CHAPTER
2

When Inflammation Is Out of Control

In This Chapter

Inflammation is associated with, or a part of, many illnesses. The numbers of people who live with inflammatory diseases are staggering: 71 million people have cardiovascular diseases, 49 million have arthritis, 27.2 million have hay fever, 21 million have osteoarthritis, 20 million have asthma, 5.6 million have gum disease, and 2.1 million have rheumatoid arthritis.

Inflammation can also rage out of control and actually cause serious disease. In fact, inflammation is involved in many of the diseases that eventually kill us or cause serious disability, such as heart disease, stroke, cancer, diabetes, and Alzheimer’s disease.

In this chapter, you learn about the broad range of diseases associated with inflammation—those that are life-threatening and those that are milder but still can result in chronic health problems. Just glancing at this chapter should give you plenty of incentive to practice the anti-inflammatory diet, which can help ward off these diseases or help control them if they do occur.

Heart Disease

Heart disease, the clogging of the blood vessels to and from your heart, is the number-one killer of both men and women in the United States. According to the American Heart Association, the lifetime risk for heart disease is two in three for men and more than one in two for women. Inflammation plays a central role in this disease.

Your arteries are the blood vessels that carry oxygen-rich blood to tissues in your body. Plaques, which are deposits of fatty material, can build up within artery walls. Inflammatory reactions within these deposits on the innermost layer of the artery walls are known as atherosclerotic plaques. These plaques can cause blood clots and narrowed arteries, a condition known as atherosclerosis, which can lead to a heart attack or other life-threatening problems.

High levels of CRP have been found in atherosclerosis, the hardware behind heart disease. According to the American Heart Association, the higher your CRP levels, the higher your risk of developing a heart attack or stroke.

You may hear your doctor refer to CRP as an inflammatory “marker.” Today, most doctors order a high-sensitivity CRP (hs-CRP) test if they suspect heart disease or other inflammation-related problems. This test measures the amount of inflammation in your body.

DEFINITION

A high-sensitivity CRP (hs-CRP) test measures the amount of a certain protein in the blood, which can indicate acute inflammation.

Inflammation and Heart Attack

Scientists and the media used to use a clogged plumbing analogy to describe the process leading to atherosclerosis. The idea was that LDL cholesterol (the bad cholesterol) clogged the pipes, which shut off blood flow. Today, scientists have developed a new picture of the disease.

Blood vessels are narrow tubes of layered, living tissue. LDL cholesterol doesn’t just lodge in arterial walls—it damages them. This injury stirs up inflammation, and legions of protective cells come to the rescue.

While the protective cells do their work, they make a mess, enlarging and changing deposits of LDL cholesterol into plaques (deposits of fatty material). Other inflammatory molecules weaken the cap on top of the plaque, and eventually the cap bursts. The contents of the plaque make another mess. Clotting factors in the blood then come “to the rescue,” resulting in a massive blood clot, a blocked artery, and a heart attack or stroke.

Signs of Heart Disease

Some of the earliest recognizable signs of heart disease are chest pain (angina); squeezing, fullness, or pain in the center of the chest; and/or pain in the shoulders, neck, or arms. Women may also have nontypical symptoms such as stomach upset, dizziness, rapid heartbeats, shortness of breath, and fatigue. Heart disease is sometimes sneaky. Some people have none of these symptoms; others will have many.

It’s crucial that you immediately call 911 if any of these symptoms come on quickly for you or a loved one. Research has also found that chewing one regular-strength adult aspirin right away when you notice symptoms can help lessen damage to your heart by reducing blood clotting.

Cancer

Although heart attacks are the leading cause of death in the United States today, the greatest health fear for many of us is cancer. Cancer is the general name for hundreds of diseases in which some of the body’s cells become abnormal and divide without control. Cancer cells may metastasize, or invade nearby tissues and spread to other parts of the body.

The most common cancers—although occurring in different areas of the body with different cell “signatures”—all have something in common: inflammation. Breast, cervical, ovarian, liver, esophagus, stomach, colon, urinary bladder, and pancreatic cancers all have links to inflammation.

Recent research has shown that most precancerous and cancerous cells show signs of inflammation. In addition, evidence suggests that the longer inflammation is present, the higher the risk of getting an associated cancer. For example, people with inflammatory bowel diseases (IBDs) such as ulcerated colitis (UC) or Crohn’s disease have a five to seven times greater risk for developing colon cancer.

WHAT THE EXPERTS SAY

Sometimes inflammation directly causes cancer, like the match that starts the fire. In other cases, inflammation causes an already established cancer to grow and spread, which is more like pouring gasoline on cancer’s flame.

