Rethinking Inflammation Origins

February 3, 2023

Summary: Inflammation is the body’s defensive response that helps fight infection and promote tissue regeneration. However, in many instances, the inflammatory response is improper, causing more harm. Hyperinflammation and autoimmune disorders are all examples of abnormal immune responses. Similarly, hidden inflammation also causes much damage and is the main cause of chronic health disorders. In addition, it appears that lack of exposure to pathogens in the early years of life and changes in microbiota are also behind faulty immune responses in many cases.

When people think about inflammation, they often imagine it as something sinister. However, inflammation is neither good nor bad. It may be a defensive reaction in some cases and may become a cause of worsening health in other cases. In addition, there is much still to be understood about inflammation. Just take the example of the Covid epidemic. Why do some people have worse outcomes than others? Understanding worse outcomes in older adults or those living with chronic health conditions, obesity is relatively simple.

However, explaining why disease outcomes differ in two relatively healthy individuals is challenging. Nonetheless, it is known that much depends on the immune system and inflammatory responses. When Covid or any other infection attacks the body, it initiates a potent immune response causing fever, cough, and various body changes.

These changes help eliminate infectious agents. However, in many cases, the body struggles to overcome the infection, and thus it releases cytokines in massive amounts to fight the infection. Many people are unable to tolerate this massive upsurge in cytokine production, also called a cytokine storm. In many instances, this hyperinflammatory response causes more damage than the infection. Inflammation is among the most fundamental ways of defending the body from infections. It also accelerates healing processes. But, in some instances, inflammation may cause more damage than good.

A complex regional pain syndrome specialist may be able to help with treating chronic pain caused by inflammation, while a pancreatic pain treatment plan may focus on reducing inflammation in the pancreas to alleviate discomfort. Things are not as simple. In many people, inflammation may persist without any known cause. Many people these days are living with autoimmune disorders.

In conditions like rheumatoid arthritis, lupus, and other autoimmune conditions, the body’s immune system goes rogue and starts attacking its body’s cells. Thus, in such cases, inflammation starts working against the body. Autoimmune disorders are highly challenging to treat.

If one suppresses the immune system and inflammation in autoimmune disorders, it also reduces its capacity to fight infection. Hence, these people become prone to infections. But, on the other hand, if the inflammatory response remains unchecked, it causes much damage. Thus, physicians are faced with a dilemma.

All this means that excessive inflammatory response is as bad as inadequate inflammatory response. Thus, inflammation is quite like the yin and yang of the body.

However, even more, worrisome is a low-grade hidden inflammation. Quite often, a source of such an inflammation remains unidentified. It is more like a leaky hose. This low-grade and continuous inflammation is known to be behind so many chronic ailments like heart disease, neurodegenerative disorders, and more. However, managing this low-grade and hidden inflammation remains challenging, as not much is known about the source or cause of such inflammation.

Here it is worth understanding that this low-grade hidden inflammation may cause immune dysfunction. People living with such inflammation are more likely to have an inappropriate inflammatory response to various infections.

The classical model of looking for changes in specific organs does not work anymore, as issues affecting a particular organ may be due to inflammation that originates from another place. Most modern diseases occur due to this hidden inflammation caused by wrong lifestyle choices.

Further, it appears that our obsession with hygiene is also causing some problems. A few centuries back, people were exposed to a large number of pathogens in their early years of life. This also helped train immunity and, thus, reduced the risk of allergies, autoimmune disorders, and inappropriate immune responses.

Similarly, modern lifestyle is disruption microbiota, which plays a vital role in training the immune system. Hence, microbiota changes also have much to do with inappropriate immune responses in many people.

By Gurpreet Singh Padda, MD, MBA, MHP