What is inflammation?

Inflammation is a biological response of the body's immune system to harmful stimuli such as pathogens or damaged cells. It is a protective mechanism and allows the healing process to begin. Inflammation can be classified as either acute (short-term) or chronic (long-term), it is a critical component of the body's healing process but when it becomes chronic, it can contribute to various diseases and health issues. Therefore, managing inflammation is essential for overall health and well-being. 

What causes inflammation?

There are many causes for inflammation, here are a few examples below:

• Infections: Bacteria, viruses, fungi, and parasites
• Physical injury: Cuts, scrapes, or other physical trauma
• Chemical irritants: Exposure to harmful chemicals can cause inflammation.
• Autoimmune reactions: The body’s immune system mistakenly attacks healthy tissues, leading to conditions such as lupus or rheumatoid arthritis.
• Chronic diseases: Conditions like diabetes, obesity, and cardiovascular disease are associated with chronic inflammation. 

How is inflammation diagnosed? 

Inflammation can be recognised through a blood test. The biomarkers that can help us spot inflammation are C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) which can be elevated. A full blood count is also a useful tool, specifically looking at the white blood cells which are part of our immune system, if these are elevated it can be a sign of an inflammatory response.

The normal CRP level for adults is 0-5 mg/L, an elevated result would be over 5mg/L. The timing of the blood test for CRP can affect results and the best time to take the test is between 8 am and 10 am. CRP levels rise following exercise; it is best to carry out the test before your workout or a few days after. The ESR measures the rate at which the red blood cells separate from the plasma and fall to the bottom of a test tube. The rate is measured in millimetres per hour (mm/hr). The normal range for ESR is 0-22 mm/hr for men and 0-29 mm/hr for women.

The blood test highlights if something is going on, but it doesn’t tell us exactly what it is, therefore, further investigation would be required such as:

• Imaging: X-ray, ultrasounds, Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan
• Biopsy: Tissue sample
• Allergy tests: To determine if inflammation is due to an allergic reaction.
• Microbiological tests: Cultures
• Rheumatoid arthritis: Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies.
• Systemic Lupus Erythematosus (SLE): Antinuclear antibodies (ANA) test.
• Inflammatory bowel disease (IBD): Endoscopy and biopsy of the gastrointestinal tract.

What’s the difference between acute and chronic inflammation?

Acute and chronic inflammation are two types of inflammatory responses that the body uses to address different types of harm or injury. They differ in their onset, duration, characteristics, and the underlying mechanisms involved.

Acute inflammation is a rapid and typically beneficial response aimed at resolving the initial cause of harm and healing tissue, while chronic inflammation is a prolonged and potentially harmful response that can lead to tissue damage and contribute to chronic diseases.

Gut inflammation

Gut inflammation refers to the inflammatory response within the gastrointestinal (GI) tract. It can affect any part of the digestive system, from the stomach to the rectum. Gut inflammation can result from various causes including infections (bacterial, viral or parasitic), autoimmune disorders (Crohn's disease and ulcerative colitis), food sensitivities (coeliac, lactose) and lifestyle (stress, diet or over-the-counter medications such as long-term use of ibuprofen)

• Abdominal pain: Cramping or persistent pain in the abdomen.
• Diarrhoea
• Constipation
• Bloating and flatulence
• Blood in stool: Visible blood or black, tarry stools. Always see a doctor if you see blood in your stools.
• Fatigue
• Nausea and vomiting

Treatment of gut inflammation:

There are a few ways we can support our gut and reduce inflammation through our diet such as elimination diets to identify trigger foods. You might have heard of a diet called the AIP diet or the auto-immune protocol. This diet has an elimination phase and a re-introductory phase.

Specific diets such as gluten-free for coeliac disease or low FODMAP which stands for Fermentable oligosaccharides, disaccharides, monosaccharides and polyols for IBS. An anti-inflammatory diet that is rich in fruits, vegetables, whole grains, and healthy fats is a good option too.

Alongside diet, our lifestyle can affect gut inflammation. Focusing on stress management through yoga, meditation and counselling can help. Ensuring you get regular exercise and keep hydrated all make a difference to systemic inflammation.

However, despite making these changes inflammation can persist and there might be a need for medications such as corticosteroids, immune modulators such as Azathioprine and methotrexate, biologic therapies, and probiotics such as Gut Love to restore gut flora balance.

Exercise-induced inflammation

Exercise-induced inflammation is a natural and often beneficial response that occurs in the body following physical activity. This type of inflammation can help with muscle repair and adaptation, contributing to increased strength and endurance. However, if not managed properly, it can also lead to overtraining and injury. 

Mechanisms of exercise-induced inflammation

• Microtrauma: Exercise, especially high-intensity or resistance training, causes small-scale damage (micro trauma) to muscle fibres. This damage triggers an inflammatory response to repair the tissues.
• Immune response: White blood cells, including neutrophils and macrophages, migrate to the site of muscle damage. These cells release cytokines and growth factors that promote inflammation and initiate the healing process.
• Oxidative stress: Physical activity increases the production of reactive oxygen species (ROS), which can contribute to inflammation. The body’s antioxidant defence usually manages ROS, but excessive production can lead to oxidative stress and inflammation.

