Anti-Inflammatory Strategies–Achieving Homeostasis
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HIV, or the human immunodeficiency virus is a virus that left untreated may lead to acquired immunodeficiency syndrome or AIDS. Unlike some other viruses, even with treatment some people infected with HIV may never eliminate the virus.

In an animal model of HIV, within 24 hours of infection, the virus hitches a ride on immune cells and travels throughout the body. HIV has a special propensity for immune cells, especially T cells. T cells help the body fight infections by activating the production of antibodies (large molecules that neutralize pathogens) and triggers inflammation to kill pathogens or destroy cells containing microbes. Left untreated, HIV infection reduces the numbers of defensive immune cells in the body, leaving HIV infected people (HIV positive) highly vulnerable to infection with other foreign agents (opportunistic infections) and cancers.

DC (dendritic cell)- A type of immune cell that plays a primary role in infections with HIV.
They are important regulators of immune system responses to infection.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033703/

 

From 80-90% of immune cells are found in the walls of the intestines and in the tissues surrounding the intestines. HIV tends to accumulate in these tissues and attack them. These inflammatory responses may weaken the gut barrier resulting in inflammatory digestive issues for HIV positive individuals.

“Inflammation and immune activation accelerate heart disease and stroke, and chronic HIV infection results in both,” says Robert T. Schooley, AIDS researcher and Professor of Medicine in the Infectious Diseases division at the University of California at San Francisco. In addition, this population is at increased risk for certain cancers, gastrointestinal, liver and kidney problems.

There are no cures for HIV, but with proper medical care, the numbers of virus infecting a person and their symptoms may be controlled. Proper medical treatment dramatically improves and prolongs lives. Anti-retroviral therapy (ART or ARV) is used to treat HIV infections.

When the “cocktail” of medications is taken as prescribed, viral loads (the number of viruses in the body) are decreased. These medications can reduce the numbers of HIV down to very low levels (called “undetectable”). However, in some individuals HIV can continue to infect immune cells. [Note: The CDC states that individuals with undetectable virus loads have no risk of sexually transmitting the virus.]

The body must be in immune balance, in immune homeostasis to protect the body from infection or fight infections. The immune system must produce the right ratio of inflammatory cytokines (pro-inflammatory) to anti-inflammatory cytokines. It needs enough inflammation to destroy the pathogen, or in this case HIV, but not so much that healthy tissues are damaged.

A recent study of people that have been treated over many years for HIV reports that HIV positive individuals are at a higher risk of getting diseases common to older individuals. Individuals that were infected in the early years with HIV are now in their 50s and 60s and develop inflammatory-related conditions at a significantly higher rate and lower age than uninfected people of the same age.

Summary:

The key to staying healthy is to remain in immune homeostasis, immune balance—this is true especially for people with chronic infections such as HIV.

 

Please contact Dr. Hellen if you wish to enhance your quality of life-don’t you deserve to do that?  The first 30 minutes of discussion are gratis. Dr. Hellen may be  contacted by using this form or calling:  302.265.3870 (ET-USA).
www.aidsinfonet.org/fact_sheets/view/484
www.cdc.gov/hiv/risk/art/index.html
www.catie.ca/en/treatmentupdate/treatmentupdate-223/inflammation-and-hiv/exploring-hiv-and-inflammation
www.biorxiv.org/content/early/2018/09/14/418012
www.sciencedirect.com/science/article/pii/S0092867400806947

 

According to the Centers for Disease Control (CDC), Lyme disease is the fastest growing vector-borne, infectious disease in the United States with a 25 fold increase in the number of cases since surveillance of the disease began in 1982. World-wide, there are over 300 strains of these bacteria, many of which tolerate antibiotics and are able to evade immune cells.

Tick Borne Infections:
Lyme disease is associated with infected ticks and may be contacted after engaging in outdoor activities. The infected ticks bite through the skin of a person or animal, getting a blood meal and introducing the bacteria into the body. (Typically the tick has to be attached for 36 or more hours before the bacteria is passed to the host.) Symptoms may include: skin rash and painful inflammation of joints (particularly the knees) and be accompanied by flu-like symptoms such as fever, headache, fatigue and chills.

