Inflammation

What is Inflammation?

Inflammation is a non specific defensive response of the body to tissue injury. The inflammatory response in tissues can be induced in a number of ways eg infection, surgical trauma, effects of radiation and exposure to irritants such as smoke and chemotherapy.

The inflammatory response develops quickly and occurs whenever and wherever tissues are injured. Essentially, inflammation acts to eliminate the harmful agent, prevent further injury, and restore the tissue to a healthy condition.

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What causes inflammation in the body?

When the tissue in the body is injured, the following inflammatory events happen.  First, because of the release of histamine and other inflammatory chemicals by injured tissue cells, macrophages, mast cells, and others, the capillaries dilate and become very permeable. This allows white blood cells and plasma fluid rich in clotting proteins, antibodies, and other substances to seep into the injured area. Then the leaked clotting proteins construct a clot, which stops the loss of blood, holds the edges of the wound together, and effectively walls off, or isolates, the injured area, preventing bacteria, toxins, or other harmful substances from spreading to the surrounding tissues. The portion of the clot exposed to air quickly dries and hardens, forming a scab.

The inflammatory events leave excess fluid, bits of destroyed cells, and other debris in the area. Most of this material is eventually removed from the area via lymphatic vessels or phagocytised by macrophages. At this point, the first step of tissue repair, organisation, begins to occur.

Inflammation - the body's response to tissue trauma

The inflammatory response is triggered whenever body tissues are injured. For example, it occurs in response to physical trauma (a blow), intense heat, and irritating chemicals, as well as to infection by viruses, fungi and bacteria. The inflammatory response causes these three processes:

  1. Prevents the spread of damaging agents to nearby tissues
  2. Disposes of cell debris and pathogens
  3. Sets the stage for repair processes

The 4 cardinal signs of inflammation

The 4 cardinal signs of short-term, or acute inflammation are: redness, heat (inflamm = set on fire), swelling, and pain.

If the swollen and painful area is a joint, joint movement may be hampered temporarily. This forces the injured part to rest, which aids healing. Some authorities consider impairment of function to be the fifth cardinal sign of acute inflammation.

The processes of Inflammation in the body

A. Vasodilation and Increased Vascular Permeability

Inflammation begins with a release of inflammatory chemicals into the extracellular fluid. Inflammatory mediators are released, including histamine, kinins, prostaglandins, complement, and lymphokines, which all contribute to the dilation of the small blood vessels around the area. As blood flow is increased, local hyperaemia (congestion with blood) occurs causing redness and heat in the inflamed area.

The chemicals also cause the capillaries to become leaky, allowing fluid containing proteins such as clotting factors and antibodies to flow from the blood into the inflamed tissue. Local oedema, or swelling, occurs because of this, and due to the pressure on nearby nerve endings, contributes to the sensation of pain. Bacterial toxins, lack of nutrition to the cells and the sensitising effects of prostaglandins and kinins also contribute to the sensation of pain.

Anti-inflammatory drugs, i.e. aspirin, reduce pain by inhibiting prostaglandin synthesis. Oedema dilutes harmful substances, brings oxygen and nutrients for repair, and allows entry of clotting proteins.

At sites of inflammation, where a mechanical barrier has been breached, the output of â-defensins (natural antibiotics present in epithelium) is increased dramatically to help control bacterial and fungal invasion in the exposed area.

B. Phagocyte Mobilisation

Soon after inflammation begins, the damaged area is invaded by phagocytes (white blood cells that eat bacteria). If the inflammation was caused by pathogens an immune response is also mounted by complement (plasma proteins), lymphocytes, and antibodies (immune elements).

The inflammatory chemicals produced act as homing devices for neutrophils - attracting them to the site of injury. The ultimate goal of an inflammatory response is to clear the injured area of pathogens and dead tissue cells so that tissue can be repaired. Once this is accomplished, healing usually occurs quickly.

Many disease states have inflammation as a component of distress. Cortisone-derived drugs and non steroidal anti-inflammatory drugs are commonly used to regulate inflammation. Fortunately many nutrients have anti-inflammatory properties and are as effective as most drugs, with little side effects. Anti-inflammatory means a substance that blocks or lessens inflammation.

