Tonight, I’d like to try to clear something up.
I write a lot about inflammation. I use the term loosely and by so doing, I risk being imprecise. Sorry about that. (I’m far more precise with an ablation catheter than words on a blog.)
My reason to focus on inflammation stems from my belief that long-term and unrelenting exposure to things antagonistic greatly contribute to chronic diseases, like heart disease, cancer and aging. And of course, understanding inflammation’s role in disease might help some (me) make healthier choices.
The simplistic view of inflammation holds that all stress is bad. Avoid it and live well.
That’s wrong thinking. Of course we need to put our bodies and mind to the test. Physical and mental exercise make us stronger by inducing adaptation. Brain and muscles grow more powerful after repeated stress. This is called fitness.
Likewise, inflammation is a necessary process used to combat harmful stimuli. The biologic response is complex: the body senses disruption, chemicals are released, white cells are called to action, and an insult walled off. Without acute inflammation, we would not survive even simple infections, cuts would not heal and mountain biking and cyclocross would surely be deadly.
Acute inflammation differs greatly from chronic inflammation. The need to deal with repeated exposure to noxious stimuli, albeit small individually, can accumulate. While healing after brief episodes of stimuli strengthens us, bathing the body in a constant stream of inflammation breaks us down. In the blood vessels, chronic inflammation leads to unstable plaque. In the heart muscle, chronic inflammation is likely important in atrial fibrillation.
What constitutes too much inflammation?
That’s a tough one to know for sure. The vastness of the Internet doesn’t really help sift this out much. Take today’s Sports Medicine news as an example: Headlines had a single-bout of one-hour spin class increasing abnormal rises in cardiac enzymes. The study, published in a remote Scandinavian journal, included only 10 patients, 2 of which had minor elevations of a super sensitive enzyme. Of course, spin classes aren’t bad for us. Stomping on a bike for short periods is great exercise.
And to make things more complicated, it’s not just physical stress that can inflame us. Something as ubiquitous as negative and competitive social interactions boosts inflammatory chemicals.
As an aging bike-racer who has perhaps logged too many miles, and a too often ill-tempered cardiologist, inflammation piques my interest. Add to this curiosity a life’s work of treating diseases entwined with chronic inflammation and it becomes only logical to write a blog.
I see inflammation-run-amok as a potential unifying theme in health. I like common denominators, forests not trees, big views not those that are zoomed in on minutia. You ask about micromanaging LDL levels; I ask about your waist size and 5k time. Imaging experts want to promote CT scans as detectors of heart disease; I like the Timex.
Is something healthy?
I think about inflammation.
Contrast…
a serving of nuts (omega-3 fats) with trans-fat laden potato chips,
an hour of spirited exercise with a 5-hour slog,
a smile with a scowl,
half-full with half-empty,
baked chicken with chicken noogets.
If only it was always so clear.
JMM
7 replies on “CW: Let’s talk inflammation and health…”
Well, I agree with you. If you ask my oncologist why I got cancer he’d tell you that I was a woman over the age of 40. If you asked me I’d tell you that I went through a nasty divorce then had a teen aged son in a war zone, that with the boss from the dark side. I am totally convinced that it was a life of constant stress.
I took biochem in the early ’80’s from a professor who would tell us to remain calm; that aggravation would raise our prostaglandins and make our platelets sticky. Today, I have no idea if that’s accurate, but it’s how I’ve tried to run my life. I enjoy your blog talking about the dangers of chronic inflammation, it validates my goal of remaining calm all these years (except for when I’m not).
I recall a “Cow” study where they kept them in an essentially a stress free environment. The null hypothesis was that this would cause them to be healthier and thus their meat to be better (somewhat disgusting objective for vegans and PETA)—the opposite occurred. Lack of stress weakened the cow and the body shut down. When exposed to nature (within normal boundaries) the cow grew and became resistant to a multitude stresses. There may be a lesson somewhere in here for us.
my take is we’re all a little nutty in some way that gives us that kick that equals self inflammation. self contained and hopefully harmless to others. you mountain bike, and race, my son, serious rock climbs ( the thought of going above the 3rd rung on a step ladder scars me, no genes in him from me as to height ) i think you’re both nuts. but in the end if something happens to either of you your at least doing what you want. as for me, i’m well into my 70’s. have had my share of life inflammations and tons of self inflicted. have had lots of luck glad i’m still rolling along. most blogs comments etc. are ok. this one dear doctor is great. thanks
The first thing my cardio asks me during my visit is “Have you been under stress lately?”. Duh. Ya gotta pill for that to make it better?
Life is stressful by it’s very nature…if you have a job, it’s job stress (some more than others). If you don’t have a job, it’s the stress of trying to get one as well as the financial stress that comes with not having one.
When CRP testing came to the forefront, I thought we’d be inundated in the lab with testing stressed-out people (with suspected inflammation) for that. Not so.