—William Joel Meggs, MD, PhD

Stroke

The inflammation that’s part of heart disease can also cause strokes due to a blood clot or bleeding suddenly stopping the flow of blood to the brain. Sometimes called brain attacks, strokes occur when brain cells are deprived of blood and they stop functioning. If the loss of blood lasts too long, brain cells die.

Here are the warning signs of stroke:

Diabetes

Inflammation of the blood vessels, which increases the risk of heart disease and stroke, is also a strong predictor of type 2 diabetes. In one study, women who had inflamed blood vessels were five times as likely to develop diabetes as other women. According to the Centers for Disease Control and Prevention, more than 17 million Americans have diabetes. In the United States, diabetes has increased nearly 50 percent in the past 10 years alone. It’s thought that one in three Americans will develop diabetes.

Diabetes, the number-six killer in the United States, is a disease in which damaging amounts of sugar build up in the blood. The buildup is caused by the body not being able to use (type 1) or produce (type 2) insulin, which it needs to convert food into energy. Being overweight is a major risk factor for type 2 diabetes.

DEFINITION

Insulin is a hormone your body needs to convert sugar, starches, and other food into energy.

Almost all the problems diabetics develop, which can be serious and life-threatening, are the result of damage to the blood vessels. Diabetes can lead to blindness; loss of toes and limbs; nerve damage; and diseases of the heart, eyes, and kidneys.

Inflammatory Bowel Disease

The effects of inflammation-related digestive problems can range from that uncomfortable feeling you get about an hour after you eat to painful and serious conditions such as Crohn’s disease.

The digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine (colon), rectum, and anus. A number of conditions in this tract involve inflammation, including the following:

Alzheimer’s Disease

Alzheimer’s disease is a progressive brain disease that gradually destroys a person’s memory and ability to learn, reason, make judgments, communicate, and carry out daily activities. This disease is not a normal part of aging; it’s a devastating heartbreaking disorder of the brain.

As Alzheimer’s progresses, victims’ personalities and behaviors change, and they become anxious, suspicious, or agitated. They also have delusions or hallucinations. Eventually, they’ll need complete care. If the victim has no other serious illness, the loss of brain function itself causes death. Although there is currently no cure for Alzheimer’s, new treatments are on the horizon.

Following are the top warning signs of Alzheimer’s disease:

Based on their ground-breaking research, a group of scientists at the Scripps Research Institute in California have proposed a new theory about the cause of Alzheimer’s disease. They believe inflammation is the switch that turns on the disease.

According to the researchers, inflammation makes abnormal substances out of normal building blocks of cells (molecules). These abnormal substances then change certain proteins in the brain (amyloid beta proteins) and cause them to misfold. These misfolded proteins are thought to be a major player in Alzheimer’s disease.

DID YOU KNOW?

According to the Alzheimer’s Association, an estimated 4.5 million Americans have Alzheimer’s disease. By 2050, that number could reach 16 million. One in ten Americans say they have a family member with Alzheimer’s, and one in three know someone with the disease. Increasing age is the greatest risk factor for Alzheimer’s. One in 10 individuals over 65 and nearly half of those over 85 are affected. Rare, inherited forms of Alzheimer’s disease can strike individuals as early as their 30s and 40s.

Arthritis

The hallmark of arthritis is inflammation. In fact, the word arthritis literally means “inflammation of the joint.” Many of the more than 100 types of arthritis are caused by inflammation going awry and attacking its own cells.

When inflammation strikes joints, increased numbers of cells and inflammatory substances cause irritation and wear away cartilage (the cushions at the ends of the bones). This process causes swelling. Flulike symptoms can accompany the inflammation.

It can also affect your heart and other body organs, with symptoms specific to the particular organ affected. For example, inflammation of the heart (myocarditis) can cause shortness of breath and fluid retention. Inflammation of the small tubes that transport air to the lungs may cause asthma attacks. Inflammation of the kidneys (nephritis) may lead to high blood pressure and/or kidney failure.

In the following sections, we look at the major types of arthritis and their connections to inflammation.

Osteoarthritis

The most common type of arthritis is osteoarthritis (OA). According to the Cleveland Clinic, osteoarthritis affects 70 percent of adults aged 55 to 78 years old.

The role of inflammation in OA is controversial. Studies of cells show inflammation in joints damaged by osteoarthritis, but not as much as in other types of arthritis, such as rheumatoid arthritis.