The major pathways of inflammation involves the release of Cytokines such as Tumour Necrosing Factor (TNF), Interferon I & II, which stimulates the production of Nitric Oxide (NO), Prostaglandin E2 (PGE2), Thromboxanes and Leukotrienes.

Platelet activating factor (PAF) is a known potent mediator of acute inflammation and has been shown to be a powerful potentiator of tumour growth. PAF is synthesised through phospholipase A (PLA2) and acetyl transferase. Inflammation and platelet aggregation promote metastasis.

Natural ingredients to reduce inflammatory mediators

Inflammatory Mediator Attenuated By
Platelet Aggregating Factor (PAF) Quercetin, Ginkgo, Zinc
PGE2 EPA, GLA, DHA
Thromboxanes Ginger
Leukotrienes EPA, DHA, GLA
Nitric Oxide (NO) Lipoic Acid, Vitamin C and E, Selenium, Glutathione, Coenzyme Q10
Tumour Necrosing Factor (TNF) TNF's stimulating effect on NO synthesis can be attenuated by pyridoxal-5-phosphate
Kinin Bromelain, Trypsin
Phospholipase A2, Lipo-oxygenase, Cyclo-oxygenase Quercetin, Rutin, Vitamin A and E, B6, Zinc


Lymphoedema
is associated with inflammation and can be controlled by Quercetin.

Inhibition of PAF activity can be achieved by ginkgolides from Ginkgo Biloba and Zinc.

Phospholipase activity can be attenuated with Flavonoids (Quercetin and Rutin) and Vitamin A. The inflammatory mediators such as Thromboxane are attenuated by Ginger.

Essential fatty acids are substrates for hormone like substances called Prostaglandins and Leukotrienes. Platelets are made less sticky by PGE1, derived from Gamma Linolenic acid (eg Evening primrose oil) and PGE3 derived from alpha Linolenic acid (eg Linseed oil) and eicosapentaenoic acid (EPA) (eg marine fish oil). In contrast, PGE2, and thromboxane (TXA2) derived from arachidonic acid which is synthesised from cis-linoleic acid metabolism, makes platelets sticky. Therefore using these essential fatty acids, and reducing arachidonic acid containing foods eg meats, safflower and corn oil, can have a profound effect on inflammation. It is well recognised that a diet supplemented with alpha and gamma Linolenic acid can retard or inhibit tumour growth.

The modulation of enzymes involved in prostaglandin metabolism, such as cyclo-oxygenase and lipoxygenase can further add to regulation of inflammatory mediators. Substances such as Quercetin, Zinc, Vitamin E, Bromelain, Rutin, EPA, ALA and B6 have all shown to modulate these enzyme activities and thus potentiate the effect of essential fatty acid supplements and hence reduce tumour growth.

Nitric oxide (down regulated by Vitamin E and Lipoic acid) and tumour necrosing factor are other inflammatory mediators.

Health problems associated with inflammation

Rheumatoid arthritis, Osteoarthritis, Asthma, Inflammatory Bowel Disease, Cancer, all Autoimmune conditions, Vasculitis (inflammation of the vascular vessels - associated with SLE), Scleroderma, Ulcerative Colitis, and Dermatomyositis are all associated with inflammation. Also complement deficiency, viral, bacterial and protozoan infections contribute to inflammation.

Insulin resistance leads to an increase in fat mass which activates the Hypothalamic-Pituitary-Adrenal (HPA) axis causing inflammation. Insulin activates NF-kappa B transcription. NF-kappa B plays an important role in mediating TNF-alpha and IL-6 expression - two pro-inflammatory cytokines. TNF secretion and increased IL6 (Interleukin 6) exacerbate TH1 and TH2.

Your immune system and inflammation

An imbalanced immune system can cause severe inflammation. Both environmental and genetic factors act in concert to determine the TH1 or TH2 polarisation.

TH1 (T-Helper 1 Cell) dominance, resulting in such things as Asthma, Eczema, Hay fever, and Dermatitis among other things, may be caused by many things including pesticide exposure. Glutathione, Vitamin A, B Complex, C, and Selenium may be used to increase TH2 (T-Helper 2 cell) levels, thus restoring balance.