Diagnostic Testing:
Diagnostic tests are only 29-40% accurate in the first three weeks after infection. Once the infection spreads to the nervous system and joints, accuracy increases. After treatment, even when test results are “negative”, live organisms may still be found in organs. Early treatment with antibiotics and anti-inflammatory medications are helpful, but if left untreated, joints, heart, brain, muscles and brain may become involved– sometimes months or years later.

Nervous System Involvement:
About 15 percent of patients with Lyme disease develop nervous system (spine, brain, etc.) inflammation. This event is accompanied by debilitating and painful muscle and joint symptoms and major neurologic changes such as facial nerve palsy, pain radiating along the back into the legs and feet, limb pain, sensory loss and/or muscle weakness.

Inflammation results in injuries to the brain and spinal cord and may result in severe headaches, fatigue, memory loss, learning disability, depression and cognitive problems.

Inflammatory immune factors are increased in the body, recruiting more inflammatory white blood cells into the brain and the spinal cord. The healthy immune cells that protect nerve cells are damaged or destroyed by the inflammation. No longer protected, nerve cells are damaged even more.

Lingering Symptoms:
A major issue with tick-borne infections is that even after treatment; up to 25% of individuals may have persistent painful joint inflammation and other symptoms lasting months or years.

There are two factors that may account for this:
a) Small numbers of bacteria remain which the immune system has not been able to successfully eliminate.
b)Once the infection is over, traces of long-lasting bacterial proteins are found within and around the joints. These proteins trigger inflammatory responses resulting in significant joint, muscle and nerve pain. It is the body’s immune response to these residual proteins, rather than a lingering infection that results in symptoms.

Summary:
As always, the key to an active quality of life is to help the body maintain immune balance– its homeostasis. Exercise (suggested: 2.5 hours a week), maintaining a healthy weight, eating smart, going outdoors for a few minutes a day, and taking an excellent immune support product will make all the difference in one’s health.

 

Achieving immune homeostasis will make a difference in your life. Contact me, DrHellen@DrHellenGreenblatt.info, use the form or give me a call at 302.265.3870 and let us talk.

http://www.ilads.org/lyme/lyme-quickfacts.php
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According to the Centers for Disease Control and Prevention (CDC), this flu season is an unusually severe outbreak with wide-spread instances of disease in 49 States with many schools being closed. The season started earlier than usual, which is never a good sign.   CDC Deputy Director Anne Schuchat has said “This year’s influenza season is proving particularly difficult”. Hospitals do not have enough beds and the prevalence of the flu has led to shortages of anti-viral medications that if prescribed in the first 48 hours may shorten symptoms by a day or so.

This season’s primary virus strain is H3N2, a deadly type of influenza A that tends to result in more severe illness and higher numbers of hospitalizations and deaths than other strains. H3N2 is especially dangerous for the frail elderly and children, although people between the ages of 50 and 64 are being hospitalized at alarming rates, second only to the elderly.  As of this post, almost 100 children have already died from the flu.

Since vaccination may lessen the severity of the illness and there are  few other options, the CDC recommends people be vaccinated with the current flu vaccine, even though it may only be 30% -40% effective. [Antibiotics are useless against viruses since they only kill bacteria.]

Although some people view the flu as “merely” annoying and inconvenient, those suffering from influenza along with COPD (chronic obstructive pulmonary disease), asthma, emphysema, diabetes and other pre-existing conditions are at a higher risk of hospitalization or death, especially if they contract a secondary bacterial infection.

The influenza virus is difficult for the body to protect itself from, because it is able to mutate rapidly and frequently. This forces the immune system to constantly change its tactics to combat the latest version of the flu.

Infection by influenza triggers an intense immune inflammatory response in the lungs in the body’s attempt to stop the virus from multiplying. The lungs’ immune cells release cytokines, small molecules that signal and recruit other cells into the lungs to increase or decrease their immune and inflammatory responses.

