Addressing Inflammation in Chronic Diseases: A Functional Medicine Perspective

According to the NIH, 3 out of 5 people worldwide die from chronic inflammatory disease. This includes strokes, obesity, cancer, diabetes, heart disease, and chronic respiratory conditions. The World Health Organization has also designated chronic disease as “the greatest threat to human health.” 

With inflammation being a driving force behind the development of chronic disease, our healthcare industry needs revitalization in integrating conventional medicine and holistic avenues such as functional medicine to change how we address this epidemic. Knowing the implications of inflammation and chronic disease in our society and how to assess and treat the whole person can be a monumental turning point in healthcare. 

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Understanding Chronic Diseases 

Long-standing progressive health conditions are the crux of chronic disease. These illnesses are often complex, involving various organ systems, and are long-lasting. While chronic diseases can shift and go through periods of control, often, they are not fully cureable. Today, 60% of American adults have a chronic illness, ranging from heart disease, cancer, stroke, asthma, diabetes, arthritis, kidney disease, and depression. 

Autoimmune disease is a pertinent class of chronic diseases that leaves people feeling depleted and struggling in many ways. The various forms of autoimmunity are at an all-time high, affecting 24 million individuals in America. Those suffering from long-term conditions are frequently put on a concoction of medications to mitigate the symptoms of their conditions. Very rarely is the root cause addressed in conventional medicine, which is important as that is where true restoration and healing occur. 

While there is a crisis in how chronic disease impacts our healthcare system and acknowledgment that many of these chronic diseases are preventable through lifestyle modification, our society is failing to implement widespread holistic interventions. Understanding the basis of chronic disease, such as inflammation, is a step towards prevention care. 

Inflammation: The Culprit Behind Chronic Disease

The body's natural reaction to internal and external stressors is the basis of an inflammatory response. Inflammation occurs with acute stimuli like a bug bite, an infectious microbe, or an allergic reaction. It can also occur in a prolonged fashion in chronic conditions such as arthritis, asthma, heart disease, and autoimmunity. 

The endogenous or exogenous triggers activate an inflammatory cascade during an acute inflammatory reaction. During this perceived assault, mediators are released from the innate immune system to respond. This includes interleukins, toll-like receptors, arachidonic acid, mast cells, complement proteins, and clotting factors. At the onset of inflammation, you can see the five cardinal signs, which are redness, increased body temperature or heat to the site of injury, swelling, pain, and loss of function. These symptoms can also be present in chronic disease that has an inflammatory component. 

Chronic inflammation typically starts off as acute inflammation that has been compounded for several months (or years), and the body has lost the ability to control the response that is occurring at a persistent rate. Some common causes of chronic inflammation include infectious organisms like bacteria and parasites, constant low-level irritants (allergies), an autoimmune process, defects in cellular response, back-to-back acute inflammatory reactions, and mitochondrial dysfunction or oxidative stress due to environmental factors. 

Chronic inflammation is a contributing factor to chronic disease. What causes the chronic inflammatory response is oftentimes the same factors that are perpetuating chronic illness. These factors include lifestyle determinants of health such as diet, exercise, sleep, stress, and environmental triggers (toxins and medications). 

The Functional Medicine Perspective on Inflammation in Chronic Disease

Inflammation and chronic disease often go hand-in-hand. Evaluating what areas of your life are causing inflammation in your body is the first step to rectification. Here are some key culprits of inflammation. 

Identifying Triggers of Inflammation 

It is possible to incorporate dietary changes that can help improve chronic inflammation:

Diet and Nutrition 

Inflammatory foods can contribute to systemic inflammation. High-inflammatory diets consist of refined carbohydrates, fried foods, sugar, excessive red meat, processed meats, and butter alternatives such as margarine. These items consist of pro-inflammatory nutrients and oils such as omega-6 fatty acids and trans fats. In diets that tend to be more inflammatory rather than whole-food-based produce, lean animal-based protein, and minimally added sugar, there is a pendulum swing that perpetuates the inflammatory cascade. 

