The Inflammation Spectrum, page 3
Personality. Glass half full or half empty? Artistic or logical? We are all different in so many ways, and that too is an aspect of bio-individuality—and related to inflammation.
Bio-individuality is also the main reason a conventional medicine approach helps some people but doesn’t help many other people to resolve their symptoms or discover the root of their health or weight issues. This is because doctors who practice conventional medicine are trained in a system oriented toward grouping and categorizing, rather than focusing on the individual.
This is how mainstream medicine diagnoses and treats diseases: When a lot of different people are observed to have the same general set of symptoms and lab test results, their condition is given a name, such as hypothyroidism, rheumatoid arthritis, or depression. These names are given diagnosis codes, which are a set of numbers and letters.
Medications are then assigned to these diagnosis codes based on how well research studies show those medications normalize lab results and diminish symptoms in some percentage of selected groups of people. For example, if medication X relieves the symptoms of fatigue in 52 percent of those whose symptoms match hypothyroidism, then that medication may become a standard prescription for hypothyroidism.
But what about the people whose health issues don’t fall into a predetermined set of symptoms? What about the other 48 percent of the people whose symptoms were not relieved by the recommended medication? This medicinal matching game plays the odds, so you can hope that you will be one of the lucky ones, but many people are not. For many, there is no associated medication for their symptoms, so they are sent home without help. For others, the medication assigned doesn’t help symptoms because they do not have the same cause as someone else for whom the medication works. Or the medication may relieve the symptoms, but also cause intolerable side effects—sometimes worse than the original symptoms! And then there are those people who question whether they really need to take any drugs. They want to know if there are more natural ways to address their symptoms and a more effective way to stop or reverse the disease process.
Moreover, what if your symptoms are vague and the lab test results are “normal”? If your symptoms fall neatly into the correct category and the standard medication works to manage your symptoms, great. But if you are an outlier with atypical symptoms or reactions to medications, or if you are more interested in healing your condition than in masking the symptoms with drugs, you may have trouble getting help using this conventional medicine model.
As you can see, there are many exceptions to the rules that define conventional medicine. The patients who represent those exceptions are the ones who most often come to me when the mainstream medical system does not work for them. They are in the group of people who are not helped by the medications they are given, or whose symptoms defy mainstream categorization, or who just aren’t getting the help they need.
But the real problem is not that the person’s symptoms don’t fit some predetermined model. The problem is that the model does not account for bio-individuality. If you gathered five people with the same conventional medicine diagnosis code in a room together, all on the same treatment, and asked each person how his or her treatment was going, you would probably get five different answers because each of those people has different genetics, a different microbiome, and a different biochemistry, and may have quite different reasons for their seemingly similar symptoms. It’s a complex picture. Fortunately, it has a common denominator.
THE INFLAMMATION SPECTRUM
Understanding inflammation is one of the most important aspects of understanding how bio-individuality can be used for better health in you. When you dive deeply into just about every health problem that we face in the world today—anxiety, depression, fatigue, digestive problems, hormone imbalances, diabetes, heart disease, or autoimmune conditions—they are all inflammatory in nature or have an inflammatory component.
But inflammation is insidious, and it starts brewing in the body long before these diseases become noticeable, not to mention diagnosable. By the time a health problem is advanced enough to be officially diagnosed, inflammation has typically already caused significant damage to the body. For instance, a diagnosis of autoimmune adrenal issues (such as Addison’s disease) requires a 90 percent destruction of the adrenal glands.2 This is true for many other chronic issues—major destruction has to happen for the diagnosis of inflammatory neurological problems like multiple sclerosis or inflammatory gut conditions like celiac disease.
But the inflammation attack that occurs in these conditions does not develop overnight; it’s the end-stage event of inflammation. When someone is diagnosed with an autoimmune condition, for example, they have already been experiencing autoimmune inflammation for an average of about four to ten years.3 The same is true for other chronic inflammatory conditions like diabetes and heart disease. You don’t become diabetic overnight. You don’t manifest heart disease out of nowhere. Inflammation has been brewing for years before fasting blood sugar is high enough to warrant a diagnosis, or before someone has a heart attack. We all exist somewhere on an inflammation spectrum, from no inflammation to mild to moderate to diagnosis-level inflammation that has resulted in a disease state.
Knowing this, why would anyone wait until they are at the far end of this inflammation spectrum to do something about it? Wouldn’t it be much better to take care of inflammation in its earliest stages, when it is much easier to arrest?
The focus of my functional medicine practice is addressing the causes and manifestations of inflammation because the time to start caring about inflammation is long before you have a serious health problem. Once you get to the diagnosis stage, the only options typically offered to people are pharmaceutical drugs. I believe we can do much better. My practice and this book are about taking proactive steps to tackle inflammation before it leads to something more serious.
