Summary: Inflammation is the body’s defense. It fights infection and helps tissue rebuild. But in many cases the response misfires and does more harm. Hyperinflammation and autoimmune disorders are both examples of an immune system gone wrong. Hidden inflammation also does great damage and is the main cause of chronic disease. In many cases, two more forces seem to drive faulty immune responses: too few germs in early life, and a changed gut microbiota.
People often picture inflammation as something evil. But inflammation is neither good nor bad. In some cases it may defend you. In others it may make your health worse. And there is still a lot we do not understand. Take the Covid epidemic. Why did some people do worse than others? In older adults, or people with chronic illness or obesity, the answer is fairly simple.
But it is hard to explain why two fairly healthy people can have such different outcomes. We do know that much depends on the immune system and how it inflames. When Covid or any other infection attacks, the body launches a strong immune response. It brings fever, cough and other changes.
These changes help clear the germs. But in many cases the body struggles to beat the infection. So it floods the system with cytokines, its alarm chemicals. Many people cannot handle this huge surge, called a cytokine storm. In many cases this hyperinflammatory response does more damage than the infection. Inflammation is one of the body’s most basic defenses against infection. It also speeds healing. But in some cases it may do more harm than good.
A complex regional pain syndrome specialist may be able to help treat chronic pain caused by inflammation, while a pancreatic pain treatment plan may focus on calming inflammation in the pancreas to ease pain. But it is not that simple. In many people, inflammation may last with no known cause. Many people today live with autoimmune disorders.
In rheumatoid arthritis, lupus and other autoimmune conditions, the immune system goes rogue. It attacks the body’s own cells. Now inflammation works against the body. Autoimmune disorders are very hard to treat. If you hold down the immune system, you also weaken its fight against infection. So these people catch infections more easily. But if the inflammation goes unchecked, it does great damage. Doctors are stuck between the two.
So too much inflammation is as bad as too little. Inflammation is the yin and yang of the body. Even more worrying is low-grade hidden inflammation. Often no one finds its source. It is like a leaky hose. This low, steady inflammation is behind many chronic illnesses, like heart disease and brain-wasting (neurodegenerative) disorders. But it is hard to treat, because we know so little about where it comes from.
This low-grade hidden inflammation may throw the immune system off. People who carry it are more likely to overreact, or react the wrong way, to infections. The old habit of looking only at the sick organ no longer works. The problem in one organ may come from inflammation that started somewhere else. Most modern diseases come from this hidden inflammation, and poor lifestyle choices cause it.
Our obsession with cleanliness also seems to cause problems. A few centuries back, children met huge numbers of germs early in life. That trained the immune system. It cut the risk of allergies, autoimmune disorders and wrong immune responses. Modern living also upsets the microbiota, the gut microbes that help train the immune system. So changes in the microbiota play a big part in faulty immune responses in many people.
Frequently asked questions
What is the main cause of chronic inflammation in the body?
Most chronic inflammation is low-grade and hidden. Its source often goes unfound, like a slow leak in a hose. Most modern diseases trace back to it, and lifestyle choices drive most of it. Two other forces leave the immune system prone to faulty responses. One is too few germs early in life. The other is a gut microbiota upset by modern living.
Is inflammation good or bad for you?
Neither. Inflammation is how the body fights infection and heals hurt tissue, so you need it. It turns harmful when it misfires. It can run too hot against an infection. It can attack your own cells. Or it can smolder for years at a low level. Too much inflammation is as damaging as too little.
What diseases are linked to chronic inflammation?
Low, steady inflammation sits behind many chronic illnesses, including heart disease and neurodegenerative disorders. The inflammation can start in one place and damage another. So looking only at the organ that hurts often misses the real source. People with this hidden inflammation also handle infections poorly. They react too strongly or in the wrong way.
What is a cytokine storm?
When the body struggles to clear an infection such as Covid, it can flood the system with cytokines, its alarm chemicals. Many people cannot handle that surge. This hyperinflammatory response can do more damage than the infection itself. That helps explain why two otherwise healthy people can fare so differently with the same illness.
Why are autoimmune diseases so hard to treat?
In rheumatoid arthritis, lupus and other autoimmune conditions, the immune system attacks the body’s own cells. Holding that response down also weakens the body’s defense against germs, so patients catch infections more easily. Leaving the inflammation unchecked lets it keep damaging tissue. Doctors have to balance those two risks for every patient.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