Lisa Brown JPEG

But such a response can be a double edged sword. Too much inflammation causes lung damage on top of the damage already caused by the virus and secondary bacterial infections such as pneumonia. Additionally, although rare, if the balance of cytokines is significantly upset, the normal level of inflammatory cytokines may become too high, resulting in a cytokine storm (or cytokine cascade) that can kill a previously healthy individual in hours.

A properly balanced immune system, one in homeostasis, is more fully prepared to defend us against invasion by foreign agents, and is ready to help us combat an infection if we get one.

Following the following steps will help keep your immune system functioning at optimum levels:

  1. Eat healthful meals with an emphasis on whole grains and plenty of colorful vegetables and fruits.
  2. Be physical active to help keep the immune system in balance; incorporate it into your daily life.
  3. Get adequate amounts of rest and avoid fatigue.
  4. Drink plenty of fluids to keep membranes moist and more resistant to invasion.
  5. Wash your hands frequently and try to keep them away from your face.
  6. Stop, or at least cut down, on your smoking—your lungs are struggling enough.
  7. Consume a superior immune support supplement to help your immune system balance.
Dr. Hellen’s passion is helping people have a better quality of life. Contact her by using this form, drhellen@drhellengreenblatt.info, or calling at: 302.265.3870 (ET, USA).
www.cdc.gov/flu/index.htm
www.cdc.gov/flu/weekly/summary.htm
www.ncbi.nlm.nih.gov/pmc/articles/PMC4711683
www.ncbi.nlm.nih.gov/pubmed/24728596

www.businessinsider.com/baby-boomers-hospitalized-with-the-flu-what-is-imprinting-2018-1

Last week I talked with a young local Asian-American business owner who shared with me that he was “a little fatigued and stressed out”. I suggested that if he took steps to getting his immune system in balance, that since our physical and emotional well-being is dependent on homeostasis, he would feel much better.

He basically replied that, “he spends half the year in Florida, has a lot of friends that are “into” nutrition, he exercises and that he didn’t need any more information, thank you”.

Nothing like a person with an open mind, but unfortunately too many people think in this narrow way.  We all know individuals that eat nutritiously, exercise 5-7 days a week and watch their weight but they still do feel “off”.  Their fingers, elbows or knees hurt, they can’t eat everything they would like, or they have other health issues despite their “great” life style.

Nutritional Recommendations:

The evidence is strong that due to the hundreds of phytonutrients, plant nutrients, in fruits, vegetables, nuts, beans, whole grains and olive oil, that plant-based foods are important for our health. A broad variety of these phytonutrients are suggested since they appear to affect a wide-spectrum of biological functions. The consumption of plant-based foods influences the health of cells, blood pressure, risk of certain cancers, immune, dental, urinary, liver and gut health.

An additional dietary recommendation is to consume fish or fish oil 2-3 times a week for their omega-3 fatty acids. This “good” fat has multiple uses in our body, but the body cannot produced these fats by itself; we need an outside source.

Studies involving hundreds of thousands of people suggest that omega-3s reduce the risk of fatal heart disease, improve the flexibility of blood vessels, lower blood pressure and reduce immune inflammation. [Note: It is controversial whether omega-3 supplements are as beneficial as eating fish; in fact, they may cause certain health issues.]

Role of the Immune System

When the body is threatened by pathogens or cancer cells, or has been injured, the body responds with short-term inflammatory responses, acute inflammation.

Immune cells flood the area to destroy invading foreign organisms or cancer cells, or to start the healing process after trauma. If the body cannot get rid itself of the infection, or if it over-responds with excessive levels of inflammation, the immune response may become chronic, or long-term.

Chronic inflammation is abnormal and damages previously healthy tissues and organs. This sort of unlimited inflammation results in autoimmune diseases, diseases in which the body’s immune system turns on the body.  Conditions such as arthritis, diabetes, lupus, multiple sclerosis, Crohn’s disease, ulcerative colitis, celiac disease, hepatitis and asthma can result from such run-away inflammatory responses.

