Keep inflammation under control

Inflammation is big business. With an aging population that wants to live long, pain-free lives, pharmaceutical manufacturers are working hard to develop new drugs to combat the many faces of inflammation. But this stuff isn't just for older people - young people who want to get more muscular and stronger can benefit too.

Inflammation is the body's first response to injury or infection. It was originally defined by the Latin words calor, dolor, rubor and tumor, which mean heat, pain, redness and swelling. It is interesting to note that pain, redness and swelling are not directly caused by the infection or injury, but are the immune system's reaction to it.

When an inflammatory reaction is triggered, chemical messengers known as cytokines are released. These cause localized dilation of the capillaries, as well as redness and warmth due to increased blood flow to the area.

Dilation of the vessels generates gaps between the endothelial cells that line the blood vessels, allowing blood plasma to leak into the surrounding tissue. This increase in fluid volume causes swelling, which leads to pain as more pressure is exerted on the local nerve endings.

Cytokine release also makes the endothelial cells "stickier", allowing white blood cells to adhere and spill out of the blood into the inflamed tissue. In order to remove invading microorganisms and/or damaged tissue, the white blood cells can release substances that can further increase inflammation and cause local tissue damage, further increasing pain.

Although this may sound like a very destructive process, acute inflammation is a normal part of life. The benefit of this temporary discomfort and swelling is that the inflammation allows a large number of immune cells to quickly reach the affected area where they are needed to kill invading microorganisms and initiate the healing process.

Imagine accidentally cutting yourself while slicing a piece of beef. A blood clot quickly forms to stop the blood loss, but by breaking the protective barrier of your skin, bacteria can enter the body.

The immune system immediately senses the presence of these bacteria and triggers an inflammatory response. This makes the blood vessels in the area permeable, causing swelling, pain and redness, but also allows white blood cells to reach the area more quickly to kill invading bacteria before they can spread and cause a larger infection.

What about post-workout muscle soreness?

The last thing we want to do is stop you from training like an animal, so you should know that the inflammation that follows a hard workout is a good thing.

In this case, muscle contractions cause a local increase in cytokine levels, which activates inflammation. Think of cytokines as local chemical messengers - they represent signaling proteins that help with intercellular communication, such as interleukin6 (IL-6), which increases glucose uptake and the use of fat for energy.

They also activate the local inflammatory response and initiate a cascade of events associated with muscle growth and repair. Along with a local release of growth factors in response to mechanical tension, infiltrating immune cells play a direct role in the activation of satellite cells through a local release of the cytokine TNFα.

Think of it like a construction site that has been damaged by a storm or hurricane. The foreman (Zytokine) tells his crew to bring in more building materials and start repairing the damage - now making the building even stronger by using more materials than originally planned. The result is a bigger and better building.

These types of acute inflammatory responses are completely normal and are involved in everything from wound healing to muscle growth. But what happens when inflammation is chronic instead of acute?

Chronic inflammation

Chronic inflammation is the real problem. The medical establishment tells us that high blood pressure is the silent killer. According to many doctors, chronic inflammation also deserves this label.

Like acute or short-term stress, acute or localized inflammation is not a big problem. But chronic/low-grade inflammation tends to be systemic and can lead to joint stiffness and body-wide muscle pain. At its worst, this chronic inflammation can result in heart disease or insulin resistance, and most chronic diseases (such as cardiovascular disease, various forms of arthritis, rhinitis) and even cancer are promoted by chronic inflammation.

The bottom line is that chronic inflammation can mean declining performance and potentially more serious health problems.

What causes chronic inflammation?

The fat balance:

Most of us eat too many omega-6 fatty acids and not enough omega-3 fatty acids. Here's why:

A competitive inhibition of delta-6 desaturase. If you look at the diagram below, you will see that the first step is dependent on delta-6-desaturase. If you consume significantly more omega-3 than omega-6 fatty acids - or vice versa - then they compete with each other. This is the reason I tell people that an extremely high omega-3 intake is not such a good idea.

If you consume too many omega-3 fatty acids, then you will have problems converting omega-6 fatty acids, which is also essential. So don't fall for the "take 20 to 30 grams of fish oil a day" recommendations.

In fact, some top physicians have reported patients with unusual bleeding and joint pain due to excessive omega-3 intake. On the other hand, problems can also occur if you consume too many omega-6 fatty acids, which are more biologically active and pave the way for more inflammation.