TH2 (T-Helper 2 Cell) dominance, on the other hand, results in conditions like Rheumatoid arthritis, Multiple Sclerosis, Type 1 Diabetes, Alopecia, Vitiligo, Ulcerative Colitis, Psoriasis, Crohn's.

Excess oestrogen, low DHEA levels, heavy metals, Zinc deficiency, and stress can cause TH2 dominance. Perilla down-regulates Th2 cytokine production. Childhood infections stimulate Th1 development, and a reduction of infections in childhood can skew an immune system to a Th2 response.

Natural products to help with TH1 and TH2 imbalances

  Th1 Th2
Astragalus Balances Balances
Bromelain Balances Balances
Cat's Claw Increases Decreases
Coriolus versicolour Increases Decreases
Curcumin Decreases Increases
Fish Oil Decreases ---
Glutathione Increases ---
Grifola frondosa Increases ---
Lactic acid bacteria Balances Balances
Perilla (luteolin) --- Decreases
Phytosterols Increases Decreases
Polypodium Decreases Increases
Reishi mushroom Balances Balances
Shiitake mushroom Increases Decreases
Vitamin E Increases @ low dose
Decreases @ high dose
Decreases
Zinc Increases Decreases


Beneficial probiotic bacteria, such as lactobacillus and bifidus, can regulate Th1/Th2 balance.

Food intolerances and inflammation

Food allergies and intolerances can contribute, in a major way, to inflammation. IGE antibody mediated food allergies occur because of a crosslink on mast cells inducing the release of histamine, proteoglycans, and leukotrienes in response to the offending agent. IGG antibody mediated food allergies result in an induction of basophil degranulation triggering histamine and other potent inflammatory chemical mediators. Dietary lectins pose a potential threat to humans due to their capacity to induce histamine release from basophils. As they can enter the circulation after oral uptake, they may play a role in inducing the so-called early IL4 (Interleukin 4) required to switch the immune response to a TH2 response.

Natural products to help the body deal with inflammation:

Omega 3 fatty acids inhibit production of Prostaglandin 2, Thromboxane and release of platelet Serotonin (implicated in migraines). They promote anti-inflammatory prostaglandin production. Omega 3 displaces arachidonic acid in mast cell and neutrophil membranes and reduces pain, inflammation and swelling. With Vitamin E, Omega 3 inhibits the production of inflammatory Prostaglandins and Leukotrienes, an activity made even more effective in combination with Evening Primrose oil. Borage oil is another source of GLA.

Trypsin and chymotrypsin are the most powerful proteolytic enzymes for the degradation of bradykinin-mediated pain and inflammation associated with acute tissue injury. These enzymes reduce the pain and oedema associated with acute trauma and assist in the removal of wound debris (bruising). Proteolytic enzymes such as Bromelain, Trypsin and Chymotrypsin have been shown to reduce kinin activity. A combination of proteolytic enzymes, Bromelain, Flavonoids and Vitamin C has been found to be as effective as non-steroidal anti-inflammatory drugs.

Bromelain has anti-inflammatory activity and increases the breakdown of fibrin, which forms around the inflamed area, blocking the blood and lymph vessels and leading to swelling. Caution do not take with other mineral supplements. The recommended dosage is 500 mg 3x daily on an empty stomach. Regulates cytokines.

Quercetin inhibits lipo-oxygenase, phospholipase and cyclo-oxygenase enzymes involved in prostaglandin synthesis. It is anti-allergic, inhibiting histamine release from human basophils and Murine mast cells. It also inhibits overproduction of TNF-alpha and NO by LPS stimulated macrophages.

Cetyl Myristoleate - (CMO) corrects erroneously programmed memory T-cells that cause the autoimmune response. It also exerts an anti-inflammatory action.

Liquid Bovine Tracheal Cartilage - exerts an anti-inflammatory effect on all connective tissues including blood. Immuno-modulatory as well. Repairs connective tissue - indispensable in the repair of soft tissue injuries.