Knowledgeable individuals know that nutrition plays only an initial role in staying healthy. Good nutrition is the foundation upon which to build health, but it is NOT ENOUGH; it is the immune system that governs one’s health and must be optimized.

The Importance of a Balanced Immune System

Immune balance, immune homeostasis, is tightly regulated by the body. It allows the organism to respond to infection, cancer cells and injury with the right amount of inflammation.  Any imbalances, either too much stimulation, or too little, results in immune disorders and health issues.

The key to good health and healthy aging is keeping the immune system in balance.

    Scales Immune Reponses Partial

Dr.Hellen’s major passion is helping people to enjoy life at its fullest. She may be contacted by using this form, at: drhellen@drhellengreenblatt.info or feel free to call:  302.265.3870 (ET, USA).

  

nutrition.ucdavis.edu/content/infosheets/fact-pro-phytochemical.pdf
www.hsph.harvard.edu/nutritionsource/fish
www.harvardprostateknowledge.org/high-intake-of-omega-3-fats-linked-to-increased-prostate-cancer-risk
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www.ncbi.nlm.nih.gov/pubmed/27357102

 

As of this writing, the Centers for Disease Control (CDC) in Atlanta is strongly recommending that pregnant woman postpone travel to many countries across the world, including the popular Caribbean islands.  The CDC is taking these steps due to the possibility that these women may become are infected with a mosquito borne virus called Zika.  The World Health Organization (WHO) Director General Dr Margaret Chan, has said that Zika had gone “from a mild threat to one of alarming proportions” and expects the virus to spread through the Americas and affect between three million and four million people.

Eighty percent of individuals who are infected with Zika do not show symptoms.  However, when symptoms do occur, they can last up to a week or so and include fever, rash, pink eye, and joint pain. Some clinicians suggest that Zika virus infection may result in the autoimmune [against oneself] condition,  Guillain-Barre syndrome (GBS).  This is rare disorder where too much inflammation damages the nerve cells, causing muscle weakness and may lead to paralysis.

The greatest concern however right now is that health agencies “strongly suspect” that when a pregnant women is bitten by a mosquito that is carring the virus, that even if she does not experience symptoms, that her offspring may develop brain malformations.

This latest outbreak adds to concerns that infectious diseases are one of the top threats challenging our world—a major topic on the agenda of last week’s World Economic Forum world leader attendees.  Until vaccines or treatments are developed, viral infections such as Zika, Ebola, SARS (severe acute respiratory syndrome), and MERS (Middle East Respiratory Syndrome) remain a threat to the world’s population.

Currently, there are no commercially available vaccines or treatments for Zika.  Until recently the cost to develop a successful vaccine was far greater than what the manufacturers would recoup in vaccine sales.  However, development of a vaccine for Zika will likely now escalate since Zika has spread so widely, infecting over 1.5 million individuals and its being linked to neurological problems, especially in newborns.

In addition to a lack of vaccines and treatments for a multitude of viral diseases, another significant health-care crisis we are facing is treatment of infection by anti-microbial-resistant pathogens. As Dr. Keiji Fukudaof the World Health Organization has stated:  “We really hope to pull the world back from the brink where antibiotics don’t work anymore”.

When bacteria are stressed, for example by a killer antibiotic, their genetic material may change, mutate, so that they can tolerate and become resistant to such compounds.  The bacteria can then replicate easily and outgrow bacterial strains that were not resistant to the antibiotic.

Fifty percent of antibiotic prescriptions written by U.S. physicians are of no benefit to the patient, and when used to fatten livestock and poultry it gives bacteria even more opportunity to acquire antibiotic tolerance.

It is our immune systems that identify, destroy, and remove invading pathogens.   When our body recognizes that it has been invaded by foreign agents, a strong inflammatory responses is triggered to meet the onslaught of the pathogens.  White blood cells accumulate in the area to combat the invaders.  These immune cells release cytokines and other immune messages  recruiting more white blood cells in an attempt to “burn out” the infection. Without a powerful inflammatory response, we cannot limit or survive infections.

