Inflammation: the new health fixation fuelled by modern life
Experts are learning more about the impact of stress and burnout on our bodies — and drug companies are investing billions
It used to be what happened when you stubbed your toe. Now, “inflammation” appears to be the new medical buzzword, seemingly at the heart of every health problem going, from long Covid to gut health. A quick search on Google Scholar throws up nearly five million results on the topic; this year alone 56,900 research papers have examined the role of inflammation in everything from coronary artery disease to obesity. Big pharma companies such as Eli Lilly are investing billions in developing anti-inflammatory drugs.
So what has changed? Is inflammation really the root of all our medical issues? And what about that old stubbed toe?
First things first. Inflammation is the same thing as it has always been: the automatic response of the body in trying to fight infections, toxins or trauma. When the body encounters, say, a virus or a trauma such as a cut, it activates the immune system, which sends out inflammatory cells and cytokines (small proteins that stimulate more inflammatory cells) to neutralise the invading virus or start healing injured tissue.
“If you look at everything through the lens of our evolution, inflammation was a good thing, because whatever was happening to us, inflammation would help our systems defend and maintain balance,” says Jon Whitehead, a professor of biomedical chemistry at Lincoln University. So you bang your toe, it gets swollen, red and inflamed, then it gets better and the inflammation is gone.
In recent years, however, inflammation has started to become a more systemic issue, contributing not only to the autoimmune conditions we have known about for some time — such as inflammatory bowel disease, rheumatoid arthritis and psoriasis, in which the immune system starts to attack the healthy cells of organs and tissues — but as a hidden, low-grade, permanent situation that may not even be externally discernible.
This sort of inflammation, says Whitehead, “contributes to what I would call most of the ‘21st-century’ diseases — cardiovascular disease, diabetes, cancer too. It doesn’t cause that disease in most cases, but it has a negative impact, worsens the outcome and speeds up those outcomes.”
Tim Spector, an epidemiologist, believes we’re beginning to realise just how deep the relationship between inflammation and the immune system is. “Virtually every disease involves inflammation to some extent,” he says. For example, “we used to think stress caused heart attacks, but actually, stress causes inflammation, which can then lead to a heart attack”.
It’s not hard to see why this is happening. “Our systems have evolved to protect, but to do so under relatively acute stress, and the stress should be resolved,” Whitehead says. Now they are “working in a way that they’re not designed to, long term, and everything’s slightly out of balance”.
Of course, most of us live longer and in more comfort than any humans in history. But the chronic stresses and strains of modern life — from processed diets to obesity to lack of natural light — mean our bodies tend towards constant fight mode, overworking our immune systems and putting us at risk.
So how can we tell if we’re suffering from chronic inflammation, and what can we do about it?
The five so-called classic markers of inflammation are pain, heat, redness, swelling and loss of function. Easily observable in a stubbed toe, less so in a dodgy liver. But some of the symptoms are similar: frequent infections, for example, can be a sign that things are not right, as can weight gain, insomnia, depression or fatigue.
“One of the things to watch out for is belly fat, because belly fat, unlike the fat that pads the thighs or upper arms, is a proxy for hidden ‘visceral’ fat that wraps around the inner abdominal organs,” says the gastroenterologist Shilpa Ravella. “This type of fat is highly inflammatory, churning out inflammatory cytokines at all hours of the day.” Research indicates that visceral adipose tissue (belly fat) is the main determining factor in type 2 diabetes, for example.
Our diet clearly plays a key role. “Studies show that if you eat a crap meal, you get an inflammatory response — the poorer the quality of the meal, the higher the inflammatory response,” Whitehead says.
A better diet means plenty of fruit and veg, enough fibre, lean protein and less red meat, fatty fish and things that are good for your gut such as yoghurt and other fermented foods (probiotic) and things like asparagus and bananas (prebiotic), because a healthy population of gut bacteria can also keep inflammation at bay.
“What you include is actually much more important than what you exclude,” Ravella says. “Our most anti-inflammatory nutrient is fibre from various plant sources, yet we include so little of it in our diets — 90 per cent of UK adults are deficient in fibre.”
Supporting your body in this way will also help with overall ageing. “We know that the one thing which is the most detrimental to longevity is chronic inflammation,” the nutritionist Gabriela Peacock says. She recommends supporting your digestion with pro and prebiotic foods, plus supplements. “I would be looking at nutrients such as resveratrol, a type of polyphenol found in red wine [as well as coffee, tea and dark chocolate], and curcumin, found in turmeric and green tea, which is full of antioxidants.”
Making other basic lifestyle changes can also help. “When you go for a hike in the woods, for example, you’re not only getting exercise but you’re getting exposure to the microbes that train and manage your immune system and chronic inflammation,” Ravella says.
All sounding a bit, well, inflammatory? As ever with medical trends, there is a danger of inflammation becoming the grand unifying theory of all ailments, a new obsession. But as Danny Altmann, a professor of immunology at Imperial College London, points out: “It’s quite nuanced and complex. Inflammation is [also] a good thing — it’s really important.”
“Balance is everything,” Whitehead says. “It’s all right to have a drink once in a while, or a late night once in a while.” Indulge to excess, however, and your system will be way out of whack. And then you could be contending with an awful lot more pain than that old stubbed toe.
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