In today’s episode, we’re going to be building on our earlier discussion in episode two. In that episode, we looked at the role of relative estrogen excess with respect to hormone balance, and the various symptoms that can present as. Now today we’re going to go on to look at the key relationship between hormones and inflammation. Inflammation is such an important topic to understand and address because it seems that each month – and each week almost – more research comes out to suggest that chronic inflammation is linked to many if not most diseases, ranging from heart disease to cancer, depression and diabetes. This is something that Chinese Medicine has long understood – that link between inflammation and health. In Chinese medicine we’ve outlined diet, stress management and lifestyle practices to mitigate inflammation and promote health.
Let’s start with a brief look at what inflammation actually is. In basic terms, inflammation is our body’s innate protective response in the face of harm or hurt – such as a cut, a bruise, a sprained ankle, or an infection. In these situations, the body will mobilize cells, chemicals and processes that will help to clear out the muck of an injured or infected site, and to remove and break down damaged tissue; it will protect against further encroachment by bacteria or other infective agents and it will start to heal the affected area. Inflammation is classically characterized by four signs – redness, pain, heat and swelling. These four arise as byproducts of the various biochemicals and processes that the body activates in the process of healing an injury or infection. Anyone who’s had a sore throat, a cut, a bruise, a swollen joint or a sprained ankle has experienced these four signs of inflammation and when they are limited by time – meaning that they are switched off once the healing and repair has occurred – this inflammation is a healthy and adaptive response.
It feels like these days we hear a lot about inflammation. It’s a term that’s often thrown about, and it generally has negative connotations. So it’s important to point out that inflammation is not all bad. These four classic signs of inflammation that we just mentioned – redness, pain, heat and swelling – they’re byproducts of the body doing healing work, which is why shutting down inflammation with measures such as anti-inflammatories or cortisone injections will certainly limit pain, but at the same time, it will put a stop to any essential healing going on in that acute situation. And this is why we’re now finally seeing research that bears out this fact: there’s a study that I’ve attached in my show notes, and it talks about how putting cortisone shots into knees actually has poorer longterm health outcomes, both with respect to pain and mobility, and also with a greater deterioration of knee cartilage in those knees that had cortisone injected in them. And this is because it literally puts a blanket on any healing process and shuts it down. But that’s a topic for another episode, because it is something that I’d love to get into on a deeper level!
So, back to inflammation and hormones! As I mentioned, when occurring over a short, defined period, inflammation is an adaptive process, meaning that it’s a positive process that facilitates healing and helps to restore our system to a state of balance. The problem arises when the inflammation becomes chronic or repeated, and this is the side of inflammation that gets the deservedly bad rap. Unlike acute inflammation, chronic inflammation doesn’t get shut off when the injury or infection is resolved – it keeps being retriggered, which leaves the body on high alert, which then will drain resources from other areas of the body and disrupt their function. These are areas like digestion, mental health, emotional health, circulation, and of particular interest to us today – in light of this episode – also hormones or the endocrine system. Chronic inflammation very often goes hand in hand with a dysregulation or imbalance of stress hormones (cortisol and adrenaline). Last week in episode two we talked about a process called pregnenolone steal. This is the process by which the stress hormones will steal the common building blocks that are essential for all hormones, but particularly the sex hormones. So when we’re pumping out a lot of these stress hormones and have a high demand for them, in order for the body to make more of them, it will steal the building blocks that it also needs to use for the sex hormones, thusdepriving our levels of those.
Now, unlike acute inflammation, which is often localized and always time limited by definition, chronic inflammation can be broad, widespread, and systemic – that means diffused throughout the body and therefore disruptive to many of the body’s systems. And because of this, it’s now widely accepted to be a major factor in most diseases. Unlike acute inflammation, which has the very obvious signs of redness, pain, heat and swelling, chronic inflammation can be sneakier and less obvious to spot – it can often be silent or just have low-grade, less dramatic symptoms like fatigue or brain fog or generalized pain or joint pain and mucus. Very often when I see patients with these symptoms, we’ll have a look at what’s going on in the diet, lifestyle, stress, emotional health and so on – and we’ll investigate if there’s some inflammation going on as well.
So what are some of the culprits in chronic inflammation? Well, as it happens, there are many trigger factors for chronic inflammation that are the same ones that we discussed last week, with respect to elevated estrogen. So let’s have a look at what some of those trigger factors are – and these are in no particular order.
We’ll start with number one, and that is toxic load. Now, toxic load just refers to the generalized and sum load of all of the toxins that our body – and more specifically our liver – has to deal with in order to detox and restore our bodies back to balance. These are very often things in our immediate environment such as the phthalates and parabens in products like moisturizers, shampoos, detergents, packaged foods with their plastics leaching into them, and also things like environmental pollutants on a grander scale – whether it’s petrol fumes or even (of particular relevance to us now in New South Wales and Queensland, where we have all these tragic fires going on) is all that smoke pollution. That constant irritation of the mucus membranes of the respiratory system is going to be contributing to a perpetual state of low grade inflammation in some people.