In the absence of drugs or treatments that prevent and control the growth of viruses and other microorganism the immune system must be optimized to protect the body against them.

 

www.cdc.gov/mmwr/index.html
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www.vox.com/2016/1/20/10795562/zika-virus-cdc-mosquitoes-birth-defects
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One of the major complaints that people have is that “they are always tired”. “They just do not care anymore, they are just too tired.” [Kindly view a post that is relevant to this subject: Depression, Anhedonia and Run-Away Inflammation.]

In the past, scientists thought that there was a blood-brain barrier that “isolated” the brain from the actions of the immune system. They labeled the brain “immune privileged”; because studies suggested that a healthy brain had few, if any inflammatory cells in it. Only when there was a brain infection did scientists think that immune cells migrated into the brain.

Researchers failed to take into account that chronic inflammatory diseases are associated the brain. For example conditions such as inflammatory bowel disease, psoriasis, liver disease, and rheumatoid arthritis may result in a lack of social interest, feelings of being unwell and unremitting fatigue—all which are governed by brain function.

Inflammation is activated when the body encounters pathogens and cancerous cells. The inflammatory response is a primary means by which the body will destroy these threats. Inflammation is basically a controlled “burn”.  Firefighters will often have a “controlled burn” in a forest to get rid of dead trees and limbs.  They strive to keep the fire limited to a specific area.  Sometimes however firefighters are unable to control the fire and acres of forest are burned in error.

Similarly, once immune cells have taken care of a threat to the body, for example cancer cells, pathogens, etc., it is essential that the immune system “turn” down the inflammatory “flame”. Chronic, unnecessary inflammation leads to many autoimmune diseases that destroy their own organs, such as diabetes, Crohn’s bowel disease, multiple sclerosis, and lupus

Inflammation is all about location, location, location. If one has inflammation in the insulin-producing cells that control blood sugar, the person may get diabetes. If their intestines are inflamed they may suffer from Crohn’s.  If there is too much destruction and inflammation of nerve cells, they may suffer from multiple sclerosis.

Let us hypothesize that an individual has two trillion immune white blood cells and that half of these cells are out of control and producing too strong an inflammatory response. This inflammation is destroying previously healthy tissues and organs.  Since the body is always striving to balance inflammation, the other half a trillion of cells are working towards lowering the amount of inflammation and destruction that is going on in the body

Each of these cells is expending a trivial amount of energy trying to accomplish its task, but a tiny amount of energy multiplied by two trillion cells is a great deal of “wasted energy”. Is it any wonder why these people complain of being tired?

Individuals who have been diagnosed with autoimmune conditions have higher levels of inflammatory cytokines, immune messages, than people without disease. In heart failure patients, significant fatigue is associated with poor recovery and a higher risk of death. Patients with high levels of anti-inflammatory cytokines, molecules that decrease inflammation, recover more fully and rapidly than patients with high amounts of inflammatory cytokines. When patients are treated for their heart problems, their cytokine levels begin to resemble the cytokine ratios of healthy individuals, and their energy returns.

In mice with liver inflammation, immune cells from the liver travel to the brain and trigger other specialized immune cells called microglia releasing a biochemical that attracts more inflammatory cells into the brain, which in turn produces more inflammation.

In individuals with multiple sclerosis, a nervous system disease with a major inflammatory component, patients had less fatigue when they took anti-inflammatory medications.

The association of appropriate levels of inflammation with a healthy brain and high energy reserves is clear; the key is being in immunological balance. Once individuals balance inflammatory and anti-inflammatory cells they typically regain their energy and focus.

