Some of us know inflammation too well. When getting out of bed in the morning becomes an auditory event in your joints that rivals a flamenco dancer’s castanets, you know inflammation. What you may not know, or at least not realize, is that your weight has something to do with it. For many of us, the seeds of inflammation were planted years ago. Our genes, body weight, diet, lifestyle and fitness determine our states of wellness and non-wellness, some of which we cannot sense. Silent inflammation is probably worse than that we can feel from getting cut or hit by a baseball. If it hurts or is uncomfortable, we’ll take care of it right away. If it’s not noticeable, it can smolder for years, eventually exploding into a chronic illness.
Inflammation is the response of tissue to injury or insult, occasionally caused by an invading pathogen. Characteristics, which you can sense, include increased blood flow to the injured area, elevated temperature, redness, swelling and pain. Inflammatory responses to what should have been a harmless agent include allergies and autoimmune diseases, states where the response is either out of proportion to the threat it faces or is directed against an inappropriate target, such as self. In these cases, the response is worse than anything the agent itself could have generated, and is often insensate. The cascade of cellular and molecular signals that accompany inflammation can perpetuate it and make it chronic, in which case monocytes and macrophages take over the management. This may sound cool, but the chemicals they create inside the tissues wreak havoc. Macrophages begin to swallow everything that appears derelict, including senescent cells and whatever is deemed a pathogen, whether it truly is or not.
At some point in this chronology, chemical mediators are released, including things like Interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-a) and prostaglandins that keep the ball rolling…on and on. When the body tries to control all this nefarious activity it replaces damaged tissue with replacement cells of the same type, but occasionally fails and results in diseased states, such as asthma, rheumatoid arthritis, tendonitis, celiac and inflammatory bowel diseases.
Inflammation is recognized as causal to several chronic diseases and all-cause mortality, and is prevalent among those who have a body mass index above 30.0. Biomarkers of inflammation are used to examine the relationship of inflammation to chronicity, with C-reactive protein (CRP), IL-6, TNF-a, and IL-8 as indicators. CRP probably is the first one your doctor will interpret, since it’s a prime marker of inflammation. It just doesn’t pinpoint the location. CRP is a native protein made by the liver in response to factors released by fat cells. In acute inflammation, such as from an infection, levels can rise in less than six hours and be hundreds of times higher than normal, which is lower than 10 mg per liter. With a severe bacterial infection, it can reach 200 or more. The absolutely perfect reading is 1.0. Levels above 2.4 are supposed to be associated with increased risk of cardiovascular events, but that’s debatable because the studies were done with people who had unstable angina (Pepys, 2003).
Human adipose tissue expresses and releases the pro-inflammatory artifacts, inducing low-grade systemic inflammation in people with too much body fat. Pediatricians in the Netherlands looked at overweight children in their country and saw higher levels of CRP than in normal-weight children (Visser, 2001), accompanied by higher white cell counts. In 2007, the Archives of Internal Medicine published an analysis of more than thirty separate studies, concluding that weight loss is a major factor in the reduction of CRP, adding that a loss of one kilogram (2.2 lbs) equates to a 0.13 mg/L drop in CRP (Selvin, 2007).
Many parents think that their kids will outgrow the chubby stage. Sometimes, yes; often, no. We now see 400-pound 20-year-olds who were obese at age eight, whose parents ignored admonitions to address the foreboded tragedy at the early age. That collection of fat that hangs over the belt, sometimes reaching the thighs, is called a panniculus, and is more than just a dormant spare tire. It secretes adipokines, or chemical signals, to other parts of the body, increasing risk of serious disease through disrupted homeostasis (Rosenow, 2010). If this describes someone you know, eventually you’ll likely see diabetes, heart disease, and maybe even some form of cancer (Ibid).
There are plenty of overweight seniors, some of whom achieve that senior designation at age 40, others above 70. Just by virtue of their age, they’re more likely to report joint pain, but obesity at any age is a predictor of low-grade chronic inflammatory state. Whether by diet or exercise, or both, weight loss is extremely vital to maintaining one’s health. In comparisons, the low-carb folks lost more weight than the low-fat. Think about this. The knee pain in the 50-year-old guy is so bad he can’t walk behind his lawnmower. The problem is that he’s carrying 375 pounds on a frame designed to carry 150-180, and his femur is squeezing the cushions at the tibia. Yes, it’s distinctly possible that thyroid issues are causative of the extra weight. There may be other factors that include lack of sleep, too much stress, certain medications, uncontrolled cortisol (kinda rare), and menopause in women. Some of these can be managed and can be worked out with the family physician and maybe a visit to a dietitian. However, looking more closely at his eating habits, we see carbohydrates as the main source of gustatory input, with beneficial fats and lean protein given the back seat. Self-inflicted obesity has no excuse. Inflammatory biomarkers can be attenuated with even a small reduction in weight (Miller, 2008) (You, 2006). Now, get this. The physical movement required to mow the lawn might be just enough to reduce inflammation, despite the immediate discomfort, which will eventually taper off. (Ford, 2002) (Miller, 2008).
Obesity is a problem of epidemic proportions. Certain people are perceived as anathema, bête noir, pariah, and may pay for self-destructive behavior. If cigarette cessation clears the lungs, could weight reduction clear the blood? Yep. Dietary interventions will help both, but sticking a finger into the dike doesn’t quite do it.
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November 10, 2012