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The five characteristics of acute inflammation: pain, heat, swelling, redness, immobility

Your immune system is amazing.  When your body is infected or injured, the immediate response is to repair and keep you healthy. 

Inflammation is the immune system’s response.  Acute injuries happen quickly – a splinter in your finger, a fractured wrist from a fall, or a virus which enters through the nasal cavity – are met with an immediate, extraordinary immune response. The inflammatory response consists of five classical signs: redness, heat, swelling, pain, and loss of function. All of these responses help the body bring needed immune fighting and repair cells (white blood cells) to the area while reminding you, through pain and swelling, to pay attention and keep still or risk further damage.  This is the good part of inflammation.  The inflammatory response sticks around as long as your body needs to heal. It supersedes and alters normal functioning until the problem is solved, but this is the price you pay for healing. 

What happens when the body’s immune system tries to repair an infection or injury that does not heal?  This is known as chronic inflammation; the immune system continues its assault on the injury causing serious disease and even death to the body.  Normal functioning never returns, and the inflammatory response becomes the defacto control mechanism.  This is akin to a coup in which a military state takes over the government.  Diseases such as obesity, asthma, rheumatoid arthritis, ulcerative colitis, diabetes, cancer, heart disease are just some of the conditions either causing chronic inflammation or being caused by it.  In addition, inflammation and disease make each other worse via a cyclical feedback loop. It is an unsolved mystery because scientists do not yet know the etiology of these diseases.

Acute inflammation makes sense, but why would the body attack itself? Okin and Medzhitoz (2012) explain it as a trade off between the cost and benefit of the inflammatory response. In other words, we cannot have it both ways.  Either we have a system in place that fights foreign invaders, or we do not. Apparently, our immune system was not built for the modern world. Changes in diet, stress, sleep, toxins, and physical activity have exposed the weakness in our inflammatory response.   My immune system can fight an infection, but a donut – not so much.

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What causes chronic inflammation?

It is very complicated, but I will give you a very abbreviated explanation.  Obesity is known to cause chronic inflammation, the bad side of immunity.  Obesity is caused by excess fat found underneath muscles and surrounding organs.  Excess fat, with few exceptions, is due to an imbalance between food intake and physical exertion.  We used to think fat or adipose tissue was metabolically inert; it did nothing except act as a storage for excess energy.  Now scientists know adipose tissue helps to regulate many physiologic processes including immunity.  As an example, adipose tissue releases immune cells like macrophages, a type of white blood cell which engulfs and rids the body of microscopic toxic substances.  Macrophages release regulatory proteins called cytokines which can decrease or increase inflammation depending on the goals of the response needed. 

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White blood cells. Photo by Pixabay

In obesity, it is theorized that when fat cells enlarge, oxygen levels decrease, and this is recognized by the body as an injury.  Of course, there IS NO injury.  Adipose tissue response is to increase the release of macrophages which in turn release a greater number of inflammatory-causing cytokines.  Interlukin-6 (IL-6) is a type of pro-inflammatory cytokine that correlates positively with body mass index (BMI).  As BMI increases, so does IL-6.   The IL-6 cytokine acts in a number of ways to cause harm such as increasing blood clotting and fatty deposits in blood vessels (a feature of heart disease), oxidative stress (a feature of cancer), insulin resistance (a feature of diabetes), hypertension (a feature of renal disease), Rheumatoid arthritis, depression, and schizophrenia. 

The inflammatory response in overdrive is where it gets ugly.  Among COVID-19 patients who are critically ill, an IL-6 “cytokine storm” occurs leading to organ failure and possibly death.  At this writing, the majority of patients who become seriously ill or die from COVID-19, had one or more chronic diseases.  My own theory is a patient who already has chronic inflammation cannot handle greater amounts needed to fight the virus.  The body simply implodes trying to save itself. 

Testing for Chronic Inflammation

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Photo by Karolina Grabowska on Pexels


A common blood test that measures general systemic inflammation in the body is called C-reactive protein (CRP). Interlukin-6 triggers liver production of CRP.  C-reactive protein should be less than 1.0 mg/l of blood with increasing amounts positively correlated to seriousness of disease.  Lifestyle may also increase CRP such as sleep apnea, lack of sleep, and stress so it is not just obesity or disease state.  Interpretation of CRP levels is more nuanced and is not used by itself to diagnose disease states.  Elevated CRP could be temporary (due to a cold) and/or harmless and caused by medications, hormone therapy, pregnancy, or birth control pills. Ask your physician about your CRP level and what it means for you.

Medical treatment for chronic inflammation

Current therapy for inflammatory diseases is to try and suppress the body’s immune system.  Medications like corticosteroids and non-steroidal drugs are anti-inflammatory agents.  But there is a steep price to pay.  These drugs increase blood pressure, swelling, visceral fat (the worse type), and infection. Chronic use of these drugs is reported to cause severe adverse effects like gastrointestinal, cardiovascular, osteoporosis, and renal abnormalities. Prednisone, a common corticosteroid, can cause steroid-induced diabetes.  Tocilizumab is a drug that blocks the production of IL-6.  It is typically used to treat rheumatoid arthritis and juvenile arthritis and now is a promising treatment for severe COVID-19.  Aspirin and statins used to prevent heart attack also decrease inflammation.  Talk to your doctor about medication that is right for you. 

Lifestyle changes

This is what I came here to preach, but this is enough information for now, so look for my next post – what you can do on your own to decrease inflammation.