Aren’t you tired of being tired all the time? Don’t wait any longer. Contact Dr. Hellen to talk bout enhancing your quality of life.  There is no fee for consulting with her for the first 30 minutes.  She may be contacted by using this form or at: 302.265.3870 (ET, USA).

http://www.ncbi.nlm.nih.gov/pubmed/25905315
http://www.ncbi.nlm.nih.gov/pubmed/25905315
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Delirium is an under-reported condition that may affect up to 56% of older individuals after surgery, patients that have been heavily sedated for a length of time, burn, cancer, and patients on ventilators for long periods. Patients experience vivid hallucinations that may be part of a vicious cycle if doctors attempt to control the delusions with larger amounts of sedatives; the medications may disorient and confuse the patient even more.

The delusions and accompanying cognitive issues can persist for months after patients leave the hospital and can lead to a misdiagnosis of dementia, rather than delirium. [Dementia develops gradually and gradually worsens, while delirium may be of sudden onset.]

Delirium is associated with excessive inflammation in the brain resulting from triggering specialized immune cells the microglia. If stimulated over a long time, the cells release inflammatory cytokines, molecules that damage nerve cells and contribute to damage and break down of the capillaries in the brain, the blood-brain barrier.

C-reactive protein, CRP, is one measure of inflammation. CRP levels were measured in elderly surgical patients who had ended up with complications such as delirium, cardiovascular issues, or infection. The levels of CRP in their blood were predictive as to how fully they recovered.

A recent study measured the levels of 12 different inflammatory and anti-inflammatory cytokines in older patients undergoing surgery. Those having episodes of delirium had consistently high levels of inflammatory cytokines as compared to patients that did not have high levels of cytokines. Similar results were seen in patients that developed delirium after procedures such as open-heart surgery and hip fracture repair.

Conclusion

In order for the body to heal after it is hurt, or to fight an infection successfully, a delicate balance of cytokines, immune messages are required. Too little of an inflammatory response and the individual may not survive an infection. Too much of an inflammatory response and healthy tissue is destroyed. Homeostasis, balance, is what the body strives for every moment.

Dr. Hellen would be pleased to provide guidance to helping enhance your quality of life.  She may be contacted by using this form or at: 302.265.3870 (ET, USA).

 

www.theatlantic.com/health/archive/2015/06/the-overlooked-danger-of-delirium-in-hospitals/394829/
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www.ncbi.nlm.nih.gov/pubmed/17504139

 

 

Mutating cells and invasion by pathogens triggers inflammatory responses in the body.  Inflammation consists of a series of events involving cytokines (immune messages), other immune factors, and circulating white blood cells. Uncontrolled levels of inflammation damages healthy tissues and organs.

Excessive inflammation of the eyes may result in sight-threatening condition.

Uveitis
Uveitis describes a group of eye inflammatory diseases.  Symptoms can develop gradually over a few days, or occur suddenly. Symptoms may include: photophobia (sensitivity to light), cloudy or blurred vision, increased floaters, difficulty in vision focus, headaches, “red eye” with pain ranging from a mild ache to intense pain, and loss of peripheral vision (ability to see objects at the side of one’s field of vision). Severe uveitis may lead to permanent damage to vision.

Many cases of eye tissue inflammation are “idiopathic”, i.e., without a known trigger.  Some clinicians suggest that uveitis is caused by:  a) autoimmune responses in which the body’s immune system mistakenly targets and attacks its own eye tissues, b) infections or cancer, c) trauma to the eye, or d) exposure to toxins.  Uveitis is more likely to occur in individuals that have other immune and inflammatory conditions.

Ebola and Uveitis
Two months after an American physician was treated for Ebola, and despite the fact that the virus was no longer detectable in his blood, there were high levels of Ebola virus in his eye. His eye infection was accompanied by an intense inflammatory reaction, uveitis. After much effort, the physician was successfully treated and thankfully  did not lose his sight.

In a study of 85 Ebola Virus Disease survivors in Sierra Leone, 40% reported that they had some sort of “eye problem”. (It is not known whether they also had uveitits.)

Retinitis Pigmentosa
Retinitis pigmentosa is a genetic disorder in which the light-sensitive retina, the “screen” at the back of the eye that captures images, becomes damaged .  Its photoreceptors,  rods and cones, begin to die off resulting in a  loss of vision.  This condition may end in blindness.

