Tips for Tackling Inflammation

Last week I’ve written about the role that chronic inflammation plays in chronic disease, including bladder conditions such as interstitial cystitis.

Today I’d like to look at lab tests for inflammation and also dietary options and supplements that may help reduce inflammation.

If you’re not sure what inflammation actually is, or what role it plays in chronic disease please read this post first.

Testing for Inflammation

Chronic illness probably always has some degree of inflammation present but there are several tests we could use to see if and how much inflammation is present.

  • C-Reactive Protein (CRP): This test measures levels of CRP, a protein produced by the liver in response to tissue damage or infection. CRP is closely linked to chronic inflammation [1] and it’s a relatively inexpensive test. It can be tested in blood or stool. For the urinary tract, serum CRP is a better marker than urine CRP as the protein is not normally present in urine [2]. However, serum CRP does not tell us where inflammation is present.
  • Erythrocyte Sedimentation Rate (ESR): This test measures the fall rate of red blood cells. Normally red blood cells fall quite slowly but if there are a lot of inflammatory proteins present they fall much quicker. This is an indirect test often used in addition to CRP for certain conditions.
  • Stool Tests: There are several markers for inflammation in the stool, which can point to inflammation in the digestive tract and conditions associated with that (coeliac, IBD, parasites, gut infections). These include Fecal Lactoferrin, Eosinophils and Calprotectin.

Mast cells in the bladder are often present in interstitial cystitis and they are linked to inflammation. Therefore, testing for mast cells could also indicate inflammation.

This could be done through a biopsy or the following tests:

  • N-methylhistamine (NMH): NMH is a metabolite of histamine, one of the inflammatory chemicals released by mast cells. Increased NMH is correlated with increase mast cell activation. This can be measured in the urine.
  • Blood tests for tryptase or histamine, or urine histamine tests could also be used to look for mast cells but may not be as good as NMH.

Tackling the Root Cause of Inflammation

Inflammation can only really be resolved if the root cause of inflammation is dealt with and removed.

So let’s take a look at some potential causes and how to tackle them:

  • Hidden infections: For the bladder specifically we know that gold standard testing misses a lot of infections, so a negative test does not mean an infection isn’t present. Testing should be done to confirm any infection – stool tests, blood tests and microgenomic urine tests could be worth considering, depending on symptoms. Once we know about an infection it can be dealt with using appropriate antimicrobials.
  • Stress: We can’t always reduce stress but we can learn how to deal with it better – the right nutrients, deep breathing exercises, yoga, meditation, walks in nature etc. may all help with stress reduction.
  • Food intolerances: Hidden food intolerances can be a source of inflammation as every time certain foods are consumed some form of immune response may be triggered (I’ve written about this here). To stop this cycle, trigger foods need to be eliminated at least for a while. This could be tackled with an elimination diet or food intolerance testing (although evidence for those tests is inconclusive).
  • Diet: Removing refined foods as much as possible, especially refined sugar and white flour products. Reducing Omega-6 fat consumption.
  • Heavy Metals: Hair mineral testing could be used to look at heavy metal levels. Chelation and mineral balancing could be strategies to deal with heavy metals.
  • Toxins and free radicals: Avoiding these in our modern world is nearly impossible but we can try to limit exposure by switching to natural products wherever possible, avoiding plastics, filtering water etc.
  • Sleep: Good sleep hygiene is very important – reducing blue light at night, getting enough bright light during the day, sleeping in a cool, dark environment and allowing enough time for sleep can all be helpful.
  • Nutrient excess or deficiency: A nutrient dense diet including all three macronutrients in balanced proportions is important.

Anti-Inflammatory Nutrients and Supplements

Many plant foods contain chemicals that help reduce inflammatory chemicals and a diet rich in these foods is important.

The following nutrients may be especially beneficial:

  • Curcumin (from Turmeric): may help reduce the formation of free-radicals, modulate the immune system, help reduce production of pro-inflammatory chemicals and has antimicrobial properties [3, 4, 5]. It has been observed to reduce CRP [6].
  • Proteolytic Enzymes: These enzymes can digest proteins and in case of tissue damage they may help to ‘clean up’ the area of debris, encouraging healing of tissue and can break down fibrin, a pro-inflammatory protein [7, 8].
  • Omega-3 Fatty Acids: Omega-3 fatty acids are precursors to anti-inflammatory signalling molecules called prostaglandins. Moreover, they can be converted into a powerful signalling molecule called resolvin that acts like an ‘off switch’ for inflammation [9]. Omega-3 fatty acids are mainly found in oily fish.
  • Quercetin: Quercetin is a flavonoid that has antihistamine properties and has been shown to also reduce other inflammatory chemicals [10]. It may also help to balance the immune system [11]. It can be found in apples and onions.
  • Pycnogenol: Pycnogenol is a pine bark extract containing bioflavonoids that help block inflammatory enzymes and also have antioxidant activity [12].
  • Grape See: Grape seed extract has antioxidant properties and may inhibit the formation of inflammatory chemicals, plus it may inhibit the release of histamine from mast cells [13].
  • Green Tea: Green tea may help inhibit inflammatory enzymes and chemicals [14].
  • Vitamin C: High dose Vitamin C may help balance the immune system [15]. A buffered source (such as magnesium ascorbate) is best for IC sufferers.
  • Antioxidants: Antioxidants in general help quench free radicals that can lead to tissue damage. This includes Vitamin A, C, E, Selenium and bioflavonoids.