Studies have shown that when consuming more nutrient-dense foods, there are lower levels of inflammatory markers. Diet can also alter your gut microbiome. A negatively impacted gut flora can lead to dysbiosis or an imbalance in commensensal (healthy) gut microbes and “bad” gut microbes. This is oftentimes associated with a leaky gut, which creates permeability in the gut lining and can cause chronic low-grade inflammation.

Lifestyle Factors 

How you live your life day in and day out can either help heal or add fuel to the fire. If you are not getting adequate sleep or you are stressed out, the body is not able to focus on mitigating inflammation. Lack of sleep or disordered sleeping can disrupt your circadian rhythm, which impacts cortisol, hormones, and metabolism markers leptin and ghrelin. 

Poor sleep can impact your gut health, cardiovascular function, neurological status, and metabolism. While stress is inevitable in life, excessive and unmanaged stress can contribute to inflammation. Cortisol, the primary hormone pertaining to stress, can impact the HPA axis and the immune system’s response to inflammation. 

Environmental toxins 

Some of the leading environmental toxins are air pollutants, soil pollution, and water contamination. These toxins get into the body and can harm core organ systems such as the cardiovascular system, respiratory organs, the reproductive system, the nervous system, and even contribute to cancer development. Environmental exposures such as pesticides, chemicals, and heavy metals can create a microbiome disaster and impact the immune system, which triggers an inflammatory response.

Individualized Treatment Plans to Reduce Inflammation

Reducing chronic inflammation requires an individualized treatment plan:

Personalized Diet and Nutrition Recommendations 

A nutrient-dense diet that focuses on anti-inflammatory foods is an evidence-based approach to minimizing your body’s inflammatory response. When it comes to chronic illnesses such as cardiovascular disease, autoimmunity, and cognitive health, inflammation is a driving force. Consuming foods that decrease inflammation and provide optimal nutrition is essential to combat this process. 

A widely studied diet in regard to inflammation is the Mediterranean Diet. This consists of whole foods rich in polyphenols, healthy fats such as olive oil, lean protein like fish and chicken, seasonal produce, moderate dairy, minimal grains, legumes, and seeds. Many individuals also have triggers that exacerbate inflammation. Gluten and dairy are two common categories, but you should work with an integrative medicine practitioner who can run specialty tests or do an elimination diet with you to see if specific foods are worsening your condition. 

Stress Management Strategies 

The stress response can impact many areas of your health, including driving inflammation up. This can become a vicious cycle as the stress hormone cortisol is secreted by the HPA axis, which creates an inflammatory response in the body. This inflammatory response can then trigger the body to produce more cortisol. 

Hoping off this cycle takes addressing the HPA axis dysfunction, supporting the nervous system, and mitigating stress. Much of this can be accomplished through stress management, like meditation, yoga, and mindfulness. Optimal sleep is vital. This is when the body recovers and reassesses areas that need support. Aiming for 7 to 9 hours of sleep per night where you are going to bed in alignment with the circadian rhythm is an excellent start. 

Detoxification Protocols

Eliminating toxins, metabolic waste, and pathogenic organisms are some of the intended goals of detoxification. Our bodies naturally detox on a daily basis through organs of elimination and in the form of sweat, feces, urine, and tears. Supporting these areas that may be impacted by environmental toxins, a poor diet, stress, and so forth is a general guideline for detoxification. 

Supporting the organs involved in elimination, such as the liver and gut, is key to a detox protocol. Products like glutathione, milk thistle, and probiotics are supplements to consider with your practitioner. Depending on what the focus is, your protocol can be individualized. Generally speaking, increasing sweating through exercising, implementing dry skin bruising to move lymph, and staying well hydrated are all important components of a detox regimen. 

How Can You Test for Inflammation?

