Chronic Inflammation: Meaning, Causes, Treatment, Symptoms, Ayurveda understanding

Article by Dr Manasa S, B.A.M.S

How does inflammation occur?

When the body is attacked by external forces like bacteria, viruses or pathogens or if it suffers an injury, then the immune system of the body is activated. This activated immune system sends out its first line of army i.e., the inflammatory cells and cytokines. These cells start an inflammatory response to the external attack either to trap or kill the attacking agents or to start the healing process at the injured site. The initial response to this can be pain, swelling, bruising or redness. The inflammation can be either acute or chronic. So, inflammation is a part of the defence system of the body.

Types of inflammation

Inflammation is of two types i.e. acute inflammation and chronic inflammation.

1. Acute Inflammation

Acute inflammation is the body’s sudden response to external attack like cutting of finger or an injury to any part of the body. To start the process of healing, the body sends out inflammatory cells to the site of injury. These cells start the healing process. This response is termed as acute inflammation.

Symptoms of acute inflammation

– Pain or tenderness
– Swelling
– Redness
– Flushed skin at the site of the injury

2. Chronic Inflammation

Chronic inflammation is a medical condition wherein there is a slow, continuous and long period inflammation which lasts for months to years. This happens when the body continuously sends the inflammatory cells even when there is no external attack. For example, in rheumatoid arthritis, inflammatory cells are released and they keep attacking the joint tissues leading to inflammation which is on and off. This causes severe damage to the joints with pain, stiffness and other deformities.

Symptoms of chronic inflammation

It is difficult to identify the symptoms of chronic inflammation. Signs of chronic inflammation include:

– Joint pain or joint stiffness
– Body pain
– Muscle pain
– Chronic fatigue|
– Insomnia
– Depression, anxiety, mood swings
– Constipation, diarrhoea and acid reflux
– Fever
– Chest pain
– Frequent infections
– Skin rash
– Sores in the mouth
– Weight gain or weight loss

Conditions associated with chronic inflammation

– Asthma
– Alzheimer’s disease
– Cancer
– Cardiac disorders
– Rheumatoid arthritis
– Ankylosing spondylitis
– Type 2 diabetes

Causes of chronic inflammation

The most common causes for chronic inflammation include –

Untreated acute inflammation

like an infection or injury. When the body is attacked by external agents like disease-causing pathogens or some toxins, if the body’s defence system fails to completely get rid of these harmful agents, the body remains in the constant process of sending inflammatory cells to combat the attack. This results in chronic inflammation.

Autoimmune disorders

such as rheumatoid arthritis, systemic lupus erythematosus.

Exposure to toxins

like exposure to harmful chemicals, pollutants or industrial effluents. When the body of a person is exposed to harmful chemicals, if the body fails to eliminate the toxins by breaking down enzymes or phagocytosis, it results in chronic inflammatory response.

Other causes

– Substance abuse like drinking of alcohol or cigarette smoking
– Obesity or overweight
– Too much of exercise too frequently or no exercise at all
– Chronic stress

Risk factors of chronic inflammation

Age

As the age increases there are increased levels of many inflammatory molecules. This is probably due to mitochondrial dysfunction or accumulation of free radicals in the bloodstream due to accumulation of visceral body fat.

Overweight or obesity

There have been many research works on the effect of obesity or overweight on the metabolism of the body, especially on the inflammatory process. Reports suggest that the increased body weight is directly proportional to the amounts of inflammatory cells being secreted and released into the bloodstream.

Diet

A diet which is rich in trans-fatty acids, fats, or refined sugar is associated with inflammatory processes, especially in metabolic disorders like diabetes, obesity and hypercholesterolemia.

Smoking

Chronic smoking of cigarettes is associated with reduction in the production of anti-inflammatory molecules and thus induces inflammatory responses which are long standing in nature.

Chronic stress and sleep disorders

Whenever a body undergoes chronic stress both physically and emotionally, the body’s system will release more inflammatory molecules to cope up with the ill effects of stress. Similar responses may be seen in those suffering from sleep disorders or chronic stress caused by insomnia.

Low sex hormones

It has been observed that sex hormones like testosterone and oestrogen can suppress the production of several pro-inflammatory markers. It is shown that maintaining normal levels of sex hormones reduces the risk of chronic inflammation.