MSM delivers biologically active sulphur to the body. It is readily absorbed orally, and through skin, and is essential for the production of keratin and other proteins. MSM helps to build and maintain healthy joints (may slow cartilage degeneration) through its effects on collagen(lessens scar tissue formation) and is needed for bile production and the formation of taurine. It has anti-inflammatory properties thus reducing muscle spasms and relieving muscle soreness. MSM adjusts body pH, helps to normalise the immune system, and dilates blood vessels - improving circulation. It can be valuable in reducing pain and inflammation.

Herbs to help with inflammation

Feverfew contains a number of active components. Parthenolide, and perhaps other sesquiterpene lactones, have been shown to reduce the secretory activity of blood platelets and white blood cells in laboratory studies, providing a possible basis for Feverfew's effectiveness in migraine, arthritis, and psoriasis. Abnormal platelet behaviour has been implicated as a possible explanation for the development of migraines. Platelets release the hormone serotonin during a migraine attack. Serotonin constricts blood vessels among other actions. Serotonin antagonists have been suggested for use in a supportive role in migraine prevention. Feverfew has been shown, in vitro, to inhibit serotonin release from platelets.

Turmeric has an extremely powerful regulatory effect on inflammatory eicosanoids synthesis. Curcuminoids action in the suppression of inflammation are believed to be due to its increasing the endogenous secretion of cortisol. This increases the sensitivity of glucocorticoid receptors to cortisol and increases the half-life of endogenous cortisol by retarding its degradation within the liver. Turmeric also possesses well documented antioxidant activities which reduce some triggers of inflammation, as well as inducing phase 2 liver detoxification.

Ginger inhibits inflammation by modulating pro-inflammatory eicosanoids such as PGE2, PGF2 alpha and series 4 Leukotrienes. Ginger increases blood circulation and is considered a warming herb which may help to increase joint mobility. Ginger also possesses antioxidant properties (due to its Shogaol and Zingerone constituents), which further reduce the triggers associated with inflammatory conditions. The gingerols inhibit cyclo-oxygenase 1 and 2 activity. Gingerols and their derivatives also block cytokine formation and are potent inhibitors of TNF-alpha.

Boswellia is a powerful inhibitor of the pro-inflammatory lipoxins and series 4 Leukotrienes, due to its boswellic acid content.

Chamomile is a herb with anti-inflammatory action. Azulenes, including chamazulene, have been shown to be anti-inflammatory. Alpha-bisabolol is another component of Chamomile that is anti-inflammatory, as well as anti-bacterial, anti-fungal, has a protective effect against peptic ulcers, reduces fever and reduces healing time in skin burns. Flavones, including apigenin, luteolin, patuletin, and quercetin, are all anti-spasmodic.

Hops is a herb that has only recectly been considered in the treatment of inflammation. recent data suggests that components(Luduxin) of Hops may inhibit the formation of prostaglandins (eg PGE2) via upstream modulation of gene expression. Luduxin consists of reduced iso-alpha acids and magnesium salt.

Olive leaf's oleanolic acid is a phytochemical widely distributed in the plant kingdom. It may support joint health by interfering with the activation of enzymes involved in eicosanoids (eg PGE2) synthesis.

Rosemary extract, two components of which are carnosol and carnosic acid, account for the majority of the antioxidant activity of Rosemary leaves. Research suggests that rosemary down-regulates the activation of transcription factors (i.e. NFk-B) that result in perpetuation of the eicosanoids cascade.

Liquorice should contain around 12% glycyrrhizin. At this strength it is a potent anti-inflammatory and the recommended dosage is 100mg 3xdaily.

Black Cohosh in a 4:1 extract, has been shown to relieve muscle and joint pain.

Nettle has a reputation as a natural antihistamine. However, in terms of hay-fever, you need to drink 2 cups of Nettle tea a day for 6 months prior to spring!

Bilberry extract contains flavonoids, which reduce inflammation.

Grape seed extract, containing 95% leucoanthocyanins, is a powerful natural anti-inflammatory.

Yucca has also demonstrated anti-inflammatory effects, particularly in the treatment of osteoarthritis. 1000 mg 3x daily is a good dose.

Devil's Claw, is another herb with well documented anti-inflammatory activity. It has been found to be beneficial in the relief of arthritis.

