Cracking the Vault: The Truth About Inflammation
When you hear the word ‘inflammation,’ images of elderly people wringing their arthritic hands or the redness and swelling on a child’s arm after a bee sting may come to mind. While these are indeed signs and symptoms of inflammation, the pain and damage it can cause goes well beyond the surface.
Acute vs. Chronic Inflammation
Let’s take a look at a definition of inflammation first.
Inflammation is defined as redness, swelling, pain, tenderness, heat, and disturbed function of an area of the body that occurs as a reaction of injury and/or tissue damage. When we experience a temperature due to underlying illness, this is a form of inflammation in response to the body’s immune system reacting to fight disease.1
This is easiest to spot with acute inflammation, something like a sprained ankle. The injured limb becomes red, swollen, and painful due to the trauma. While painful and uncomfortable, our bodies usually recover fully from acute inflammation and we move on.
Chronic inflammation is a bird of a different feather. When our bodies are under 24/7 attack from chronic inflammation, there can be a lot more damage.
Inflammation and Arthritis
Arthritis is a perfect example. There are several hundred forms including osteoarthritis, gout, and rheumatoid arthritis, and all involve inflammation. This often includes pain, swelling, and sometimes joint disfigurement.
The most common type of arthritis is osteoarthritis (OA), the wear and tear type people can develop at an early age (like in a high school football player) but which can then last a lifetime.
In this type of arthritis, the cartilage that normally protects and cushions bones and joints break down. Being overweight or obese increases the risk (and pain) of osteoarthritis.2
Weight as an Exacerbating Factor
Excess weight not only puts more pressure on joints, but fat tissue also plays a role in inflammation. Dubbed “meta-inflammation,” low-grade inflammation occurs throughout the body due to adipose tissue.
It’s initiated by macrophages that live in the colon, liver, muscle, and fat tissue.3 Macrophages are part of the immune system and are vital to fight infections. They can congregate and be altered by extracellular and intracellular cues that may lead to metabolic disorders including insulin resistance, heart disease, cancer, and autoimmunity.2
Fat tissue secretes “adipokines,” chemicals that include cytokines, hormones, and various proteins, all of which can trigger pathophysiologic processes.4
Autoimmunity: The Inflammatory Twist
Rheumatoid arthritis (RA) is a chronic inflammatory condition that impacts people of all ages. In RA, the body’s immune system attacks itself and causes joint damage and dysfunction over time. The cause of RA is unknown, though researchers believe it may be genetic, environmental, or related to a previous infection.
Various factors in the immune system play a role in the development of RA. T cells and macrophages in joint synovial fluid are targets of interleukin 18 (IL-18) in RA. IL-18 activates these cells to make proinflammatory cytokines, chemokines, and other compounds that prolong inflammation and cause cartilage and bone destruction.5
RA , Inflammation, and the Heart
Like other autoimmune conditions (such as lupus or multiple sclerosis) RA is a systemic disease that can impact other parts of the body, including the heart and endocrine system. Compared to controls, one study found that heart disease occurs in 50% of patients with RA. Scientists believe it’s related to inflammatory cytokine activity, which advances ischemic heart disease and risk for stroke.5
In addition, endothelial cells in the body may become activated through inflammation. When these cells are turned on, they may lead to atherosclerosis through a rise in the expression of leukocyte adhesion molecules. When endothelial tissue is damaged, it is seen as an early preclinical sign of hardening of the arteries, commonly seen in patients with RA. Medications to target these cells and evaluation of endothelial function may be helpful to further monitor RA patients’ risk for heart disease. RA patients are at higher risk for cardiovascular disease. 6
Eat Right for Inflammation Reduction
While there is no cure for any type of arthritis, diet is certainly a lifestyle factor that makes a difference.
Avoiding “nightshade” fruits and vegetables has been advised for those with RA for several years. This class of produce includes potatoes, eggplant, peppers, tomatoes, and citrus fruit.
To date, there is no research to support the avoidance of these fruits and vegetables. In fact, they’re all a source of antioxidants, which may be beneficial in reducing inflammation. 7, 8
Polyphenols from green tea, berries, cabbage family, and green leafy vegetables and red wine may aid in the reduction of inflammation. 8
What to advise your clients:
Lose weight if overweight. Even a five pound weight loss reduces twenty pounds of pressure from your knees if you have OA. When patients with OA lose weight, they also reduce pain.9
Eat less saturated and trans fats. Solid fats have been found to be pro-inflammatory and are also associated with heart disease and cancer. 10
Stock up on a variety of fruits and vegetables daily.
Have your vitamin D level checked. If you’re deficient, supplement your vitamin D intake. Low vitamin D is common in patients with autoimmune disease and the deficiency is linked with joint paint in both OA and RA patients. 11
References:
https://www.merriam-webster.com/dictionary/inflammation
Li C, Xu MM, Wang K, Adler AJ, Vella AT, Zhou B. Macrophage polarization and meta-inflammation. Transl Res. 2018 Jan;191:29-44
Unamuno X, Gómez-Ambrosi J, Rodríguez A, Becerril S, Frühbeck G, Catalán V. Adipokine dysregulation and adipose tissue inflammation in human obesity. Eur J Clin Invest. 2018 Sep;48(9):e12997.
Dai SM, Shan ZZ, Xu H, Nishioka K. Cellular targets of interleukin-18 in rheumatoid arthritis. Annals of the Rheumatic Diseases. 2007 Nov;66(11):1411-1418. DOI: 10.1136/ard.2006.067793.
El Bakry SA, Fayez D, Morad CS, Abdel-Salam AM, Abdel-Salam Z, ElKabarity RH, El Dakrony AHM. Ischemic heart disease and rheumatoid arthritis: Do inflammatory cytokines have a role? Cytokine. 2017 Aug;96:228-233.
Yang X, Chang Y, Wei W. Endothelial Dysfunction and Inflammation: Immunity in Rheumatoid Arthritis. Mediators Inflamm. 2016;2016:6813016.
http://blog.arthritis.org/living-with-arthritis/nightshades-arthritis/
Oliviero F, Scanu A, Zamudio-Cuevas Y, Punzi L, Spinella P. Anti-inflammatory effects of polyphenols in arthritis. J Sci Food Agric. 2018 Mar;98(5):1653-1659
Messier SP, Resnik AE, Beavers DP, Mihalko SL, Miller GD, Nicklas BJ, deVita P, Hunter DJ, Lyles MF, Eckstein F, Guermazi A, Loeser RF. Intentional Weight Loss in Overweight and Obese Patients With Knee Osteoarthritis: Is More Better? Arthritis Care Res (Hoboken). 2018 Nov;70(11):1569-1575.
Fritsche KL. The science of fatty acids and inflammation. Adv Nutr. 2015 May 15;6(3):293S-301S.
Manoy P, Yuktanandana P, Tanavalee A, Anomasiri W, Ngarmukos S, Tanpowpong T, Honsawek S. Vitamin D Supplementation Improves Quality of Life and Physical Performance in Osteoarthritis Patients. Nutrients. 2017 Jul 26;9(8):799.