There are conflicting opinions as to whether inflammation plays a major role in this disease.

One study that support the contention that immune responses are involved in retinitis pigmentosa measured the levels of TNF-alpha.  TNF-alpha is a cytokine, that among other functions, helps regulate immunological responses. Depending on when and how much of the cytokine is produced , TNF-alpha may be pro-inflammatory (initiate inflammation), or anti-inflammatory (inhibit inflammation).   In animals with uveitis-like conditions, the levels of TNF-alpha in the eye are  increased between 5-10 fold over control animals.

Also,  in retinitis pigmentosa, immune white blood cells are attracted to the retina, perhaps to clean up debris from dying cells. Some investigators suggest that when these immune cells are overly stimulated, they initiate an autoimmune response, destroying other light-sensing centers in the retina.

Immune Homeostasis, Immune Balance
Immune inflammation is essential to defend the body against cancerous cells and invading microorganisms.  However, the appropriate levels of  “protective” cytokines are needed to balance the “destructive” cytokines produced in the eye so that it can maintain immune homeostasis, immune balance. Unchecked inflammation results in tissue damage and an inability of the body to mount stable and proper immune responses in the face of various challenges.

Dr. Hellen is available at 302.265.3870 for discussion on the role of inflammation and immune homeostasis in one’s health.  There is no charge to speak with her.  She may be contacted at: drhellen@drhellengreenblatt.info, or use the contact form.  Thank you.

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Immediately after the body is injured, it starts the processes of stopping blood loss, restoring function, and preventing infection from pathogens on the skin or objects that may have caused the damage. The microenvironment of the injured area is in constant flux with the host cells continuously responding to the fluids, bacteria, and the dead and dying cells at the wound site.

One of the first phases of the healing process is for circulating platelets to attach to a fibrous scaffold, a matrix, to stop blood flow. Platelets, recently defined as immune cells, release cytokines, immune messengers, which permit cells to communicate with one another.

 Once the flow of blood ceases, specialized immune cells enter the area setting up an inflammatory response that “cleans” the wound site and removes bacteria, damaged tissues, and foreign matter. In order to achieve the appropriate levels of inflammation, many complex cell-to-cell interactions occur in specific order.

Accumulation of fluids, exudates, results from inflammation, along with swelling at the wound site. Exudates are essential for the healing process and contain debris, inflammatory cells, bacteria, and a large variety of immune proteins. Depending on their concentrations, factors may enhance healing or interfere with the process. Proteins found in exudates have a variety of functions including regulation of inflammatory responses, triggering growth of new blood vessels, and stimulating growth of new cells.

A delicate balance of inflammatory and anti-inflammatory messengers is crucial and it determines the pace, and outcome of healing. Homeostatic, balanced, inflammatory responses are essential. Too little, too great, or too lengthy of an inflammatory response damages healthy tissue and delays healing.

The remodeling phase is one where tissues regenerate and close the wound. Closure occurs as cells cross-link and organize themselves attaching to a scaffold, a matrix that will draw edges of the skin closed and cover the area.

Poorly Healing Wounds

The presence of bacteria, foreign bodies, a lack of oxygen in the tissues, and/or fragments of necrotic, dead, tissue can stimulate inflammatory cells continuously, resulting in uncontrolled inflammation and wounds that heal poorly.

Infection of a wound site also interferes with proper healing. Communities of bacteria tend to organize themselves into a biofilm, a thin sheet of bacteria. Biofilms increase survival of bacteria colonies, reducing chances that inflammatory immune responses, or antibiotics, can control them.

Exudates in poor healing wounds contain an over abundance of inflammatory cells and immune mediators that increase inflammation. Sufficient anti-inflammatory factors to control the damaging effects of excessive inflammation may not be available.

Proteolysis is another one of the steps required for healthy healing. This is an event during which the body degrades necrotic tissue, and dead and dying pathogens. [Think of proteolysis as an acid/enzyme reaction that breaks down tissues.] When immune cells release too many proteolytic proteins over a longer period, they become destructive of healthy tissue, and the body’s ability to heal the wound is overwhelmed.