Preventive measures

Chronic inflammation has a serious effect on the health and longevity of individuals. Therefore it is the key to prevent the ill-effects of chronic inflammation to an extent.

The following are some of the best ways to prevent chronic inflammation –

Step up the intake of anti-inflammatory foods – Consumption of whole grains, enough proteins, lots of vegetables and fruits which have high fibre content and low glycemic value, intake of omega 3 fatty acids, animal products like fish and fish oils help to prevent the chronic inflammation to a great extent.

Less dependence on non-steroidal anti-inflammatory drugs and antibiotics – Prolonged intake of these medications leads to release of many kinds of toxins which tend to trigger the inflammatory process. These toxins produce inflammation in many parts of the body including the colon. As a part of inflammatory response the gut microbiota would get destroyed along with inflammation in the walls of the intestines.

Being physically active – Being physically active is important to maintain an ideal BMI. Overweight or obesity is associated with chronic inflammatory changes and further have a negative impact on the health of individuals. They are also associated with increased risk of cardiovascular disease, strokes, joint and bone health.

Getting enough sleep – 7 to 8 hours of night sleep helps to stimulate good hormonal health and helps in rebuilding the cells and tissues of the body.

Stress management – Long standing psychological stress has a negative impact on the normal functioning of the bodily activities. Chronic stress is linked to increased risk for depression, heart disease and stroke. Yoga and meditation are helpful in relieving stress induced inflammation and its harmful effects on the body.

How is chronic inflammation managed?

Most cases of chronic inflammation can be managed through diet and lifestyle modifications which include –

Low glycemic index foods – Foods which are high in glycemic index are related to high risk of stroke, coronary heart disease and type 2 diabetes mellitus. Therefore taking these ‘low glycemic index foods’ becomes the first line treatment in any chronic inflammatory disorders, especially metabolic diseases. Along with low glycemic foods, it is beneficial to limit the consumption of sodas, refined carbohydrates, and fructose corn syrup in the diet.

Fibre rich food – A good amount of dietary fibre in the diet reduces chronic inflammatory responses.

Foods low in trans-fats – Some saturated fats & synthetic trans-fats aggravate inflammation, while omega 3 fatty acids do help in lowering inflammation.

Intake of fruits and vegetables rich in antioxidants – Blueberries, apples, brussels, sprouts, cabbage, broccoli, carrots, and cauliflower are high in antioxidants and polyphenols and other inflammation lowering compounds which protect against inflammation.

Nuts – Almonds, flax seeds, melon and sunflower seeds rich in omega 3 fatty acids are known foods that combat long term inflammatory processes.

Turmeric – Curcumin which is the active ingredient of turmeric has shown a lot of promising effects on reduction of inflammation.

Fish oil – Fish oil which is rich in omega 3 fatty acids are associated with lowering levels of CRP and IL-6 and hence ideal for those having chronic inflammation.

Micronutrients supplements – Consumption of micronutrients like magnesium, vitamin D, zinc and selenium are listed as one of the most effective anti-inflammatory dietary supplements.

Active lifestyle – Trials on human beings have shown that the energy utilised through exercises lowers multiple pro-inflammatory molecules and in-turn helps to reduce weight in overweight or obese individuals.

Medications used commonly in chronic inflammation

Non-steroidal anti-inflammatory drugs – Medications like naproxen, ibuprofen and asprin inhibit a-cyclooxygenase that is attributed to inflammation. These drugs are generally used to relieve pain caused by inflammation in patients with arthritis.

Corticosteroids – They prevent many processes involved in inflammation. Glucocorticosteroid relieves several inflammatory disorders like inflammatory arthritis, systemic lupus, sarcoidosis and asthma.

Metformin – is generally used in the treatment of type 2 diabetes in those who have dyslipidemia and low- grade inflammation.

Herbal supplements – Herbs like ginger, turmeric, cannabis, are shown to have anti-inflammatory properties.

Why does chronic inflammation need prompt treatment?

The progress of the chronic inflammatory disease is slower and many times it is unnoticed till a major health issue crops up. It needs a prompt approach both preventively and therapeutically because it puts a greater risk on the longevity and health of individuals.