Cats claw containing 3% alkaloids, when taken at 200 mg 3xdaily, has potent anti-inflammatory effects. It is particularly useful for infections such as the 'flu, as it also increases Natural Killer (NK) cell activity.

Reishi extract stabilises mast cell membranes, inhibiting the degranulation and release of inflammatory prostanoids and proteins. T suppressor cells are able to recognise and destroy antibodies generated against 'self' tissue. Reishi has a potentiating effect on T suppressor cell activity.  We have this combination product, which contains Reishi - Astraforte

Nutrients also play an important role in moderating inflammation:

Zinc helps to control inflammation and promotes healing. High dose Magnesium with Malic acid, Potassium, Calcium, and other vitamins to enhance mitochondrial activity, reduce muscle pain, relax nervous excitability, whilst preventing excessive free radical damage and inflammation. fast relief of spam, pain and inflammation. Magnesium deficiency is associated with increased spasm potential, increased oxidative damage and 'substance P' production (a promoter of inflammation). These magnesium powders also contain Malic acid - Endura and Mega Magnesium Powder.

DHEA may be used to down-regulate inflammation associated with Lupus. A therapeutic dosage of 10-1000mg daily is recommended. DLPA increases the pain threshold by inhibiting the degradation of mood elevating and pain killing endorphins.

Vitamin C is a major antioxidant present in the airway surface liquid of the lung. Low levels are associated with increased asthma severity and may function via inhibition of PGE2 synthesis, increased histamine breakdown and decreased smooth muscle contraction. Vitamin C 3000-6000mg divided doses essential to the healing process and in reducing swelling. Vitamin C has proven anti-inflammatory properties. It stabilises cell membranes, as well as having fibrolytic and anti-histamine effects. Its requirement also goes up in inflammation.

Vitamin E inhibits inflammatory mediators in autoimmunity and protects against free radical cell damage. Vitamin E protects lysosomes and has powerful anti-inflammatory properties.

A Vitamin B12 injection, 1mg daily, can be given for 10 days to help reduce inflammation.

Homeopathy may also be of help with inflammation

Homoeopathic Colchicum may be used in the treatment of Gout for its acute inflammation. Euphrasia is for eyes that are sore, red and inflamed. The eyes water with burning tears. It may be used for pink eye or anything that is red and itchy. Pulsatilla is also for pink eye. It is also indicated for yellowish-green sticky discharge from the eyes or nose. Symphytum may be used daily for several weeks once a broken bone has been set. Also for eyeball injuries. Ruta grav is for strains to the joints and connective tissues, that are worse for cold and damp, and feel better for warmth.

Rhus tox is for extreme restlessness with a red itchy rash. Symptoms are better for warmth, and worse for cold, damp, and overexertion. Phytolacca is for sore throats that look dark and angry. The pain feels like a hot ball and may extend to the ears. Swollen tender breasts with hard lumps and cracked nipples. Chamomilla helps with extreme sensitivity to pain. Bad temper and irritability often accompany the Chamomilla picture. Chamomilla is often used for teething. Inflamed gums, drooling, and a desire to keep fingers in the mouth are common signs. Commonly, one cheek is hot and red, while the other is pale. Cantharis is indicated for cystitis presenting with intense burning pains on urination. Burns or burning pains generally, such as in sunburn or burns from hot pans will respond to Cantharis. Hypericum is for pains are often felt shooting up the limbs, along the tracks of the nerves.

Belladonna is for throbbing pains, especially in the head area, the face or affected part is usually bright red. There may be fever with high temperature, little thirst and burning, dry skin. The pupils may be dilated and over-sensitive to light. Apis is a useful remedy after injuries, especially from bites or stings where there is swelling, puffiness and redness. Fever appears quickly and with-out thirst. Allium cepa is for the nose and eyes that burn and are irritated. Nasal discharge is acrid while the tears are bland. It is a major remedy for hay-fever (when the nose is affected more than the eyes) and for colds. Sneezing, often repeatedly, with a streaming nose. Arnica after any injury for bruising. Good for shock also. Aconite may be used to control inflammation.