When you think about it, what’s the point, especially when you can use a sed rate and/or RA more cheaply and faster…unless the doctor wants the CRP to be part of the picture puzzle. In any event, I don’t see it ordered as often as I thought it would be.
I’m getting pretty sold on taking Yoga to alleviate the stress in my own life, and, hopefully, inflammation in turn. Now if I can just de-stress about getting to the yoga class on time!
Oh…and a sense of humor helps!
Dr. John: I love your columns. I’m a NP but that’s all we have in common is a love of medicine. I dislike exercise as abundantly as you love it! But I know I must do it!
Also being one who believes there is much about inflammation that contributes to my heart disease, diabetes, and Barrett’s esophagus, I thought you might be interesting in reading about a new medication in clinical trials that has been used to actually REVERSE chronic kidney disease and is anticipated will be used for many kinds of inflammatory diseases. See the clinical trials timeline on this page.
Check out the website: http://www.reatapharma.com/investors-media.aspx
I heard about this thru a friend of a friend and sure do hope this drug is able to deliver on all the hopes the college who discovered/invented it has for it.
Lynn
Dr. John,
First of all, I apologize for making this a VERY long post, but I think it is important to share this information with you.
I wholeheartedly agree with you on the cardinal role of inflammation in etiology of heart disease and certain arrhythmias. I recently came across several articles in in Russian EP journals which hypothesized that chronic inflammation might be a root cause of several idiopathic arrhythmias, ranging from frequent ventricular ectopics beats to lone atrial fibrillation.
The first article (1) talked about a group of 22 patients who were scheduled to undergo ablation for idiopathic ventricular arrhythmias (frequent PVCs, NSVT, VT). All patients had no clinically identifiable heart disease, based on ECG, ECHO, Stress Test and MRI. Subsequently, all patients had a endomyocardial biopsy sample taken from arrythmogenic focus zones in their ventricles, which were localized using 3D elecetrophysiological mapping. 19 patients were found to have either acute of chronic form of myocarditis and 3 other patients had signs of arrhythmogenic dysplasia. None of the patients had a ‘healthy heart’, despite the fact that all clinical test, including MRI, could detect any signs of heart disease in this group of patients. The authors of the study conclude that a diagnosis of ‘idiopathic ventricular arrhytmia’ should not be used, unless all possible invasive and non-invasive diagnostic tests should be carried out to rule out all potential causes of an arrhythmia.
Another article (2) examined a group of 16 patients with idiopathic rhythm disturbances. Endomyocardial biopsy of right ventricle was carried out in all patients with «idiopathic» rhythm disturbances (mainly atrial fibrillation but also premature beats, paroxysmal tachycardia, various conduction disturbances and their combinations). Elevated levels of anti-myocardial antibodies, antibodies to antigens of endothelium, cardiomyocytes, conductive system and also (in some patients) identification of antinuclear factor with bull’s heart antigen (in absence of other laboratory markers) were considered as additional indications for biopsy. Normal histological picture was not received in any cases. Immunoinflammatory
abnormalities were diagnosed in 87.5% of patients (myocarditis — in 10 patients, virus cardiomyopathy — in 1 patient, endomyocarditis — in 1 patient, systemic vasculitis — in 2 patients); virus genome was detected in myocardium of 3 patients
(herpes simplex virus type 6, parvovirus B19); 2 patients had arrhythmogenic right ventricular dysplasia and Fabry disease respectively. The authors of the study theorized: that chronic myocarditis is not always preceded by an acute and highly symptomatic acute myocarditis. In fact, a presumption could be made that acute and chronic myocarditis do not represent different stages of the same disease, but are rather two separate diseases. Chronic myocarditis can be resticted to a localized region of the myocardium or the surrounding vessels. Furthermore, it can be completely asymptomatic or rhythm disturbances and cardiac conduction abnormalities can be the only clinical manifestations of this condition. The authors believe that all patients with idiopathic arrhytmias should be extensively tested for the presence of myocarditis.
Dr. John, what do you think about the role of sub-clinical heart infections in the genesis of ‘idiopathic arrhytmias?’Are you familiar with any American studies of similar nature?
Regards,
IU
References (in Russian):
1. ОТДÐЛЕÐÐЫЕ РЕЗУЛЬТÐТЫ Ð ÐДИОЧÐСТОТÐОЙ ÐБЛÐЦИИ ЖЕЛУДОЧКОВЫХ ÐРИТМИЙ У ПÐЦИЕÐТОВ БЕЗ СТРУКТУРÐОЙ ПÐТОЛОГИИ СЕРДЦÐ. Online access – http://www.vestar.ru/article.jsp?id=10793
2. «Idiopathic» arrhythmias as a symptom of latent cardiac disease: nosologic diagnostics using endomyocardial biopsy.
Online access –
http://www.mediasphera.ru/uppic/Cardsurg/2010/1/13/KSS_2010_01_56.pdf