Nearly all sick people have inflammation. If you are struggling with any kind of chronic health problem, it is almost a sure bet that inflammation has a role in your condition. Inflammation is easily linked to arthritis, cardiovascular disease, diabetes, depression, and autoimmune conditions such as hypothyroidism and fibromyalgia. Take a look around you and you’ll see that people are selling anti-inflammatories everywhere! There are vitamins, fruit drinks, and anti-inflammatory diets, but what does this all mean? Is all inflammation bad? Are all anti-inflammatories basically the same? Should everyone take anti-inflammatories or is there a way to test to see if you have inflammation? These questions and more are the topic of today’s post.
Hello, I’m Dr. Warren and welcome to my blog. Over the past few weeks and months we have been talking about various hormone tests, thyroid tests, stool tests, etc. that I recommend and use in the office. I strongly believe in customized, individualized health assessment. I do not get people better in my clinic because I have magic vitamins or fancy gadgets no one else has. I get people better because I can accurately assess someone’s problem and get them exactly what they need to get better. Today we are going to talk about inflammation because inflammation is the great magnifier. It makes anything worse.
If I am treating someone and identify a thyroid problem, arthritis, depression, or anything else I always ask “Is inflammation pouring gasoline on the flames of this health problem?” If it is, then getting rid of excess inflammation is an absolute must for that person’s health.
Today I am going to take you through my thought process. I will divide my thoughts into three questions (I will get through the first two today, and the third will take a separate post). The three sections will be the following:
- How is inflammation related to your health or illness?
- Are any of your tests for inflammation present?
- How can I best help get rid of your specific type of inflammation?
Let’s start at the beginning.
How is inflammation related to your health or lack of health?
I would like to start by saying inflammation is a normal, healthy process. Inflammation is designed as a system for your body to repair injury from any cause including bacteria, chemicals, and trauma[i]. This is a very good system in response to acute injury (like rolling an ankle). However, this process is not meant to be turned on chronically, and that is where we run into health problems.
Chronically elevated inflammatory chemicals prevent your body from thriving and growing. Think of an army base on high alert where the soldiers cannot sleep. This is a good thing if a threat is imminent, but how long can the base go on like that without adequate sleep?
Chronically elevated inflammatory markers are active in many conditions, such as inflammatory bowel disease, arthritis, gastritis, asthma, atherosclerosis, insulin resistance, obesity, intestinal permeability (leaky gut), poor hepatic biotransformation (detoxification) and autoimmune diseases[ii],[iii],[iv].
In case that last paragraph went by too quickly. Inflammation is associated with the following:
- Inflammatory bowel disease
- Insulin Resistance
- Intestinal permeability (leaky gut)
- Poor hepatic biotransformation (detoxification)
- Autoimmune diseases like:
- Thyroid disease
- Rheumatoid Arthritis
Is the list long enough for you? That’s the point! If you are suffering from a chronic disease, you must know if inflammation is a major player in helping you get healthy again. Remember inflammation is the great magnifier. It just makes things worse!
How can we test for inflammation?
We’ve just talked about how inflammation can magnify or cause many different diseases. This next section is devoted to testing to see if you have inflammation. Why do we need to test? We need to test because it is wrong to assume everyone has inflammation! I’ve had sellers of various anti-inflammatory health products in my office and their sales pitch is basically stating that everyone is inflamed in America so everyone will benefit from *insert their product here*. I could not disagree more. Let me tell you about two patients who came into my office recently.
A few weeks ago I gave two reports to very similar patients. Both were struggling with chronic fatigue and chronic pain, but one patient has a ton of inflammation contributing to her symptoms and the other did not. In one week on some specific anti-inflammatories (tumeric and resveratrol) the one with inflammation felt better! The patient without inflammation told me while we were talking, “Yeah I’ve tried an anti-inflammatory diet and turmeric before because it helped my friend, but it doesn’t do anything for me.” I was not surprised when she had no signs of inflammation on my testing. I believe in individualized assessment. If you have inflammation, then the right anti-inflammatory can make a world of difference. If you don’t have inflammation, then anti-inflammatories are not where you should spend your hard earned money.
The following is a short list/description of some inflammatory markers I run on almost every patient.
- CRP: C reactive protein is the “gold standard” for inflammation. We want to see patients with it below 1 and definitely below 3. If your CRP is elevated then inflammation is present.