Individuals with non-healing skin ulcers, such as those found in diabetics, not only struggle with excessive inflammatory responses, but their proteolytic enzyme levels are significantly elevated giving rise to further imbalances in inflammatory responses and interference with the body’s repair mechanisms.

Summary

The sensitive balance between stimulating and inhibitory mediators during diverse repair of wound is crucial to achieving tissue homeostasis following injury. Once unbalanced and excessive inflammation is controlled, will healing begin.

 
There is no fee for speaking with Dr. Hellen. She may be contacted by using this form or at: 302.265.3870 (ET).


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The act of conceiving, getting pregnant, requires many steps among which are: release of an egg from a follicle (ovulation), fertilization of the egg by sperm, transport of the egg through the Fallopian tubes to the uterus, and attachment to the uterine wall, (implantation).

Each step to becoming pregnant must occur in the right order and requires interaction with hormonal and immune system pathways.

Infertility is the inability to conceive after 1 year of unprotected intercourse. Ten to 15% of reproductive-age couples are unable to conceive. Thirty percent of the time infertility is due to issues with both the man and the woman, or no cause can be determined (idiopathic infertility).

Infertility Issues:
Hormonal and/or immunological imbalances.
Hormonal imbalances affect the way the body interacts with the immune system and affects the ability to conceive.

Seminal fluid, the liquid from male testicles that delivers sperm to the egg contains hormones, cytokines, and other immune messages that interact with the cells lining the female reproductive tract. The factors in seminal fluid prepare the site to receive sperm and set up the proper environment for implantation of the egg. The sequence of events resembles an inflammatory response, but too much inflammation can result in infertility issues.

Pelvic Inflammatory Disease:
Common pelvic inflammatory diseases such as appendicitis and colitis result in inflammation of the abdominal cavity, which in turn may affect the Fallopian tubes and lead to scarring and blockage of the tubes. Since the Fallopian tubes are the pathway by which the egg gets to the uterus for implantation, implantation may not occur. Abdominal surgery, scar tissue, and sexually transmitted infections can also result in inflammatory pelvic disease.

Endometriosis is an inflammatory and hormonal condition that occurs when the tissues lining the uterus grow and spread outside of the uterus. They release blood at menses, the monthly cycle. Thirty-five to fifty percent of infertility cases in women are due to endometriosis.

Poor Egg or Sperm Quality.
Life style decisions such as abuse of alcohol or drugs, smoking, poor diet, obesity, lack of consistent physical activity, and environmental factors may all contribute to poor viability of the egg or sperm.

Smoking contributes greatly to inflammatory responses of the body.

If either partner smokes, the chances of conceiving, via natural or clinical means, are reduced by 33%. Smoking by men lowers their sperm counts and affects the health of their reproductive organs. Women who smoke take longer to conceive compared to non-smokers and are at increased risk of miscarriage, premature birth, and low-birth-weight babies. Even women who do not smoke, but live in homes where they are passively exposed to smokers, may take more than a year longer to become pregnant than women living in smoke-free homes.

Infections and Medical Conditions.
Women and men with sexually transmitted diseases often show no symptoms. Untreated infections can result in excessive inflammatory responses which damage and scar reproductive organs.

Anti-sperm antibodies
Up to 50% of infertility problems in women and men may be associated with the presence of anti-sperm antibodies, large immune proteins that attach to the sperm and trigger immune responses.

In women, antibodies to sperm may attack her partner’s sperm and result in inflammation and damage of vaginal tissues. Over 70% of all men who get a vasectomy develop anti-sperm antibodies. If damaged sperm fertilizes an egg, chances of a miscarriage increase.

Summary:
The reasons behind idiopathic infertility are not understood. It has been my experience that when couples focus on returning to immune balance, to immune homeostasis, they appear to enhance their chances of having children.

Contact Dr. Hellen with the contact form, or  302.265.3870 (ET) or at DrHellen@DrHellenGreenblatt.info.


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