Signs of exercise-induced inflammation:

• Muscle soreness or delayed onset muscle soreness (DOMS), typically occurring 24-72 hours after intense exercise.
• Swelling
• Redness and heat: Mild redness and warmth in the muscles due to increased blood flow.

Managing exercise-induced inflammation:

• Rest and recovery: Incorporating rest days and active recovery (light activities) is essential.
• Proper nutrition:
• Protein: Essential for muscle repair and growth.
• Antioxidants: Found in fruits and vegetables, help combat oxidative stress.
• Hydration: 2-3 litres of fluid daily. Ensuring electrolytes are also balanced.
• Ice and heat therapy:
• Ice can reduce acute inflammation and pain immediately after exercise.
• Heat can help relax muscles and improve blood flow during recovery.
• Massage and foam rolling: These techniques can help reduce muscle tension and promote blood flow, aiding in the recovery process.
• Supplements
• Curcumin: The active ingredient in turmeric, has anti-inflammatory properties.
• Fish Oil: Rich in omega-3 fatty acids, can reduce inflammation.

How to avoid excessive inflammation

• Gradual Progression:
• Gradually increasing the intensity and duration of exercise can help prevent excessive inflammation and injury.
• Listening to your body:
• Paying attention to signs of overtraining, such as persistent soreness, fatigue, and decreased performance.
• Adjusting training intensity and volume based on how the body feels.
• Balanced training:
• Incorporating a mix of strength training, cardiovascular exercise, flexibility, and mobility work to balance stress on the body.

Menopause and inflammation

Menopause is a natural biological process that marks the end of a woman's menstrual cycles and reproductive years, typically occurring in the late 40s to early 50s but can be earlier. This transition is accompanied by significant hormonal changes, particularly a decline in oestrogen levels, which can influence various physiological processes, including inflammation.

• Hormonal changes and inflammation
• Decline in oestrogen: Oestrogen has anti-inflammatory properties, and its decline during menopause can lead to increased inflammatory activity. Lower oestrogen levels can affect the immune system, potentially leading to a heightened inflammatory response.
• Increase in pro-inflammatory cytokines: Postmenopausal women often show higher levels of pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α). These cytokines play a role in various inflammatory and autoimmune conditions.
• Health implications of increased inflammation
• Cardiovascular disease: Increased inflammation is a risk factor for cardiovascular diseases (CVD) putting menopausal women at higher risk of developing heart disease.
• Osteoporosis: Inflammation can accelerate bone loss, contributing to osteoporosis. Oestrogen helps maintain bone density, and its decline can lead to increased bone resorption and decreased bone formation.
• Metabolic changes: Menopause is associated with changes in body composition, such as increased abdominal fat, which is often visceral fat, this is metabolically active and can produce inflammatory cytokines, further increasing systemic inflammation.
• Joint pain and arthritis: Many women report increased joint pain and stiffness during and after menopause. Oestrogen deficiency can contribute to the development of osteoarthritis and other inflammatory joint conditions.
• Cognitive health: Chronic inflammation is linked to neurodegenerative diseases such as Alzheimer’s. The decline in oestrogen may impact brain health and increase the risk of cognitive decline.

• Treating inflammation during the menopause:
• Hormone Replacement Therapy (HRT): Can help alleviate menopausal symptoms and may reduce inflammation by replenishing oestrogen levels - HRT is not suitable for everyone and should be discussed with a healthcare provider considering the risks and benefits.
• Supplementation:
• Vitamin D and Calcium: Important for bone health.
• Turmeric (Curcumin): Has anti-inflammatory properties.
• Probiotics: Can support gut health, which is linked to systemic inflammation.

Arthritis

Arthritis is a general term that refers to inflammation of the joints. There are several types of arthritis, each with different causes and manifestations, but inflammation is a common underlying feature. 

Types of Arthritis:

• Osteoarthritis (OA): The most common form of arthritis characterised by the breakdown of cartilage in the joints. Traditionally considered a "wear-and-tear" disease that involves low-grade inflammation. Common symptoms include joint pain, and stiffness, which often occur in hips and knees.
• Rheumatoid arthritis (RA): An autoimmune disease where the immune system attacks the synovium (lining of the joints). Chronic inflammation leads to the thickening of the synovium, which can damage cartilage and bone. Common symptoms include symmetrical joint pain, swelling, stiffness (especially in the morning) and fatigue. 
• Psoriatic Arthritis (PsA): An inflammatory arthritis associated with psoriasis, a skin condition. Inflammation affects both the skin and joints. Common symptoms include joint pain, stiffness, swelling, and skin plaques characteristic of psoriasis. 
• Gout: A type of arthritis caused by the accumulation of urate crystals in the joints. Urate crystals trigger an intense inflammatory response. Common symptoms include sudden, severe attacks of pain, redness, and swelling, typically in the big toe. 