- Ferritin: Ferritin is the stored form of iron in the body, but this also goes up with inflammation. To tell if a high ferritin is from an overload of iron or inflammation we correlate it with other iron markers. This marker is an absolute must for identifying iron overload, iron deficiency, and inflammation.
- TIBC: Total Iron Binding Capacity goes down in the presence of inflammation. When I see a TIBC under 250 I am suspicious of inflammation.
- Fibrinogen: This is a component for blood clotting. This goes high with inflammation because your body is preparing for a fight and a possible bleed. It wants your blood to be extra sticky so it can plug bleeds quickly. This is good if you are in a knife fight, but bad for your arteries if the inflammation sticks around for a long time.
- High HDL Cholesterol: This is one that surprises many people. Several of my patients are struggling with health problems, but are very proud (and their cardiologist is very proud) that their “good” HDL cholesterol is so high. Unfortunately, sometimes good is too good to be true. HDL loses its protective value in the presence of inflammation[v],[vi]. The enzyme paraxonase can increase its activity with inflammation pushing the HDL high. In my practice, I am suspicious of autoimmune diseases and inflammation when a patient has an HDL above 75.
I would like to stress that if any of these markers are positive it can be indicative of inflammation. Sometimes patients (or even doctors) will argue that if the CRP is not elevated then there is no inflammation. This is just an oversimplification and plain wrong! If the CRP is elevated you absolutely have inflammation, but if it is low that doesn’t mean you are free of inflammation!
Finding the source of Inflammation
While these tests are terrific for helping us identify inflammation, they do not tell us where the inflammation is coming from. To start that process a couple other tests can be helpful.
Follow up Testing:
- WBC w/ differentials. Your white blood cells (WBC) fight infections, which are a major source of inflammation. In my office we use 5-8 as our normal, healthy range for WBC. If the WBCs are low I am suspicious of a chronic infection. For further clue on what type of infection you can look at the white blood cell differential.
- Neutrophils fight bacteria. I become increasingly suspicious of a bacterial infection as neutrophils >70.
- Lymphocytes fight a virus. I become increasingly suspicious as lymphocytes >40 of a viral infection.
- Eosinophils fight parasites: Healthy range <3
- LDH: This is an enzyme called lactate dehydrogenase and it is released from cells in the body as they die. When elevated you can run isoenzymes and break down into LDH1, LDH2, LDH3, LDH4, LDH5 to find exactly where it is coming from in the body.
- Transaminases: This is a group of markers on a blood test called AST, ALT, and GGT. Once again these enzymes are released as tissue is damaged and can help a doctor narrow down and pinpoint a specific part of the body that is under duress.
Solving the Inflammation Problem
As a quick recap we’ve just talked about how inflammation is “The Great Magnifier”. It can make any condition much worse. Because it is so important, it is a good idea to test for it and then try and identify where it is coming from.
Now that we are through that, we can talk about how to get rid of inflammation! My next post will be dedicated to different types of inflammation and how to solve them. Come back next week as we talk about glutathione, turmeric, resveratrol, pycnogenol, green tea, grape seed extract, Echinacea, anti-inflammtory diets, vitamin D, fish oil, and which one might be right for eliminating your inflammation!
[i] Guyton and Hall. Textbook of Medical Phsyiology. 2006. P434.
[ii] Ruland J. return to homeostasis: downregulation of NF-kB responses. Nat Immunol. 2011 Jun 19;12(8):709-14.
[iii] Zhao Y, Krishnamurthy B, Mollah ZU, Kay TW, Thomas HE. NF-kB in type 1 diabetes. Inflamm Allergy Drug Targets. 2011 Jun; 10(3):208-17.
[iv] Barbarroja N, Lopez-Pedrera R, Mayas MD, Garcia-Fuentes E, Garrido-Sanchez L, Macias-Gonzalez M, El Bekay R, Vidal-Puig A, Tinahones FJ. The obese healthy paradox: is inflammation the answer? Biochem J. 2010 Aug 15;430(1):141-9.
[v] Van Lenten B, Navab M, Shih D, Fogelman A, Lusis A. The Role of High-Density Lipoproteins in Oxidation and Inflammation. Trends in Cardiovascular Medicine 2001 May: 11(3-4):155-161.
[vi] Ansell B, Fonarow G, Fogelman A. The paradox of dysfunctional high-density lipoprotein. Current Opinion in Lipidology 2007 Aug; 18(4):427-434.
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