Number two is sleep, and the pace of modern life. Sleep isn’t a sexy health hack – it’s not some shiny new gadget or superfood that’s going to give you amazing healing results. But the fact is that sleep is such a potent healing tool because when we’re asleep, our body can drop into the parasympathetic nervous system mode, which is where we rest, digest, repair and heal – and the body and brain can clean and heal at rest. So it’s so important for our health on every level. The pace of life and the society that we live in glorifies busy-ness, and being overwhelmed is almost a badge of honour and you know, rather than calling it out and consciously slowing down or letting some things drop by the wayside (and I know that may not always be possible!) we just push on, and punch down some more caffeine or sugar or energy drinks to keep us going. That can feel amazing in the short term, because all of those substances trigger our sympathetic nervous system – the fight or flight system – so they release cortisol and adrenaline, which are stress hormones. In the short term these can make us feel invincible and clear-headed, so we think “this is great, we’ll just keep going!”. What that does though, is that it doesn’t allow enough time in the parasympathetic mode – in the rest and digest mode. That’s the time when our body goes around and mops up any pockets of inflammation and just tones down the whole inflammatory response.
I think we have this idea that “more is more”, and we’ll just push on through, but there was a very interesting example recently in Japan, where the whole culture of overwork has actually become a major public health concern. In fact it’s so endemic that there’s even a word in Japanese, karoshi, which means “overwork death”. In light of this big burden on public health, Microsoft in Japan recently trialled a four day work week. What they found was that by cutting 20% of the workweek, rather than dropping in productivity, productivity actually went up by 40% and in a bonus to the environment, costs went down: there was 23% less electricity used and a whopping 58% less pages printed, and all for more productivity. It just goes to show that more is not always more! So when guilt potentially sets in, whenthat little voice in your head goes “well, you can’t rest, there’s more stuff to do”, I think it’s good to remember that sometimes having a rest can actually yield greater results.
Number three in the list of trigger factors for chronic inflammation are, not surprisingly, inflammatory foods. And this is something that we will go into further in future episodes, when we have more time to focus on that. But just top line, these are things like polyunsaturated vegetable oils (canola oil, sunflower oil, soy oil) which unfortunately are so prevalent in packaged foods, and even in seemingly healthy foods – if you actually look through the ingredients, you’ll see that in probably 95% of cases, these are the oils that are unfortunately used. Things are slowly changing, but it’s always pays to read those labels. Another big culprit is fructose, which is prevalent in fruits and also, together with glucose, forms 50% of common table sugar. We also see high amounts of fructose in things like high fructose corn syrup, and it’s prevalent in a lot of soft drinks and again, packaged foods. It’s so popular in packaged foods because it delivers more of a sweet kick, but it also comes at a cost because it bumps up inflammation in the body as well. It’s interesting that in a Traditional Chinese Medicine diet, we don’t have much of a fruit component, or a sugar component. There’s also a very interesting book called Sweet Poison, which looks at the impacts of fructose on a whole range of health conditions, and actually ties fructose to cholesterol – and not cholesterol and fat consumption. A study from 2012 that I came across, looked at how a low fructose diet lowered blood pressure and inflammation in patients with chronic kidney disease – so that’s a big one to watch out for as well.
Number four is toxins in food. And by this I mean non-food ingredient – these are things that you can’t recognize as a whole food ingredient when you read the packaging. A good rule of thumb is, if you can’t recognize it or it has numbers in it (like preservatives and additives and so on), then it shouldn’t really be going either into your body or on your body, as a moisturizer or skin product or whatever.
Number five is alcohol, and this doesn’t mean that you can’t enjoy the occasional glass of wine, particularly if it’s red because it has a great antioxidant called resveratrol in it, which has some positive effects. But certainly the sweet spot seems to be no more than three drinks a week. At that point, it does seem to start to overload the body and can contribute to chronic inflammation.
Number six is unresolved infections, lingering pathogens and what we referred to as bacterial debris – this is bits of the bacterial cell that can remain, even after antibiotic use and even after the overt symptoms of an illness have gone. These lingering infections can occur if the body is too rundown to completely kick an invading bug to the curb. If we’re pushing ourselves, and overworking and not resting enough, and then maybe smashing it in the gym, the body just simply runs out of reserves to address the immune system side of things. And so it just kind of lays down and gives up the fight, and it allows that disease process to just fester quietly in the background. What often happens in these situations is that once we start rebalancing those underlying imbalances, and we start building the body up again and allowing it to bank some energy, then very often, once there is again some energy to continue that fight and pick it up again, these infections may come to the surface again – even years after the fact. This is a good thing, because it means that they can then be finally resolved, and that low-grade inflammatory burden can be resolved as well. On that note also, chronic inflammation can also happen when there’s another process that the body is perceiving as something imbalanced – that might be plaque deposits on the arteries, or a disrupted gut leading to leaky gut, for example, that will also contribute to the body’s state of high alert, and / or chronic inflammation.