The omega-6 pathway

Here are a few key points:

• Prostaglandins. These are lipid compounds derived from fatty acids. They can have both pro-inflammatory and anti-inflammatory effects. A good way to remember whether a prostaglandin is pro-inflammatory or anti-inflammatory is that even numbers represent pro-inflammatory prostaglandins and odd numbers represent anti-inflammatory prostaglandins.
• "Ase." Anything ending in "ase" is an enzyme that drives the conversion process.
• Arachidonic acid is not as bad as its reputation. PG2 is made from arachidonic acid, but so are lipoxins, which are powerful anti-inflammatory agents. Lipoxins are a relatively new discovery and help to slow down inflammation. They are produced when salicylic acid is available. So take a baby aspirin or eat plenty of fruit and vegetables and your needs are covered.
• Cox-1 production is a good thing. Look at the pathway to the left of DGLA. This is a very powerful anti-inflammatory pathway that leads to the production of PGE1. This is one of the reasons why GLA is a very good thing.

The omega-3 pathway

• The prostaglandins produced via this pathway are all anti-inflammatory
• DHA also produces resolvins and protectins, which like lipoxins are a relatively new discovery.
• Resolvin reduces inflammation. Dr. Charles Serhan has done some fascinating research showing that resolvin E (which is made from EPA) inhibits activation and movement of immune cells, resulting in a decreased inflammatory response. Resolvin E has also been shown to reduce skin inflammation and periodontal inflammation in animals and do other cool things. Resolvin D (which is made from DHA) also has amazing benefits.
• As the name suggests, proteins protect us in different ways.

Factors that can promote inflammation

Trans fats

Simply put, trans fats are garbage. Look at the delta-6-desaturase enzyme in the two pathway diagrams. Trans fats prevent this step by inhibiting delta-6-desaturase. In other words, trans fats inhibit the healthy processing of fatty acids! Trans fats are also incorporated into the cell membrane and displace EFAs, increasing insulin resistance.

Alcohol

Just like trans fats, alcohol can also inhibit the activity of the delta-6-desaturase enzyme. As a result, alcoholics usually suffer from chronic inflammation. It is therefore better to hold back on alcohol.

Insulin

At this point I am referring to insulin injections. In some cases these may be a medical necessity, but those who inject insulin for its anabolic properties should be aware that it is also pro-inflammatory.

Excessive caffeine consumption

A cup or two of coffee is not a problem, but if you're drinking coffee all day long, you're also promoting inflammation.

Excessive consumption of processed carbohydrates

Constant consumption of nutrient-poor refined carbohydrates can also cause inflammation. One of the mechanisms responsible for this is that these carbohydrates make the delta-5-desaturase enzyme hyperactive. In the omega-6 diagram you can see that this enzyme converts DGLA into arachidonic acid, which produces pro-inflammatory prostaglandins.

How to detect chronic inflammation

The most commonly used way is to perform a C-reactive protein test. Many doctors also use this test to predict the risk of a heart attack. Although it is not a perfect test, it is excellent for measuring underlying chronic inflammation.

• A value below 1 mg/L indicates a low risk.
• A value of 1 to 3 indicates an average risk.
• A value of over 3 indicates a high risk!

However, you should not stop after testing for C-reactive protein.

Next, you should have an omega-3 index test done. This test for low omega-3 levels is also used as an indicator of cardiovascular disease risk. I like the idea - instead of focusing on lowering cholesterol through medication, focus on increasing omega-3 levels.

Also ask your doctor for an antioxidant level test. Levels of vitamins A and E, as well as various minerals such as selenium, can be measured. Low antioxidant levels usually mean higher levels of inflammation.

What about medication?

While I don't believe that anti-inflammatory medications are an inherently bad thing, they are used far too often and can be dangerous if abused. It's one thing to pop a few anti-inflammatories once a month, but continuous use can lead to problems.

By inhibiting the activity of pro-inflammatory prostaglandins, non-steroidal anti-inflammatories also inhibit muscle protein synthesis after exercise. In addition, anti-inflammatory junkies are unaware of the fact that chronic use of non-steroidal anti-inflammatory drugs can degrade joint cartilage. Hello arthritis.