But even if you are already at the point of “serious,” there are still many things you can do to reclaim your health. Studies point to what many in functional medicine have been saying for decades: Lifestyle and foods are significant influencers to wellness or a lack of it, and I would add that lifestyle and foods are the primary methods for reducing the inflammation that leads to disease. In fact, studies estimate that about 77 percent of inflammatory reactions are determined by factors over which we have at least some control—our diets, our stress levels, and our exposure to pollutants—with the remainder determined by genetics.4 That means there is much you can do in the here and now to back down the inflammation spectrum rather than moving forward toward chronic disease.
In my experience, the vast majority of us wield quite a bit of power. We can take control of our health in the form of positive lifestyle health interventions right now. Whether those changes improve our quality of life by 25 percent or 100 percent, they’re a move in the right direction on the inflammation spectrum. Instead of repeatedly doing the same thing you always have done but expecting different results, you need to try something new. This is the only way to turn negative changes into positive changes.
You are probably reading this book because you have some symptoms you would like to resolve or are struggling with some chronic health issue. Here is a simple fact for you to consider as you mull over bio-individuality and your place on the inflammation spectrum: What causes inflammation in you (certain foods, certain exposures, certain kinds of stress) is bio-individual, and what inflammation causes in you (weight gain, fatigue, acid reflux) is also bio-individual. However, although inflammation causes a lot of problems, it is also a sort of skeleton key to discovering bio-individual reactions to internal and external stressors. What’s great about focusing on inflammation is that:
Inflammation is upstream from symptoms, meaning that it can cause or worsen many symptoms. Therefore, resolving inflammation can in turn reduce or eliminate the cascade of symptoms downstream that the inflammation caused—multiple symptoms resolved with one attack plan.
Inflammation is also downstream from some triggers. A confluence of factors, such as food reactivities, stress, gut problems, infections (bacterial, yeast, or viral), mold or heavy metal toxicities, and genetics is often the driver of inflammation. Cooling inflammation often allows your body to fix the primary dysfunction on its own, resolving the symptoms naturally by eliminating their cause. Inflammation gets in the way of the body’s natural ability to heal. If you can discover your own inflammatory triggers (what is causing the inflammation in you) and where your inflammation resides, you can learn how to douse it at its source.
This is how we solve the problem of your health issues: Lower inflammation by customizing your diet and lifestyle to eliminate what is increasing inflammation in you and add what fights inflammation in you. Doing this is likely to directly address your chronic health issues rather than just masking your symptoms.
And how do we customize your diet and lifestyle? We use the information we gain from a personalized and carefully organized elimination diet.
What Exactly Is Inflammation?
Inflammation is your body’s natural defense response. In its most acute form, inflammation is the redness, swelling, and pain you get at the site of an injury, such as a scrape, a cut, or a sprained ankle. Inflammation is a product of the immune system. In an inflammatory response, the immune system causes a rush of pro-inflammatory cells to the injury site to keep out bacteria, viruses, and subsequent infection. This is how your body heals. We would all be goners without a healthy, balanced inflammatory response.
The problems start when inflammation gets out of control or out of proportion to the problem, doesn’t go away after the injury is healed or the invader is conquered, or when the body activates it mistakenly in response to something that is not actually an invader. When any of these things happen, inflammation becomes its own problem and can trigger many kinds of symptoms in different areas of the body, depending on the cause and site of the inflammation. When inflammation doesn’t subside appropriately, continuing for long periods of time at a low level, this is called chronic inflammation. In this state, the immune system can become oversensitive and overreactive, releasing inflammatory cytokines constantly, spreading inflammation system-wide.
In short, when it comes to a healthy inflammation response, it’s all about the Goldilocks principle: You don’t want too little inflammation, but you don’t want too much, either. You want your inflammation to be just right—occurring when necessary, in an amount appropriate for the problem, and then going away when the job is done.
An elimination diet will help you discover what foods and behaviors are causing inflammation in you, and where. Because the localization of inflammation into a particular area of the body is bio-individual, influenced by genetics, activities, past injuries, lifestyle choices, and probably other factors we have yet to discover, knowing your inflammation susceptibility and your location on the inflammation spectrum will help you know the best way to improve it. Inflammation tends to develop in eight primary systems:
Brain and nervous system
Digestive tract
Liver, kidneys, and lymphatic system (together, these comprise your body’s detoxification system)
Liver, pancreas, and cellular insulin receptor sites, which control your blood sugar/insulin balance
Endocrine system (the brain’s communication with the hormone system: thyroid, adrenals, and ovaries or testes)
Muscles, joints, and connective tissue (your musculoskeletal system)
Immune system, which can turn against your body, causing autoimmunity
Lots of places at once. Some people (many of my patients, in fact) have inflammation in more than one of these areas and/or throughout the body, including in the arteries that go everywhere (which can affect the heart as well as the brain). This may be due either to unusual sensitivity or ignoring inflammation for too long. I refer to this problem as “polyinflammation.”