That’s it for now. Please let me know of any nutrients that helped you overcome inflammation or your experience with inflammation in the comments!

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Lab Tests Online Erythrocyte Sedimentation Rate (ESR) May 2014

H.Tarhan et al C-reactive protein levels in girls with lower urinary tract symptoms Journal of Pediatric Urology [Volume 12, Issue 2, April 2016, Pages 105.e1-105.e4]

Mayo Medical Laboratories Test ID: NMHIN N-Methylhistamine, 24 Hour, Urine Oct 2017

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  2. Yao-ChiChuang et al Urine and Serum C-Reactive Protein Levels as Potential Biomarkers of Lower Urinary Tract Symptoms Urological Science [Volume 21, Issue 3, September 2010, Pages 132-136]
  3. CAC Araújo et al Biological Activities of Curcuma longa L. Inst. Oswaldo Cruz [vol.96 no.5 Rio de Janeiro July 2001]
  4. Kobayashi, T. et al Curcumin inhibition of Dermatophagoides farinea-induced interleukin-5 (IL-5) and granulocyte macrophage-colony stimulating factor (GM-CSF) production by lymphocytes from bronchial asthmatics Biochemical Pharmacology [Volume 54, Issue 7, 1 October 1997, Pages 819-824]
  5. Funk, Janet L. et al. “Turmeric Extracts Containing Curcuminoids Prevent Experimental Rheumatoid Arthritis.” Journal of natural products [69.3 (2006): 351–355. PMC. Web. 20 Oct. 2017.]
  6. Belcaro et al Product-evaluation registry of Meriva® , a curcumin-phosphatidylcholine complex, for the complementary management of osteoarthritis PANMINERVA MED 2010;52(Suppl. 1 to No. 1):55-62
  7. Secor et al. Oral Bromelain Attenuates Inflammation in an Ovalbumin-Induced Murine Model of Asthma Evidence-Based Complementary and Alternative Medicine [Volume 5 (2008), Issue 1, Pages 61-69]
  8. Mazurov et al Beneficial effects of concomitant oral enzymes in the treatment of rheumatoid arthritis Int J Tiss React 1997 [19:91]
  9. Serhan, Charles N., Nan Chiang, and Thomas E. Van Dyke. “Resolving Inflammation: Dual Anti-Inflammatory and pro-Resolution Lipid Mediators.” Nature reviews. Immunology 8.5 (2008): 349–361. PMC. Web. 20 Oct. 2017.
  10. Comalada, M., Camuesco, D., Sierra, S., Ballester, I., Xaus, J., Gálvez, J. and Zarzuelo, A. (2005), In vivo quercitrin anti-inflammatory effect involves release of quercetin, which inhibits inflammation through down-regulation of the NF-κB pathway. J. Immunol., 35: 584–592. doi:10.1002/eji.200425778
  11. Bischoff, Stephan C Quercetin: potentials in the prevention and therapy of disease Current Opinion in Clinical Nutrition & Metabolic Care: November 2008 – [Volume 11 – Issue 6 – p 733–740]
  12. Choi, Y. H. and Yan, G. H. (2009), Pycnogenol® inhibits immunoglobulin E-mediated allergic response in mast cells. Res., 23: 1691–1695. doi:10.1002/ptr.2812
  13. Sakurai et al Oligomerized grape seed polyphenols attenuate inflammatory changes due to antioxidative properties in coculture of adipocytes and macrophages The Journal of Nutritional Biochemistry [Volume 21, Issue 1, January 2010, Pages 47-54]
  14. Choi et al Effects of Green Tea Catechin on Polymorphonuclear Leukocyte 5′-Lipoxygenase Activity, Leukotriene B4 Synthesis, and Renal Damage in Diabetic Rats Ann Nutr Metab [2004;48:151–155]
  15. Chang et al High Dose Vitamin C Supplementation Increases the Th1/Th2 Cytokine Secretion Ratio, but Decreases Eosinophilic Infiltration in Bronchoalveolar Lavage Fluid of Ovalbumin-Sensitized and Challenged Mice Agric. Food Chem., 2009, [57 (21), pp 10471–10476]

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