Your inflammation marker is the most important indicator of your present and future health status– but how do you test it, and what actions can you take if the result is less than ideal?
If I were asked to select one laboratory test that would accurately reflect my current and future health, it would be the inflammation marker. The risk of inflammation can be traced back to early childhood, and its effect can persist throughout life. The marker accurately predicts your life span, physical and mental health, ageing process, and disease profile.
What is inflammation?
Inflammation is a body’s defence mechanism against invading organisms and is instigated to repair damage. Non-infective triggers are due to body tissue damage, such as a blockage of an artery in heart attacks, physical injury, or exposure to heavy toxins or excess alcohol. Acute inflammation can become life-threatening if not regulated, such as an overwhelming infection leading to septic shock.
The mechanism of inflammation (the science bit!)
Inflammation can occur due to infective or non-infective causes. It is triggered by chemicals released from microbial agents, scientifically known as Pathogen-Associated Molecular Patterns (PAMPs), or body tissue damage (as a sign of danger), known as Danger-Associated Molecular Patterns (DAMPS).
These chemicals signal receptors on the immune cells known as the Tall-like (TLR), which activates an intercellular inflammatory cascade. The cascade propagates and reaches the nucleus to produce a genetic code, NF-kB, which releases the inflammatory cytokines, chemicals the body uses to mount an inflammatory response.
Why are we concerned about inflammation?
Because inflammation is the primary cause of insulin resistance (IR), if we pin down IR to one culprit, it will be inflammation. Without inflammation, IR, which prevents sugar delivery to the body’s cells and causes metabolic syndrome, would never happen. Before you conclude that inflammation is harmful, please let me explain more about it.
Inflammation is divided into two main types – acute and chronic. Acute inflammation is necessary to maintain the body’s structure and may save lives. For example, if you cut your finger, the site swells and becomes warm, red and painful. These are the cardinal signs of inflammation described by the Roman writer Aulus Celsus. Galen, the Roman physician and surgeon, added a fifth sign – loss of function.
However, we must understand the purpose of triggering the inflammatory response and what your body wants to achieve.
The body increases the circulation to bring the immune system to the injured area. The immune system will determine the cause of the emergency and whether there are microbes to fight. After dealing with the cause, the immune system will ‘clear the rubble’ and clean the area, a crucial step before the repair is completed to maintain the body’s structure.
Acute inflammation is good; chronic inflammation is bad
Chronic inflammation is the underlying cause of insulin resistance and metabolic syndrome. It is a 24/7 low-grade inflammation with no apparent purpose except to destroy bodily tissue and cause disease. It’s a no-brainer to pick sugar as the culprit. But which type of sugar is the worst?
Simple sugar and processed refined carbs, broken down into sugar, trigger inflammation in the first place.
Foods that trigger inflammation
The Western diet is the primary cause of chronic low-grade inflammation. Simple sugar or processed carbohydrates cause inflammation and insulin resistance. High fructose corn syrup (HFCS) renders the liver and muscles insulin-resistant, fuels an irresistible appetite, and raises uric acid, well known to cause gout but not as an insulin resistance marker.
Processed and refined carbohydrates, such as cereals, bread, highly polished white rice, pasta, pizza and biscuits, can also cause inflammation. They break down instantaneously into glucose and raise blood sugar quickly, giving a sugar spike followed by a sugar crash.
Vegetable cooking oils, such as corn, sunflower and safflower, are a double whammy. They contain the pro-inflammatory omega-6 and are heat-labile. Together with trans-fat in fast and restaurant food, these are common causes of inflammation and insulin resistance.
Allergens can also trigger inflammation. Gluten is the main offender in this group, but so are dairy, soy, eggs and peanuts.
Ultra-processed foods change the gut microbiome
The Western diet is low in fruits, vegetables, beans, nuts and seeds but high in simple sugar, refined carbs and ultra-processed foods (UPF). UPF damages health due to lack of fibre (prebiotic), necessary to feed the beneficial bacteria. Again, UPF is the preferred food for harmful gut bacteria. The Western diet tips the balance in favour of harmful bacteria, which release toxins known as lipopolysaccharides (LPS) that damage the gut lining, making holes in the gut wall and leaking into the bloodstream to ignite chronic low-grade inflammation.
Studies revealed that UPF increases body fat mass and causes obesity. Another study confirmed that Zonulin (a marker of leaky bowel) was elevated in obese children and adults.
A third exciting study found that UPF activates multiple inflammatory pathways in older adults, explaining multiple comorbidities prevalent in this age group.
Belly fat
Food usually initiates chronic low-grade inflammation, but visceral fat is the typical source that keeps it on 24/7. As an endocrine and metabolic organ, belly fat produces inflammatory cytokines. This induces chronic low-grade inflammation, the hallmark of insulin resistance.
