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Buzzed on inflammation

Brent Bauer, M.D.
General Internal Medicine, Editorial Board member of Mayo Clinic Health Letter

Inflammation is the new medical buzzword. It seems as though everyone is talking about it, especially the fact that inflammation appears to play a role in many chronic diseases. The July issue of Mayo Clinic Health Letter highlights inflammation's role in cardiovascular disease.

Of course, inflammation isn't entirely bad. Acute inflammation — the kind that protects and heals the body after an injury or infection — is essential and normal. In the wake of a nasty cut or broken bone, the battle is on! Immediately, a biochemical cascade improves blood flow to the area. Nerve endings and other cells at the site of the injury or infection send out signaling molecules and other chemical components to recruit the body's equivalent of the Superhero — white blood cells that fight off foreign bodies. It's an amazing process that from the surface looks like swelling and can hurt, but it's all part of making things better. That's acute inflammation. It's necessary and normal for good health.

The other kind — chronic inflammation, also known as low-grade or systemic inflammation — can play a more puzzling and long-lasting role in the body. Consider the vast array of autoimmune disorders — such as rheumatoid arthritis, lupus and polymyalgia rheumatica — where the body's immune system mistakenly initiates an inflammatory response even though there's no apparent inflammation to fight off. Chronic inflammation plays a more obvious role in diseases such as asthma and the inflammatory bowel diseases ulcerative colitis and Crohn's disease.

And what about the not-so-obvious role of chronic inflammation? Consider the possible connection between gum disease and cardiovascular disease. Research indicates that heart disease, clogged arteries, stroke and bacterial endocarditis may be linked to oral health. Although more study is needed to confirm this possible link, some scientists believe that bacteria from gum disease can enter the bloodstream and make its way to the heart.

Even less obvious — but of enormous interest to researchers — is the part inflammation plays in cancer. For instance, chronic bladder inflammation due to repeated urinary infections or cystitis may increase risk of a squamous cell bladder cancer. In some areas of the world, this type of cancer is linked to chronic inflammation caused by infection with a parasite.

Just what does all this mean for you? Can you actually do something to reduce your risk of chronic inflammation that may play a part in disease? That depends. At present, it's still too early in the science to reasonably conclude that reducing inflammation leads to a reduction in cancer risk. Many of the questions concerning cause and effect with cancer have yet to be proven.

What you can do, though, is make a point to avoid certain things that cause inflammation and are proven unhealthy. Prime examples are smoking and excessive alcohol use.

Some people advocate an "anti-inflammatory diet." Although there's less evidence such diets work to directly thwart inflammation, most of the recommended foods are typical of the Mediterranean style of eating and in principle are good choices. Key components of the Mediterranean diet include:

  • Eating generous amounts of fruits and vegetables

  • Consuming healthy fats, such as olive oil and canola oil

  • Eating small portions of nuts

  • For some, drinking red wine in moderation

  • Eating fish on a regular basis

  • Consuming very little red meat

You may wonder if nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin, ibuprofen and naproxen — would be helpful, as the drug class name would seem to imply. Research is underway into NSAID use as a possible new strategy for potentially treating or preventing cancer. The prospects are intriguing, but the data isn't solid. If you take aspirin or another NSAID under a doctor's direction for a health-related concern such as preventing heart attack or relieving chronic pain, that's an accepted and appropriate use for this class of drugs. As always, the risks of gastrointestinal bleeding have to be considered with regular NSAID use.

And then there's the huge area of dietary supplements, which is largely uncharted when it comes to carefully done clinical trials for safety and effectiveness. Unlike prescription drugs, dietary supplements are not regulated by the Food and Drug Administration for safety and effectiveness. With that caveat, here are some that may be of interest:

  • Cat's claw (Uncaria tomentosa) — Limited studies indicate modest benefits for easing rheumatoid arthritis joint pain and osteoarthritis knee pain during activity, but more studies are needed before its use can be recommended.

  • Devil's claw (Harpagophytum procumbens) — Studies suggest devil's claw is effective in the short-term treatment of osteoarthritic pain. It's used extensively in Europe as an anti-inflammatory agent.

  • Mangosteen (Garcinia mangostana) — It's credited with anti-allergy, antibacterial, antifungal, antihistamine and anti-inflammatory qualities, and even as a possible cancer treatment. But high-quality human trials are still lacking that support its effectiveness or safety.

  • Milk thistle (Silybum marianum) — Milk thistle appears to protect the liver and block or remove harmful substances from the organ. Although more study is needed, it appears to improve organ function in people with cirrhosis, a chronic liver disease. It may also be helpful in treating chronic hepatitis. More research is needed before any specific recommendations for its use can be made.

My best advice concerning chronic inflammation is to stay tuned. This is a huge area of interest in the medical world and there are bound to be discoveries down the road that can improve well-being and the quality of health.

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