Lifestyle Modifications for managing inflammation in arthritis

• Exercise: Regular, low-impact exercise can reduce joint pain and improve flexibility and strength.
• Weight management: Maintaining a healthy weight reduces stress on weight-bearing joints.
• Physical and occupational therapy: Therapists can provide exercises to improve joint function and suggest assistive devices to reduce joint strain.

Alternative therapies:

• Acupuncture: May help reduce pain and improve function in some individuals.
• Herbal supplements: Turmeric (curcumin), ginger, and other supplements have anti-inflammatory properties.
• Surgical interventions: In severe cases, joint replacement or repair surgeries may be necessary to restore function and relieve pain. 

How to reduce inflammation

Reducing inflammation in the body involves a multi-faceted approach that includes dietary changes, lifestyle modifications, and sometimes medical interventions.

Lifestyle modifications

• Regular exercise:
• Moderate exercise: Activities like walking, swimming, and cycling can reduce inflammation. Aim for at least 30 minutes of moderate exercise most days of the week.
• Strength training: Helps build muscle and improve metabolic health.
• Maintain a healthy weight: Excess body fat, especially around the abdomen, is linked to increased inflammation. Achieving and maintaining a healthy weight through diet and exercise can significantly reduce inflammation.
• Stress Management:
• Mindfulness and meditation - Reduce stress through meditation, self-care, journalling, and mindset
• Adequate sleep: Aim for 7-9 hours of quality sleep per night. Poor sleep can increase inflammation.
• Hydration: Drink plenty of water throughout the day to help flush out toxins and support overall health.
• Environmental: Minimise exposure to environmental pollutants and chemicals. Household Products – try to use natural and non-toxic cleaning and personal care products.
• Smoking: Quit smoking to reduce inflammation and improve overall health.

Inflammatory and anti-inflammatory foods:

Here are some of the top pro-inflammatory foods. Consuming these foods excessively may contribute to inflammation in the body. Conversely, incorporating anti-inflammatory foods can help reduce inflammation.

Best supplements for pain and inflammation – Turmeric

Turmeric is often praised for its anti-inflammatory properties due to its active compound called curcumin a bioactive compound which is a potent anti-inflammatory agent. Curcumin has been shown to inhibit inflammatory molecules in the body, such as cytokines (TNF-alpha, interleukins), enzymes (COX-2), and transcription factors (NF-kB), which play a key role in the inflammatory process. Curcumin modulates several signalling pathways involved in inflammation, which helps reduce inflammation at the molecular level.

Curcumin acts as a powerful antioxidant, neutralizing free radicals that contribute to oxidative stress and inflammation. Scavenging free radicals and enhancing the activity of antioxidant enzymes in the body, curcumin helps protect cells from oxidative damage.

Curcumin has potential benefits for cardiovascular health by improving endothelial function, lowering cholesterol levels, and reducing inflammation in blood vessels.

Some research indicates that curcumin may support brain health by promoting neuroplasticity and reducing inflammation associated with neurodegenerative diseases.

Curcumin’s bioavailability is typically low when taken alone. However, combining it with piperine (found in black pepper) enhances absorption and can improve its effectiveness. Our Natruflex Turmeric contains piperine and magnesium to help aid absorption and improve muscle and nerve function.

A common question – Is coffee inflammatory?

The relationship between coffee consumption and inflammation is complex and can vary based on individual factors.

Potential anti-inflammatory effects of coffee:

• Coffee is rich in antioxidants.
• Polyphenols
• Liver Health: Some studies suggest that coffee consumption may protect against liver inflammation and reduce the risk of liver diseases like non-alcoholic fatty liver disease (NAFLD).

Caveats:

The effects of coffee on inflammation can vary among individuals. Some people may experience increased inflammation or sensitivity to caffeine. Caffeine is a stimulant found in coffee and can affect individuals differently. In some people, excessive caffeine intake may contribute to inflammation or exacerbate existing inflammatory conditions. Sweeteners and creamers added to coffee can contain sugars, artificial additives, or trans fats, which may promote inflammation if consumed in excess.

Coffee is acidic, and some people with gastrointestinal conditions may experience irritation or inflammation in the digestive tract.

Current research and findings:

• A systematic review and meta-analysis published in the British Journal of Nutrition (2014) found that moderate coffee consumption was associated with lower levels of markers of inflammation, such as C-reactive protein (CRP).
• Another study published in the American Journal of Clinical Nutrition (2016) suggested that coffee consumption was inversely associated with markers of inflammation, but the effects varied by genetic factors and individual response.

• On the balance of risk, it is probably best to consume coffee in moderation (typically 1-3 cups per day) is generally considered safe. However, pay attention to how your body responds to coffee. If you notice increased inflammation, digestive issues, or other adverse effects, consider reducing your intake. Another thing to consider is organic coffee to minimise exposure to pesticides and other contaminants.

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Charlotte Parker-Lennox

Charlotte is a pharmacist with 6 years of experience working in retail pharmacy and integrated urgent care (IUC) alongside nurses, paramedics and doctors. She has changed the direction of her career to support people with a holistic approach to wellness by treating the root cause of your health concerns. She enjoys an outdoor challenge, completing marathons and cycling adventures around the UK.