Within each of these areas, inflammation exists on a spectrum, from absent to mild to moderate to extreme—they each have their own inflammation spectrum.
The opposite chart shows you how inflammation in any one area exists on a continuum from mild to extreme, and the different interconnected areas in your body that inflammation can impact. The Inflammation Spectrum Quiz in the next chapter will help you determine your level of inflammation in these different areas and also where you fall on the spectrum for each, so that you can target your problem areas with diet and lifestyle changes.
If you are worried that you might get bad news from this quiz, fear not—no matter where you are on the inflammation spectrum, it is rarely too late to turn things around, and that is exactly what we are going to do. By using an advanced and personalized elimination diet to decrease inflammation triggers in your diet and lifestyle, you will soon learn exactly what you need to do to reverse your direction on the inflammation spectrum.
Inflammation Spectrum Lab Tests
In addition to the quizzes you will take in the next chapter, another way to gauge where your inflammation levels are right now is through testing. Below are some of the lab tests that I run for my patients, to get a comprehensive perspective on where they are on the inflammation spectrum. Although you don’t have to get any lab tests to get started tackling inflammation, you could ask your doctor to have some or all these labs run to get a baseline on your inflammation before you start your journey. Having the extra information can motivate you to stay the course and make progress. A functional medicine doctor is likely to be your best source for some of these labs, as this testing is more comprehensive than is standard for conventional medicine. (I run and interpret these labs for people around the world.)
hsCRP: C-reactive protein is an inflammatory protein and this test will show you how much of it you have. The high-sensitivity CRP test is also a surrogate lab to measure IL-6, another pro-inflammatory protein. They are both linked to chronic inflammatory health problems. The optimal range is anything under 1 mg/L. Higher levels are a risk factor for heart disease and can contribute to many other inflammation-based health issues.
Homocysteine: This inflammatory amino acid is linked to heart disease, destruction of the blood-brain barrier, and dementia. It is also commonly elevated in people struggling with autoimmune problems. The optimal range in functional medicine is less than 7 μmol/L.
Ferritin: This lab is normally run to look at stored iron levels, but high levels can also be a sign of inflammation. The optimal range for men is 33–236 ng/mL; premenopausal women: 50–122 ng/mL; postmenopausal women: 150–263 ng/mL.
Microbiome labs: This panel helps assess the health of the gut, where around 80 percent of the immune system resides. By looking at bacterial and yeast overgrowths as well as inflammatory markers like calprotectin and lactoferrin, we can assess gut-centric inflammation.
Intestinal permeability: This blood test looks for antibodies against the proteins that determine the integrity of your gut lining (occludin and zonulin), as well as bacterial toxins called lipopolysaccharides, which can cause inflammation throughout the body.
Multiple autoimmune-reactivity labs: This array shows us if your immune system is creating antibodies against many different parts of the body, such as the brain, thyroid, gut, and adrenal glands. The labs are not meant to diagnose autoimmune disease but rather to look for possible evidence of abnormal autoimmune-inflammation activity.
Cross-reactivity labs: This panel is helpful for gluten-sensitive people who have gone gluten-free and eat a clean diet, but still experience symptoms like digestive problems, fatigue, and neurological symptoms. In these cases, relatively healthy food proteins—such as gluten-free grains, eggs, dairy, chocolate, coffee, soy, and potatoes—may be mistaken by the immune system for gluten, triggering inflammation. To the immune system, it’s as if the person never went gluten-free.
Methylation gene labs: Methylation is a biochemical superhighway that regulates many of the functions necessary for a healthy immune system, brain, hormones, and gut. A process occurring about a billion times every second in your body, methylation needs to work well if you are going to work well. Methylation-gene mutations, such as MTHFR, are closely associated with autoimmune inflammation. For example, I have a double mutation at the MTHFR C677t gene; this means that my body is not good at managing an amino acid called homocysteine, which can cause inflammation in some people. I also have autoimmune conditions on both sides of my family, which is a red flag that I need to be even more careful of my place on the inflammation spectrum. You can’t change your genes, but by knowing your genetic weaknesses, you can pay extra attention to supporting particular processes in your body to reduce risk factors as much as possible.
Cannabinoid Gene CNR1 rs1049353: Our endocannabinoid system regulates everything from sleep, appetite, pain, inflammation, memory, and mood to reproduction. The cannabinoid gene CNR1 rs1049353 is a significant gene in this system, and changes to this gene are significantly correlated with food sensitivities and autoimmune-inflammation issues. Studies indicate that the gut nervous system is the main site of CB1 cannabinoid receptors.5
APOE4 and APOA2: Variants of these genes affect how the body metabolizes saturated fats. For these gene variants, eating foods higher in saturated fats is associated with inflammatory health problems and weight gain, respectively. People with these gene differences should limit or avoid foods such as dairy, red meat, eggs, coconut products, and other foods higher in saturated fats. Focus instead on plant fats like avocado, olives, and nuts and seeds.