The belly (visceral) fat releases inflammatory mediators such as tumour necrosing factor alpha (TNFA) and Interlaken I and 6 (IL1 and IL-6). IL-6 is an endocrine cytokine that controls appetite and energy storage. It stimulates the liver to produce the inflammatory marker CRP.
Belly fat triggers inflammation through another mechanism – the typical adipocytes (fat cells) increase in number (hyperplasia) to store more fat. However, visceral (belly) fat cells increase their size (hypertrophy). Having giant cells storing too much fat can lead to areas of hypoxia (low oxygen) that can result in cell death or damage, releasing DAMPs to mount chronic low-grade inflammation and IR.
Studies have documented that visceral obesity accelerates the ageing process and increases the risk of heart disease, stroke, dementia and cancer.
Other consequences of inflammation
Besides insulin resistance, inflammation can damage the blood vessel lining (endothelial) cells and result in high blood pressure. It can raise cholesterol levels and increase the risk of heart disease, stroke and diabetes. It also causes muscle loss (sarcopenia) in young and older adults.
How do we measure chronic low-grade inflammation?
Some of my smart patients often challenge me when I start talking about inflammation. They are reluctant to buy the inflammation theory to explain their insulin resistance, referring to having recent blood tests that showed normal inflammatory markers.
The standard tests (ESR and CRP) are excellent for detecting inflammation due to infection but not due to a metabolic derangement. To assess low-grade inflammation, the hallmark of insulin resistance, we need a member of the inflammatory panel, sensitive enough to detect low-grade inflammation, which is high-sensitivity CRP (hs-CRP).
hs-CRP test measures the same protein as standard CRP and can provide prognostic values. A person with hs-CRP within the highest quartile value has 2 to 4 times the risk of developing vascular disease. hs-CRP test can also help detect certain types of food intolerance (IgG), and monitor response to dietary protocols, and assess general health and well-being.
Simple observations showed that weight gain raises hs-CRP, and weight loss brings it down within the normal range.
To enjoy good health, you should avoid inflammation (low hs-CRP) and maintain a high adiponectin level.
Adiponectin is an anti-inflammatory agent.
Adiponectin is a hormone produced by fat cells. Known for promoting insulin sensitivity and for its anti-inflammatory effect. It increases local nitric oxide production, which relaxes arteries and lowers blood pressure. Low adiponectin is associated with obesity and is typically an indicator of metabolic syndrome. It raises blood sugar, blood pressure, and triglyceride whilst lowering HDL (the good guy) cholesterol. A reduced level of adiponectin predicts high cardiovascular mortality.
Skeletal muscle also releases CRP and other inflammatory cytokines into the bloodstream, mainly during low physical activity. A sedentary life is conducive to insulin resistance, high blood pressure, and loss of muscle mass (sarcopenia), which increases the risk of metabolic conditions such as diabetes, heart disease and non-alcoholic fatty disease.
A large study followed physically inactive individuals who achieved the recommended 150 minutes of moderate-intensity aerobic activity per week. Found that the incidence of diabetes plummeted by 26% and cardiovascular mortality by 23%. Another study reported a 40% lower risk of Alzheimer’s dementia in individuals who remain physically active.
Chronic low-grade inflammation was not reported in people who remain physically active, eat minimally processed foods, and are exposed to less pollution. However, 30% of people worldwide and 50% of American adults are physically inactive.
The ultimate prescription to lower chronic low-grade inflammation
An anti-inflammatory lifestyle comprises whole food, a nutrient-dense diet of wholegrain, beans and legumes, fruit and vegetables. The diet is rich in anti-inflammatory, rainbow antioxidants, and healthy fats – nuts, seeds, avocado, fish, olive and coconut oils. The Mediterranean diet is at the top of the league with well-documented health benefits. Other healthy lifestyle factors include restful sleep, regular physical activity, reduced stress levels and tender loving relationships.
Saunas, separately or combined with cold showers, increase blood circulation and improve tissue oxygenation, positively impacting inflammation. Vagus nerve stimulation, like humming or using devices, is another anti-inflammatory treatment well documented in the medical literature and effectively reduces chronic low-grade inflammation. Visiting places of worship is also reported to lower inflammation, with benefits that continue for many years.
So, my friends, you can see how crucial your inflammation marker is in determining your health profile. hs-CRP is the most important barometer of your well-being. It is cheap and available everywhere. If you are worried about your health in this respect, then I would be only too happy to check your inflammation. As you have seen, if the results are less than ideal, the remedy is straightforward and well within your capability to follow.
Please share your thoughts and questions by commenting on this piece, and please subscribe to the newsletter so you don’t miss further vital information. Thank you!
References
Chronic inflammation in the aetiology of disease across the life span
https://www.nature.com/articles/s41591-019-0675-0
Inflammatory responses and inflammation-associated diseases in organs
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805548/
Acute Inflammatory Response