These include –

Diabetes – In people suffering from diabetes, immune cells such as macrophages infiltrate pancreatic tissues releasing pro-inflammatory molecules. These inflammatory cells cause complications both in micro-vascular and macro-vascular structures which include stroke, heart attacks, diabetic retinopathy, neuropathy, and nephropathy.

Cardiovascular diseases – Many studies have shown that there is a strong and consistent relationship between inflammatory markers and cardiovascular disease predictions. Atherosclerosis which leads to cardiovascular events such as myocardial infarction and stroke is considered a low grade inflammatory feature.

Cancer – Many types of cancers like kidney, prostate, ovarian, hepato-cellular, pancreatic, colorectal and lung cancers have low grade inflammation.

Rheumatoid arthritis – When rheumatoid arthritis is inadequately treated, then the persistent chronic inflammation in the synovium of the joints is associated with poor prognosis and radiographic progression of the disease.

Allergic asthma – This is a chronic inflammatory disease of airway passages and when asthma is not properly managed with medications and lifestyle modifications it leads to decline in airway functioning.

Chronic obstructive pulmonary disease – This is an obstructive inflammation of the lungs. This develops into chronic inflammation in response to inspired respiratory irritants, allergens, microbes etc. This in turn leads to long term breathing issues.

Chronic kidney disease – Presence of low grade chronic inflammation is a common feature of chronic kidney disease. If the inflammation is not addressed properly, then the retention of pro-inflammatory molecules in the kidney leads to progression in the disease and mortality.

Inflammatory Bowel Disease – These are a group of chronic inflammatory disorders of gastro-intestinal tract. It can develop as ulcerative colitis or Crohn’s disease which are characterised by inflammation of mouth, oesophagus, stomach and anus.

Alzheimer’s disease: This a condition often related to the aging process which is linked to cognitive decline and dementia.

Related Research Works

Research shows that chronic inflammation is associated with heart disease, diabetes, cancer, arthritis and inflammatory bowel diseases.

Study – shows inflammatory responses and inflammatory diseases in the organs.

Ayurveda Perspective of Chronic Inflammation

There is no single instance or condition available in Ayurveda treatises which resemble the clinical picture of chronic inflammation. But we have scattered explanations of many things in the texts which resemble the ongoing inflammatory process inside the body which can be correlated with chronic inflammation.

Inflammation is related to pitta. Ama, sama pitta, sama vata and vata can also cause inflammation or aid pitta in that process. But pitta is the boss of the inflammatory process. Pathological increase of pitta – mainly prakopa and prasara needs to be considered. Pitta disorders will definitely have signs and symptoms which resemble an ongoing inflammation of acute or chronic origin. Pitta subtypes of all disorders will have mild to moderate inflammation.

Agantuja, Pittaja and Vishaja Shotha are the close comparisons for chronic inflammation. Vrana Shotha is the closest one – it refers to the inflammatory swellings occurring inside or outside of the body.

Chronic inflammation taking place inside the body involving the tissues, viscera, channels etc are indicative of damage of these structures by aggravated pitta. These fall under the category of nija vranashotha since they are caused by doshas and not necessarily by injury or infection.

Chronic inflammation caused by injury or infection, which stands as an ongoing process falls under the category of agantuja vranashotha. In this, the pitta predominant doshas will plug in, in the later course of the inflammatory process.

There are 40 types of pitta specific disorders mentioned under the topic Pitta Nanatmaja Rogas. Many of these conditions represent chronic inflammation, like osha, plosha, daha, davathu, antardaha etc.

While pitta is an active participant in acute inflammations, chronic inflammation gives us a clear picture of vata involvement to a great extent, along with association of pitta.

All pitta aggravating foods and activities are the causes of chronic inflammation.

The treatment principles would include isolation of causative factors and addressing high pitta and other conditions mentioned above. Many treatment modalities as explained by Master Sushruta in his Shashti Upakrama would come in handy in treating vrana shotha vis-a-vis chronic inflammation.

Virechana and Vasti will come in handy as the best Panchakarma procedures in dealing with chronic inflammation. Rasayana therapy, monitoring the disease and its symptoms, regular consumption of medicines, disciplined diet and lifestyle practices, staying away from the causative factors and regular follow ups are the key principles of an effective follow up following comprehensive treatment of chronic inflammation.

Related Reading – Chronic Inflammation – Ayurveda Perspective