent threat. Lasting months or even years, chronic inflammation can lead to other serious, often life-threatening conditions.

The World Health Organization now lists chronic diseases, including those associated with chronic inflammation, as the single greatest threat to health.¹ It can be a challenge to impart the seriousness of chronic inflammation to patients because symptoms are often mild (and sometimes nonexistent), and when they are present, they are easily confused with the normal aches and pains of everyday life. To effectively treat chronic inflammation, physicians sometimes have to first overcome the cultural myths surrounding this disease.

Separating Myth from Fact

Myth: Chronic inflammation is no different than acute inflammation.

Fact: Acute inflammation is the body’s normal, healthy reaction to injury or infection. When a person gets a splinter or beesting, the body rallies to isolate the intrusion and begin healing the damaged tissue. When a person contracts the flu or a bacterial infection, the immune system mobilizes itself to hunt down the invaders. Once the splinter is out and the puncture healed, or once the flu or infection is over, the immune system winds down and things return to normal.

Chronic inflammation, on the other hand, is an ongoing condition in which the body is reacting to a benign stimulus in a destructive way. Since there is no injury or infection to treat or attack, the white blood cells can, in some cases, begin attacking the body itself, leading to an autoimmune condition such as multiple sclerosis, lupus, Crohn’s disease or rheumatoid arthritis.

In addition, while acute inflammation will subside as the injury heals or infection abates, chronic inflammation will, in many cases, persist indefinitely if left untreated.

Myth: Chronic inflammation is no big deal.

Fact: In addition to the autoimmune diseases listed above (often referred to as chronic inflammatory systemic diseases²), untreated chronic inflammation can also lead or contribute to a host of other serious health challenges, including:

• Cardiovascular disease, including heart attack and stroke. In particular, chronic inflammation has been shown to contribute to atherosclerosis, the buildup of fatty plaque in the blood vessels.³ If the body misidentifies the plaque as a foreign substance, it will attempt to build a barrier around it, further constricting the interior dimensions of the blood vessels.
• Cancer, specifically colorectal cancer. Those with inflammatory bowel disease (IBD), including Crohn’s and ulcerative colitis, are at heightened risk of developing colorectal cancer. And, chronic inflammation is a known risk factor for IBD.⁴
• Type 2 diabetes. Clinical obesity is a suspected trigger for chronic inflammation, and that inflammation can interfere with the body’s production of and reaction to insulin.⁵
• Alzheimer’s disease. A study at Johns Hopkins followed 1,500 participants for more than two decades, and tracked C-reactive protein (associated with chronic inflammation) against brain damage associated with Alzheimer’s disease, finding a strong correlation between the two.⁶ While this doesn’t definitively establish a causal relationship, the correlation was strong enough to warrant further study.

Because of its role in autoimmune diseases, cardiovascular disease, cancer, diabetes and dementia, chronic inflammation is an especially dangerous condition that needs to be treated and managed.

Myth: It’s easy to know if a person has chronic inflammation.

Fact: While any kind of inflammation — acute or chronic — can cause symptoms of swelling, pain, redness and/or fever, many times there are no symptoms or they are not immediately obvious. Patients may report a lingering fatigue, soreness or weakness in their muscles or joints, or a sense of malaise.⁷ But the symptoms may be mild or only noticeable some of the time and are general enough that they can be attributed to other causes.

If a patient reports any of these symptoms, or if a physician notices a patient is having frequent or recurring infections, chronic inflammation may be suspected. Ongoing or repeated gastrointestinal problems can also be a clue. The only way to know for certain if a patient has chronic inflammation is through a clinical blood test. A physician will generally diagnose chronic inflammation by ordering an hsCRP blood test to look for the C-reactive protein, which is associated with chronic inflammation.³

Myth: Chronic inflammation is easily treated with diet and lifestyle changes.

Fact: Eating healthy, ceasing smoking and regularly exercising are important components in effectively treating chronic inflammation, but they are not always enough. Still, good dietary and lifestyle habits will amplify any other treatment’s efficacy and should be encouraged.

The first step is to manage a healthy weight. Obesity is a critical risk factor for developing chronic inflammation, and reducing weight to a healthy level can also reduce the seriousness of any chronic inflammation. Foods high in omega-3 fatty acids are particularly useful in fighting chronic inflammation, according to the Scripps Clinic in San Diego, Calif. Cold water fish, grapes, celery, blueberries, olive oil and tea all contain nutrients useful to the body for keeping chronic inflammation at bay. Scripps doctors also recommend limiting fried foods and trans fats, and avoiding processed sugar as much as possible.⁸

Regularly scheduling exercise can be the most challenging lifestyle change. After all, everyone is already going to take the time to eat each day, so dietary modifications can be handled without giving up other activities. But in an age when too many people are overbooked, finding time for aerobic workouts and weight training can be a challenge. Nevertheless, Scripps staff recommends about an hour to an hour and a half of exercise four to five times a week, with about two-thirds of that aerobic and the rest working with weights.