Cell salts may be of assistance with inflammation

Kali phos cell salt is used for inflammation and nerve injuries. Mag phos is for violent, cramping, spasmodic pains often in the abdominal area - problems like colic, menstrual pains, sciatica, toothache or earache. Pain improves with warmth. Ferr phos is for congestion, inflammatory pain, high temperatures, and a quickened pulse. It is best in the early stage of an acute disorder.

Arnica, applied topically, decreases pain and inflammation. May be applied to unbroken skin only. If the skin is broken, Hypercal lotion or cream may be used instead.

We have Yang Balm for the relief of muscular pain, swelling and bruising. A powerful New Zealand made muscular healing agent that can be excellent for acute injury and chronic muscular spam. Applied topically it helps to reduces inflammation, bruising and pain and speeds recovery.

Nutritional and Herbal Support for Inflammation includes:

High Potency Anti-inflammatory Herbs - Turmeric & Boswellia - Pain Relief. A powerful blend of anti-inflammatory herbs, all with potent regulating activity on inflammatory eicosanoids. Turmeric also provides a strong antioxidant action to reduce inflammatory triggers. The combined action of these herbs inhibits mast cell degranulation and reduces allergic and inflammatory reactions.This is our strongest combination product for helping with pain and inflammation.

Quercetin and Bromelain- Acts to protect and preserve the structure of capillary blood vessels and promote circulation. It has a powerful anti-inflammatory effect and may be helpful to those suffering from swelling due to an injury and from allergic reactions. Helps promote circulation and post-traumatic reabsorption of inflammatory by-products, thus allowing speedier recovery time from injuries - reducing swelling and inflammation and helping to reduce pain symptoms.

Fish oil - The body converts the fatty acids into prostaglandin's and other similar compounds. These then exert their effects on various tissues of the body. Some people find these substances also provide relief from arthritis. Arthritis sufferers may find our product especially beneficial, as the salmon oil we have used also contains vitamins A and D - traditional remedies for relieving the pain of arthritis.

Some interesting points on Inflammation:

Your diet (i.e. the foods you eat and beverages you drink) is very important!

Avoid all processed and refined foods - especially refined carbohydrates such as cola, sugar, white flour and other junk foods. If you are aware of any particular foods that disagree with you (food allergies) avoid them!  Do not smoke and avoid all tea, coffee, milo, chocolate (caffeine in general) and alcohol.

Increase your consumption of fresh fruit and vegetables, and quality protein for healing. Fish like Salmon is ideal.  Ensure water intake is adequate - at least 2 litres a day.

Other nutrients that have been found to be effective are Valine, Creatine, and d-l-Phenylalanine.

Onions contain "cepaenes" (sulphinyldisulphides) which inhibit platelet aggregation and fatty acid oxygenase, cyclo- and lipoxygenase. Ginger in your cooking may also be helpful.

The traditional method for relieving inflammation

  • Positioning the affected part properly (including splinting if necessary)
  • Applying ice initially
  • Using alternating hot and cold a little later
  • And plenty of rest.
     

Any antioxidants will help block free radical damage that can cause inflammation. A broad spectrum antioxidant will help to remove the products of oxidant stress from the site of inflammation. Copper, Manganese and Zinc to promote production of the vital anti-inflammatory enzyme superoxide dismutase is a good idea. Coenzyme Q10 is also of value. SOD is a high potency free radical scavenger that is particularly wide acting.

Nutrient deficiencies may cause inflammation also. A Vitamin B3 deficiency may cause skin inflammation. A Biotin deficiency may cause an inflamed tongue. A Chromium deficiency may cause nerve inflammation.

 

The Naturopathic Team
Ideal Health

Disclaimer: The health information presented here has been written for the New Zealand health consumer. It is of a general nature and is only intended to provide a summary of the subjects covered and is intended to be used for educational and general information purposes only. It is not intended as medical advice or as a means to diagnose, treat, cure or prescribe for any particular condition or disease. You assume all responsibility for the treatment which may be undertaken as a result of the information on this site, or treatment recommended by any other party. While all care has been taken to ensure the accuracy of the information, no responsibility or liability is accepted, and no person should act in reliance on any statement contained in the information provided. All health ailments should be treated by a qualified health professional.


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