Stiffness, joint pain, and swelling are the earliest symptoms of OA. In contrast to inflammatory arthritis, activity or weight-bearing activity can make osteoarthritis painful. However, people with osteoarthritis must exercise regularly to keep their joints lubricated and their muscles strong.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is one of the most common and serious forms of arthritis. It’s caused by inflammation of the membrane lining the joint, called the synovium, and leads to pain, stiffness, warmth, redness, and swelling. The inflamed synovium can invade and damage bone and cartilage, causing joint deformities, loss of movement, and limitation of activities.

According to the Mayo Clinic’s Dr. Maradit Kremers, “We believe that inflammation is a strong risk factor for cardiovascular disease among rheumatoid arthritis patients.”

RA can start at any age, including during childhood. It affects two or three times more women than men.

Gout

Gout causes sudden, severe attacks of pain and tenderness, redness, warmth, and swelling in some joints. It’s the result of a buildup of too much uric acid in the body. This buildup forms crystals in the joints and causes inflammation. (Uric acid is a substance that normally forms when the body breaks down waste products called purines.) Gout can be inherited or happen as a complication of another condition.

Gout usually affects one joint at a time—often the big toe. Episodes develop quickly, and the first time it strikes is usually at night.

DIET DO

If you have gout, stay away from beer and other alcoholic beverages, anchovies, sardines in oil, fish roes, herring, yeast, red meat, organ meats (liver, kidneys, and sweetbreads), legumes, meat extracts, consommé, gravies, mushrooms, spinach, asparagus, and cauliflower.

Gout can be caused by any of the following:

If you’re a male over age 40, you’re the most at risk for gout, but it can affect anyone of any age. Women with gout usually develop it after menopause.

Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is a common cause of aching and stiffness in older adults. Symptoms are worse at night and when getting out of bed in the morning.

PMR can be difficult to diagnose because it rarely causes swollen joints or other abnormalities. The symptoms of PMR are aching and stiffness in the upper arms, neck, thighs, and buttocks.

Low doses of corticosteroids usually greatly relieve symptoms.

Allergies

If you have allergies, your body overreacts to triggers that often cause no reaction in other people. Triggers can vary from person to person. You may be allergic to dogs and not cats, for example, but your best friend may be allergic to cats and not dogs.

Symptoms of allergies are inflammation, sneezing, wheezing, coughing, and itching. Many allergies are linked to serious inflammatory illnesses, such as the breathing disorder asthma.

DEFINITION

Asthma is an inflammatory lung disorder in which the airways become obstructed. It can cause death if not treated.

Acne

Acne is an inflammatory disorder of the skin’s oil glands and hair follicles. It’s best known for its characteristic pimples and deep pustules (small, inflamed, pus-filled, blisterlike lesions). Acne begins when oil and dead skin cells get trapped in pores in the skin.

Acne affects about 80 percent of people between the ages of 12 and 24, but adults can get it also. If severe enough, acne can leave permanent scars.

Despite what your mom might have said, acne does not come from chocolate, french fries, or dirty skin. However, following the anti-inflammation diet and washing your face well enough to keep your pores clean can help prevent and control acne.

Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is an eye disease that affects the macula, a part of the retina that enables you to see fine detail. AMD has the unhappy distinction of being the leading cause of blindness in people over age 55 in the United States.

DEFINITION

Degeneration is the deterioration of specific tissues, cells, or organs with impairment or loss of function.

According to Joan W. Miller, MD, chairwoman of the Department of Ophthalmology at Harvard, “There is growing evidence that chronic inflammation plays a role in the development of macular degeneration.” Most vision loss in AMD is caused by the growth of abnormal blood vessels under the retina. With it, the vessels bleed and scar tissue is formed, and this inflammation causes blurred central vision or a blind spot in the center of your visual field.

Other Autoimmune Diseases

With autoimmune diseases, the body’s immune system, which normally fights such things as bee stings and viruses, does not shut off after the trigger is gone. Instead, the immune system attacks the body’s healthy tissue, causing more inflammation and destroying tissue. The numerous forms of arthritis described earlier in the chapter are examples of common autoimmune diseases.

Any disease in which cytotoxic cells attack the body’s own tissues is considered an autoimmune problem. Because autoimmunity can affect any organ in the body—including the brain, skin, kidneys, lungs, liver, heart, or thyroid—the symptoms of the disease depend upon the site affected.

DEFINITION

Cytotoxic means of or relating to substances that are poisonous to cells.

Autoimmune diseases include, but are not limited to the following:

Allergies  See the “Allergies” section earlier in this chapter.