There are inflammatory markers you can test for that will provide helpful information in understanding your health status. These inflammatory biomarkers include:

• Erythrocyte sedimentation rate (ESR or sed rate)
• C-reactive protein (CRP)
• Neutrophil-to-lymphocyte ratio (NLR)
• Interleukin-6 (IL-6)
• Tumor necrosis factor alpha (TNF-alpha) 
• Hs-CRP (inflammatory marker pertinent to cardiovascular risk)
• Fibrinogen

Functional Medicine Labs to Test for Root Cause of Inflammation

Evaluating the root of the inflammation is vital to genuinely addressing the ongoing health issues. Peeling back the layers to uncover what is leading to chronic disease in part comes from obtaining objective data from lab findings. 

CBC 

A Complete Blood Count with Differential Test will help assess for anemias that are linked to nutrient deficiencies or chronic infections. This test will also provide the neutrophil and lymphocyte counts, which you would use to determine the NLR inflammatory value. This is calculated by dividing the neutrophil count by the lymphocyte count. When the number becomes higher than three, an inflammatory process is occurring. 

Micronutrients

An inflammatory diet can lead to nutrient imbalances. Utilizing a comprehensive test like SpectraCell's Micronutrient Test can help evaluate what nutrients you are deficient in. This test also measures fatty acids and can reveal if you have an elevation in omega-6 fatty acids like arachidonic acid. Along with clinical presentation, this is an effective way to determine if your nutrition is impacting your health. 

Cortisol

Measuring cortisol provides a depiction of how your body is managing stress. Cortisol can be evaluated as a one-time snapshot via a blood test but is best evaluated for chronic stress by doing multiple salivary Cortisol samples like ZRT Laboratory offers. This evaluates four salivary collections throughout the day, which provides the pattern of your cortisol levels throughout the day.

Comprehensive Stool Test

The GI-Map + Zonulin test by Diagnostic Solutions can detect a microbial imbalance and pick up microbes contributing to chronic illness. This test can objectively measure digestion, absorption, inflammation, and immune function. Adding zonulin to the test will provide an indicator for leaky gut, which is an objective measurement of intestinal permeability. High zonulin indicates damage to the intestinal wall tight junctions, which, if permeable, can lead to inflammation. 

Organic Acids Test (OAT) 

An OAT is a urine test that will look at biomarkers of intestinal health, vitamins and minerals, neurotransmitters, and oxidative stress. This is a comprehensive option for those who are chronically ill with digestive issues, neurocognitive conditions, or signs of systemic inflammation. Results of this test can also be helpful in cases of anxiety, depression, and diabetes. 

Environmental Toxins

Environmental toxins can accumulate in tissues, hair, and blood, which can create a total body burden that negatively impacts health outcomes. Investigating environmental toxicity through an environmental toxins panel and heavy metal test can provide comprehensive insight into your toxic load and whether or not that is contributing to inflammation and chronic disease. 

Integrating Conventional Medicine and Functional Medicine 

Integrative healthcare is taking the necessary components of conventional medicine and blending in the holistic approach of functional medicine. There is a time and a place for each of them, especially when managing chronic health conditions. Oftentimes, patients do need diagnostic testing, like an endoscope or cardiac-specific testing, to help assess where dysfunction is occurring. Cultivating a partnership between both worlds is the best way to assist a patient in achieving their desired health outcomes. 

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Summary

The inflammatory response is a built-in mechanism that has allowed our species to survive on this planet. While it’s necessary in acute situations, a persistent inflammatory response due to lifestyle, environment, and diet can play a detrimental role in the development of chronic illness. 

Chronic disease is a growing epidemic in this country, which needs to be addressed in a multi-disciplinary approach. Looking for the root cause of dysfunction through functional medicine testing and a thorough clinical evaluation can provide a basis for integrative medicine and conventional medicine to address the foundations of health and chronic disease collaboratively.