Now number seven is an interesting one, and that is excessive cardio, particularly steady state cardio, but it can also cover interval training in people who already have a dysregulated nervous or endocrine system. And unfortunately that is a great many of us in the society that we live in, and the demands that we place on our bodies. Exercise is an important part of health – it’s one of the pillars of health – and daily movement should be a part of life for all of us, but it’s when we’re smashing our body that it can actually cause more harm than good. This is because if we’re already in that fight or flight dominant state (which can happen as a result of work stresses and long work hours, shorter sleep, inflammatory foods, stresses in your relationships) if the sympathetic nervous system is already dominant, then further smashing it and pumping out more stress hormones with an elevated heart rate and high intensity cardio is just going to perpetuate that problem. There’s more on this on my blog, and I will go into it again in other podcasts, but I did write an article about it called Exercise, Too much of a good thing?. It doesn’t mean that people in this situation have to stop heavier exercise forever, but it just means that until their nervous and endocrine systems get a chance to rebalance – and inflammation gets a chance to drop down – for that period, they will be pursuing calming exercise that support healing. Then, once the body is healed, they can pick up that more intense exercise again.
So we have quite a list of factors there that can contribute to inflammation. Just quickly as an overview, we’ve got 1) toxic load, 2) the lack of sleep and pace of life, not enough downtime, 3) inflammatory foods, 4) toxins and non-foods, 5) alcohol, 6) persistent and lingering infections or underlying imbalances in the body, 7) excessive cardio, or exercise that’s not serving us, or wiping us out. But the big one, the number one headline factor in causing chronic inflammation is stress. This is such a big one, and I think such an insidious and sneaky one as well, because we humans are such amazingly adaptive creatures that I think all of us have probably had that experience where we don’t realize how stressed we are until a particular situation ends, and we become aware of the difference in how we feel. Very often that stress just builds up, week by week, month on month, year on year, and we’re functioning and we’re getting by, so we think we’re not stressed, everything’s fine, I’m happy, everything’s good in my life – but the fact is that even positive experiences can add to our stress load – being stressed doesn’t necessarily mean it’s all negative emotions. It can even be really beautiful things, like a wedding, or a new baby, or a new job or moving to a place that you’ve always wanted to move to. All of those things can come with stress. And if we’re not offering our bodies the balancing support to process that stress, and to balance that stress out, then it is going to cause an elevation of stress hormones, and it’s going to perpetuate chronic inflammation in the body.
Another culprit with stress is the internal state: we mentioned earlier that inflammation is the body’s response to a perceived hurt or harm, and this also relates to psychological hurt and harm. Unfortunately for many people, they have an inner critic and a negative self-voice that says awful things, that they would never dream of saying out loud to someone that they care about, and yet this negative loop is just going on in the background 24-7. There are some estimates that we have, that of the thoughts that we have every day, 70 to 90% are repetitive or redundant and roughly the same amount were negative or, at best, neutral. That’s such a such an intense barrage that we’re getting from the inside – and that’s in addition to all of the external life stresses that our body is trying to find balance against. In light of that, one of the big things that I do myself (it’s a non-negotiable part of my day) and one thing that I recommend to all my patients, is meditation. There’s such a abundance of trials and research now that show just how effective meditation is in reducing stress levels and changing immune markers in the body. There’s even a fascinating study that showed that meditation could reverse or slow aging! So meditation is such a big one – meditation, gratitude, fostering positive states of mind.
I just came across what I think is the first one of its kind, where they looked at gratitude journalling in teenagers with Type One Diabetes -these are teenagers that need to rely on insulin to maintain their blood sugar. They found that the teens who wh were practicing daily gratitude journaling – focusing on the positive aspects in their life – had a statistically significant improvement in their blood sugar regulation. It was such a positive writeup, so I’ve included that in the show notes as well. What that shows is that meditation, and our state of mind, can have a direct biochemical effect on our physical health. It’s such a simple thing to do, and it’s something that really can benefit pretty much any health situation. Even when we don’t have any overt symptoms, it’s so great for maintaining our health, and for slowing ageing and keeping us healthy as we get older. I mentioned in an earlier episode that Dr Mark Hyman said that if it was a patentable and sellable drug, then everyone would be prescribing it for every illness. It really is that wonderful! Meditation can be such a simple thing to integrate into your day. It can just be five minutes on waking – to set a positive brain state and a positive emotional and body state for the day – and five minutes at the end of the day – as a kind of mental shower (or mental floss!) to clear your brain of the day, and set you up for a deeper and more restorative sleep.
The thing that meditation and journalling both have in common is that they slow us down, and bring us into the present moment – they encourage awareness of what is going on in our mind and bodies. I think that self-awareness in each moment is one of the foundations of good health – we can start to become aware of an imbalance as it arises – whether it’s something that we need to eat (if our body is calling out for something) – when we slow down, we start to become more attuned to these healthy cravings. We can also start to become attuned to certain emotions that aren’t getting a chance to be felt or expressed – so things that might be being redirected towards our partner or child, that maybe have nothing to do with them at all. It has so many positive effects in all aspects of our life, and the effects and benefits are cumulative – but even after a few days or a week of meditation, you can absolutely start to notice the benefits!
My next episode is going to be about meditation, journalling and positive states of mind – and in addition to that, I’ll be including a bonus five minute meditation episode to guide you through the process as well, so make sure to tune in!
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