Silent Inflammation

Ever wonder why so many gym members suffer with chronic joint pain, prolonged muscle soreness or sport injuries that never seem to heal? Part of the answer lies in the fact that exercise and sport practiced or played with any degree of intensity actually causes inflammation.

When muscle fibers are strained by intense, repetitive contraction, and oxygen is consumed at high levels, tiny myofibrils located inside individual muscle fibers are traumatized and damaged by superoxide free radicals, hydroperoxides, hydroxyl radicals and ammonia.

The shoulder, knee and lower back are all susceptible to overuse and heavy load as they are seldom stabilized by training all the links that support them. Benching and overhead pressing often lead to shoulder problems related to rotator cuff impingement. Impact injuries in sport can cause bruising and vascular damage. When such injuries are severe, connective tissue, ligaments and tendons often rip and tear.

A limited amount of low-level inflammation caused by exercise is to be expected. It is a natural by-product of training that a healthy body is designed by nature to remedy. However, a diet high in the omega-6 pro-inflammatory fat arachidonic acid (AA) (cow's milk, egg yolks and red meat) and low in the omega-3 anti-inflammatory fats alpha-linolenic (ALA) and eicosapentaenoic acid (EPA) (greens, flax and wild fish) impedes the body's ability to counter and control inflammation. But there is more to this story.

There are two forms of inflammation. The first is known as "classical" inflammation. This form consists of a dynamic complex of reactions that occur in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation. The injury or abnormal stimulation is typically caused by a physical, chemical or biological agent. The cardinal signs of inflammation include redness, heat, swelling, pain and loss of function. All of these signs may be present but by definition no one of them is necessarily always present.

The second less obvious form is called silent inflammation. This is different from classical inflammation in that it is below the threshold of perceived pain. As a result, no conscious action is taken to stop or deal with it, so it lingers on inside the body for decades, causing damage to vital organs like the brain and heart. Silent inflammation has more to do with nutrition than training although workout frequency and intensity play important roles.

Can you pinch an inch? As the glycemic load of the diet increases, more insulin is secreted. The consequence is activation of the enzyme that produces AA. Insulin promotes the storage of body fat and guess where excess AA is stored? As the level of AA increases in fat cells, more inflammatory mediators are produced. The end result is an increase in systematic inflammation that originally began as silent inflammation forming in adipose tissue.

Thus the current obesity epidemic is in reality an epidemic of silent inflammation.

Acute inflammation has a fairly rapid onset and becomes severe relatively quickly. Symptoms usually manifest for only a few days, but may persist for as long as 1-3 weeks. Chronic inflammation may begin with a relatively rapid onset or a slow, insidious and even unnoticed manner. It can persist for several weeks, months and even years and often has an indefinite termination. Chronic inflammation results when the cause of the inflammation continues to persist and the host lacks the biological and immunological resources to overcome the offensive nature of the injuring agent. Classical inflammation is a protective, nonspecific and inherently necessary biological defense mechanism, especially in sports injuries, where the cause is not normally associated with a defective immune function, auto-immune disorder or disease condition such as arthritis, bronchitis or dermatitis. Inflammation is often painful and thus it is tempting to use drugs that provide immediate relief.

However, the inflammatory process is a critical step in healing and sets the stage for repair and restoration. This is why covering up the pain with drugs is not recommended. Acute pain short term, yes, but long term use of aspirin, non-steroidal anti-inflammatory drugs [NSAIDs], COX-2 inhibitors, and corticosteroids... not a good idea. Instead it's best to manage inflammation by increasing your intake of omega-3 fatty acids, improving insulin chemistry by avoiding refined carbohydrates and keeping a sharp eye on your exercise technique.

If you suffer with chronic inflammation anywhere in your body examine your diet. The culprits are almost always the same. Wheat flour, peanuts, oxidized fats, sugar, cow's milk, pasteurized fruit juices, luncheon meats, commercial refined breakfast cereals and ice cream. All inflammation is ultimately driven by a group of hormones known as eicosanoids. These hormones influence the production of prostaglandins that directly influence inflammation and can be altered by dietary intervention.

How do you know if you have silent inflammation? There two clinical markers. The first is called high sensitivity C-reactive protein (hs-CRP). The second measures the ratio of arachidonic acid (AA) to eicosapentaenoic acid (EPA). The AA/EPA ratio provides a reliable estimate of the balance between the precursors of pro-inflammatory eicosanoids (derived from AA) and the anti-inflammatory eicosanoids (derived from EPA). It is the balance of these eicosanoid precursors that determines the actual extent of silent inflammation in the body.

Inflammation is something you shouldn't ignore. It is the seat of most chronic joint and soft tissue pain. But it is also the origin of many debilitating disease complexes not related to joints and sports injuries, including obesity, depression, heart disease, edema, cancer, diabetes and fouled-up insulin chemistry. Low grade inflammation often starts in the gut and small intestine and because it goes on and on unresolved, it gradually permeates into the major cavities of the body. My guess is that many of us have some form of silent inflammation working away within us right now. So what to do?

Start by increasing your intake of omega-3 fatty acids. Choose sardines, prawns, mackerel, trout, bison and salmon over pork, turkey, chicken and beef. Buy eggs laid by chickens that eat bugs and worms or a diet to which flax seeds and vitamin E and been added. Add 1-2 tablespoons of an omega-3 dominated sport oil to your pre- and post-workout protein shakes. Ideally the oil should consist of both plant (flax, hemp, pumpkin) and marine oils (sardine, mackerel, anchovy).

At the same time reduce, minimize or eliminate your intake of fried food (chips, French fries, meat, eggs, bacon), cow's milk, wheat, sugar and refined high-glycemic carbohydrates (cookies, donuts, bagels, toast, buns, Danish). Invest in a juicer and drink fresh live fruit and vegetable juices. Eat more raw vegetables and steamed greens (spinach, broccoli, kale, chard) and drink enough filtered water to stay well hydrated.

Choose raw walnuts or pumpkin seeds instead of peanuts. Use spelt, whole rye, or sprouted wheat for bread. Better yet, drop the bread 'cause bread is dead'. Use raw vegetables and greens instead. Go to your local health food store and ask about omega-3 dietary supplements.

All inflammation can be altered or modified by what you eat because inflammation is a biological response. Expect positive changes in 1-3 weeks and life saving benefits for the rest of your life.

Photo by Samantha Hurley from Burst

As always, stay well and live free!

Dr.C