Conventional non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, etc) interfere with the activity of cox-1 and cox-2 (look at the diagrams above to see which pathway these fall into). Cox-1 is essential for maintaining a healthy stomach. In fact, Helicobacter pylori infections that lead to stomach ulcers are often caused by non-steroidal anti-inflammatory drugs.

After the cox-2 enzyme was discovered, a new class of drugs was developed that inhibited cox-2 but left cox-1 alone. However, these cox-2 inhibitors were soon found to also increase the risk of heart attack by a factor of 4 compared to traditional non-steroidal anti-inflammatory drugs.

12 tips for controlling inflammation

1. Ensure a balance of essential fatty acids. Avoid cooking oils such as corn oil, safflower oil or other oils rich in omega-6 fatty acids.
2. Eat more cold-water fish or use fish oil capsules. Wild salmon, sardines and herring are excellent sources as they do not contain much mercury. If you are still worried about too much mercury, eat a portion of Brazil nuts every day. The selenium contained in these nuts binds mercury and renders it harmless.
3. Eat meat from grass-fed animals, as this meat has a superior fatty acid profile. Be careful though, as there is a lot of fraudulent labeling on the market. It can't hurt to know the farmer.
4. Limit the amount of processed carbohydrates. Refined sugars are "non-nutrients" - they take more from the body than they give. They also raise insulin levels, which is not catastrophic, but a constant increase in insulin levels will result in increased inflammation. Only use simple carbohydrates immediately after training and perhaps a small portion in your intra-workout shake. Alternatively, you can use a carbohydrate-free protein hydrolysate during training and avoid carbohydrates altogether.
5. Lose weight if you are overweight. Fat cells produce IL-6, TNFα and other pro-inflammatory cytokines. The fatter you are, the more of these you produce and the more inflammation you will have.
6. Get a massage. Massage is an excellent way to reduce inflammation. Try to get one or two massages every week.
7. Increase your intake of spices such as turmeric, ginger and oregano. Curcumin is a must. There are over 2000 studies supporting its use. Turmeric suppresses interleukin-6 along with other pro-inflammatory compounds. I usually recommend ginger for those who suffer from a sensitive stomach or nausea. Ginger can also block lipooxygenase. (See the omega-6 diagram to see what this can be beneficial for).
8. Avoid trans fats. That's all I have to say on this topic.
9. Avoid alcohol (or limit your alcohol intake). Slamming drinks down like it's New Year's Eve is fine occasionally - e.g. on New Year's Eve - but if your idea of moderate drinking is to limit your alcohol consumption to days ending in "g", then you probably have a problem.
10. Avoid excessive caffeine consumption.
11. Eat more fruit and vegetables. These will increase your body's antioxidant status.
12. Use antioxidants and vitamins in supplement form. If you can't eat enough food during the day or simply don't like certain foods, then use supplements. EPA/DHA and GLA supplements are the most important, but you can also add vitamins A, C, E and D, as well as some magnesium, selenium and zinc.

And that's about it

Inflammation is a complex topic and this article has only just scratched the surface. We hope we've at least given you a few ideas to consider in your quest for better health. Remember that inflammation can be a "silent killer", but that doesn't mean you shouldn't do anything about it.

References

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2. Pedersen BK, Febbraio MA. Muscle as an endocrine organ: focus on muscle-derived interleukin-6 Physiol Rev 2008;88:1379-406.
3. Palacios D, Mozzetta C, Consalvi S, Caretti G, Saccone V, Proserpio V, et al. TNF/p38alpha/polycomb signaling to Pax7 locus in satellite cells links inflammation to the epigenetic control of muscle regeneration. Cell Stem Cell 2010;7:455-69.
4. Rashad S, Revell P, Hemingway A, Low F, Rainsford K, Walker F. Effect of non-steroidal anti-inflammatory drugs on the course of osteoarthritis. Lancet 1989;2:519-22.
5. Teather LA, Packard MG, Bazan NG. Post-training cyclooxygenase-2 (COX-2) inhibition impairs memory consolidation. Learn Mem 2002;9:41-7.
6. Trappe TA, White F, Lambert CP, Cesar D, Hellerstein M, Evans WJ. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab 2002;282:E551-E556.
7. Vazquez-Vela ME, Torres N, Tovar AR. White adipose tissue as endocrine organ and its role in obesity. Arch Med Res 2008;39:715-28.

By John Meadows, Bill Willis, PhD

Source: https://www.t-nation.com/supplements/managing-inflammation