Celiac disease  The body’s inability to tolerate wheat protein. Symptoms include foul-smelling diarrhea and emaciation, often accompanied by lactose intolerance.

Crohn’s disease  A serious inflammation of the small intestine causing frequent bouts of diarrhea, abdominal pain, nausea, fever, and weight loss.

Hashimoto’s thyroiditis  A disease of the thyroid gland resulting in its enlargement (goiter).

Hormone-related (endocrine) disorders  A group of disorders in the same family as Hashimoto’s thyroiditis, including type 1 diabetes, Graves’ disease, and Addison’s disease.

Multiple sclerosis (MS)  A long-term degenerative disease of the central nervous system, leading to muscular weakness, loss of coordination, and speech and visual disturbances.

Sjögren’s syndrome  A chronic disease in which white blood cells attack the moisture-producing glands. The hallmark symptoms are dry eyes and dry mouth, but it can affect many organs and cause fatigue.

Systemic lupus erythematosus (SLE)  A chronic rheumatic disease that affects joints, muscles, and other parts of the body.

WHAT THE EXPERTS SAY

Whatever the ultimate cause, the damage caused by autoimmunity has an obvious immediate cause: inappropriate, unchecked inflammation.

—Andrew Weil, MD, founder and director of the Program in Integrative Medicine (PIM) at the University of Arizona, and author of numerous books, including Healthy Aging

According to the American Autoimmune and Related Diseases Association, approximately 20 percent of the population has autoimmune diseases. Women are more likely than men to be affected.

The Itises

As mentioned in Chapter 1, itis is Greek for “inflammation.” When used as a suffix, -itis means “inflation of” the root word. For example, colitis is literally “inflammation of the colon.” Any area of your body can become inflamed.

The following list gives you an idea of how prevalent these diseases are:

Appendicitis  Inflammation of the appendix, a narrow, closed-ended tube that attaches to the colon. Inflammation and infection spread through the wall of the appendix, which can rupture. After rupture, infection can spread throughout the stomach area.

Arthritis  See the “Arthritis” section earlier in this chapter.

Bronchitis  A condition that occurs when the inner walls of the main air passageways in your lungs become infected and inflamed.

Bursitis  Inflammation of the bursa, the small, fluid-filled sacs that lubricate and cushion pressure points between bones, tendons, and muscles near joints.

Conjunctivitis  Inflammation of the conjunctiva, the clear membrane covering the white part of the eye and lining the inner surface of the eyelids.

Dermatitis  Inflammation of the skin. Although there are many different types of dermatitis, the term generally describes swollen, reddened, and itchy skin and lesions.

Encephalitis  An inflammation of the brain, usually caused by a virus.

Endocarditis  An infection leading to inflammation of the heart valves and parts of the inside lining of the heart muscle (known as the endocardium).

Epiglotitis  A life-threatening inflammation of the cartilage covering the trachea (windpipe).

Hepatitis  Inflammation of the liver. Viral hepatitis is inflammation of the liver caused by a virus.

DID YOU KNOW?

Five types of viral hepatitis have been identified, and each one is caused by a different virus. Hepatitis A, hepatitis B, and hepatitis C are the most common types.

Meningitis  Inflammation of the membranes (called meninges) surrounding the brain and the spinal cord. Often referred to as spinal meningitis.

Myocarditis  Inflammation or degeneration of the heart muscle.

Myositis  Swelling of the muscles.

Pancreatitis  Inflammation of the pancreas, the organ that makes pancreatic juices and hormones such as insulin. Pancreatic juices contain enzymes that help digest food. Insulin controls the amount of sugar in the blood.

Pericarditis  Inflammation of tissue surrounding the heart.

Periodontitis  A disease involving inflammation of the supporting tissues of the teeth, progressive loss of teeth, and bone loss.

Sclerotitis  Inflammation of the membrane part of the outer covering of the eyeball.

Sinusitis  Inflammation of the sinuses, the air-filled holes in the bones of the skull.

Temporal arteritis  An inflammatory condition affecting the medium-size blood vessels that supply blood to the head, eyes, and optic nerves.

Tendonitis  Inflammation of the tendons, the tough flexible bands of tissue connecting your muscles to your bones.

Tonsillitis  An inflammation of the tonsils caused by an infection.

Vasculitis  An inflammation of the blood vessels.

All these conditions do have inflammation in common; however, it’s important to note that although some are chronic and dangerous, others are much more acute and minor. So if you see a condition you have, don’t assume your health is in danger. And if a description appears to match symptoms you’ve been having, make an appointment with your health-care professional to get it checked out.

The Least You Need to Know