Obviously, patients who smoke or use other tobacco products should be encouraged to stop since tobacco increases stress on the body and can lead to chronic inflammation.⁹

Finally, Scripps doctors recommend finding ways to practice stress reduction throughout the day, whether it’s meditation, yoga, breathing exercises or another technique.

Myth: There is no treatment for chronic inflammation.

Fact: In addition to dietary and lifestyle changes, other treatments can help reduce both the symptoms and the existence of chronic inflammation. Non-steroidal anti-inflammatory drugs such as naproxen, ibuprofen and aspirin can be taken to treat the swelling and pain associated with inflammation — although they do not address the underlying cause of chronic inflammation. In addition to lowering cholesterol levels, statins also reduce inflammation. Steroids can be used to help not only treat the symptoms of inflammation, but suppress the immune system to reduce the processes of inflammation. However, long-term steroid use carries the risk of serious complications, including increased risk of infection, vision problems, elevated blood pressure and increased blood sugar levels.¹⁰

Myth: Only old people develop chronic inflammation.

Fact: While age is a risk factor for developing chronic inflammation, it is only one factor, and plenty of young people have chronic inflammation. However, older patients are at greater risk of developing chronic inflammation. One likely reason is that as people age, their immune system becomes less and less efficient, and thus more prone to dysfunction.¹¹ Other possible reasons chronic inflammation becomes more common as people age are an increase in body fat, mitochondrial decay or accumulation of free radicals.¹

Myth: Doctors and researchers don’t know what causes chronic inflammation.

Fact: While the specific triggers that can cause chronic inflammation may never be known in many patients, there is understanding about what can lead to chronic inflammation in a general sense. In some cases, chronic inflammation starts out as acute inflammation. A bacterial, viral or fungal infection is successfully fought off, but somehow the body doesn’t get the message that the infection is gone, and it remains in fight mode. In other instances, chronic inflammation may develop from exposure to poisonous substances or microparticles the body cannot process or dispose of (for instance, inhaled silica dust). Since these foreign substances cannot be expelled or broken down, the body will stay in continuous inflammation. And, as mentioned earlier, some conditions such as obesity increase chances the body’s immune system will go into a state of chronic inflammation.

But, the reality remains that in many cases, perhaps most, doctors simply won’t know what caused a specific patient to develop chronic inflammation.

Myth: Doctors can easily cure chronic inflammation.

Fact: Since the specific cause of patients’ long-term inflammation may not be known, there is generally no one-stop cure to reverse the condition. Rather, doctors and patients work together to improve patients’ underlying health so their bodies can restore themselves to balance and shut down unnecessary inflammation. This is accomplished through a combined regimen that may include changes in diet, exercise, lifestyle and/or medications.

At the same time, any other conditions that arise due to chronic inflammation must also be treated simultaneously. And, unfortunately, if patients develop an autoimmune disease or cardiovascular disease as a result of chronic inflammation, it can become more challenging to address the inflammation itself.

Myth: There is a vaccine to prevent chronic inflammation.

Fact: Since a variety of underlying causes can trigger chronic inflammation, there is no one way to prevent its onset. And, at this time, there is no pharmaceutical preventive for chronic inflammation. However, patients who proactively adopt a balanced diet, exercise regularly, avoid tobacco use, maintain a healthy weight and avoid exposure to environmental toxins have a good chance of not developing chronic inflammation.

Myth: Scientists will soon know the specific causes of chronic inflammation, and how to cure and prevent it.

Fact: While the Centers for Disease Control and Prevention lists several hundred recent and ongoing research studies on chronic inflammation, the fact remains that the human body’s immune system is tremendously complex, and much about it remains a mystery. While some studies are looking into the root causes of chronic inflammation, and others are exploring new treatment options, the odds of a cure or a vaccine in the near future remain long.

Dispelling the Myths Now

Chronic inflammation is not only dangerous, it is cumulatively dangerous. The longer patients suffer from untreated chronic inflammation, the higher their risk of developing an associated subcondition. Clearly, the cost of ignorance regarding chronic inflammation can be staggeringly high.

It is imperative patients be given accurate information regarding chronic inflammation, and that they be encouraged to work on a plan of treatment with their physician. With so many sources of information now available to patients, they often feel empowered to participate in decision-making regarding their own health, but they can be overwhelmed by the amount of misinformation proliferating online.

Asking patients questions about their understanding of chronic inflammation can help physicians determine which popular myths about the disease may be coloring patients’ resistance to diagnosis or effective treatment. At the same time, including them in the design of a plan of attack can go a long way toward lowering that resistance and gaining patient buy-in.