Anti-Inflammatory Strategies–Achieving Homeostasis
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Severe nasal reactions to medications, pollen, dander, foods, fragrances, and other environmental stimuli may occur as people age. These responses, often not a true allergic response, are termed vasomotor or nonallergic rhinitis (1), because they are not due to a typical “allergic” response.

Nonallergic rhinitis (“itis” as in inflammation) is associated with increased irritability, problems in focusing, sleep issues, and daytime sleepiness. Also individuals with rhinitis are at higher risk of getting asthma (2).

Hallmarks of nonallergic rhinitis include inflamed sinuses, drippy, congested nose, chronic sneezing or coughing. Nonallergic rhinitis is seen when inflammation occurs in the sinuses of the face, and the nasal membranes and blood vessels in the nose expand filling the lining of the nose with blood and fluids.

According to the Mayo Clinic specific triggers for nonallergic rhinitis also include (3):

Infections: Viral infections can result in nonallergic rhinitis due to postnasal drip and nasal discharge. Facial pain and sinusitis (inflammation and pressure in the sinus cavities of the face) may also be an unwelcome outcome.

Medications: Overuse of decongestant nasal sprays can cause rhinitis as can medications such as sedatives, beta blockers, antidepressants, oral contraceptives, erectile dysfunction drugs, blood pressure medications, aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs).

Environmental: Strong odors, such as perfumes or cleaning fluids, smoking, secondhand smoke, dust, can become a cause of nonallergic rhinitis.

Foods and beverages: Nonallergic rhinitis may occur when you eat, especially when eating hot or spicy foods. Drinking alcoholic beverages, such as beer and wine, also may cause the membranes inside your nose to swell, leading to nasal congestion.

Weather: Temperature or humidity changes can trigger the membranes inside your nose to swell and cause a runny or stuffy nose. Dr. Rohit Katial, Director of Adult Allergy and Immunology at National Jewish Health, Denver, CO states “Even cold air becomes more problematic as we get older” (1).

Stress and Exercise: Stress and exercise have been shown to induce inflamed sinuses.

Hormonal changes: Changes in hormones due to menstruation or pregnancy, or a autoimmune hormonal conditions.

The majority of inflammatory illnesses result from over production of pro-inflammatory (inflammation enhancing) cytokines, and other immune cellular factors. Our survival on earth depends on the ability of the body to rapidly generate appropriate inflammatory responses to “burn out” pathogens that threaten to destroy us.

The body must be able to modulate the amount of inflammation produced and decrease its intensity as the challenge is met. The key to health is immune homeostasis. We must generate enough of an inflammatory response to meet the threat, but in controlled amounts so that bystander tissues and organs are effected.

1) http://online.wsj.com/article/SB10001424053111903480904576510302458640840.html
2) http://emedicine.medscape.com/article/874171-overview
3) http://www.mayoclinic.com/health/nonallergic-rhinitis/DS00809/DSECTION=causes

This morning I had a note from a client that said:
“I hope you can help me fight off the fungal, bacteria and EBV in me.”

Part of my response was: No I cannot. Neither I, nor anyone else, can help your body fight infections-
that is the job of an optimized immune system which you have to achieve yourself.

The key is to re-educate your body to learn to balance its inflammatory immune responses. One has to generate enough of an inflammatory response to destroy pathogens, but not so much as to cause the numerous health issues with which you are dealing.

Immune homeostasis, immune balance, is the only way our body defends itself against infection. Even if we are infected, the body is more able to resolve the infection if the immune system is functioning optimally.

Take the following steps to help your body return to immune homeostasis. Once you are in homeostasis your body will figure it out.

  • Incorporate physical activity into your daily life (burn off about 150 calories/day, or consume at least 150 fewer calories a day if you have a weight problem).
  • Eat nutritious meals and emphasize plenty of darkly pigmented vegetables and fruits (especially berries).
  • Get moderate amounts of sun and PLENTY of fresh air
  • Supplement your diet with vitamin D and omega-3 fatty acids
  • Consume 1-2 daily servings of hyperimmune egg

An article in this week’s New York Times* focused on men and  women in their late 60’s, 70’s, 80’s, and 90’s who decided to have face, neck,  (and for women) breast surgery to appear younger. As one woman, 83 years of age  says, “Physically, I’m in good health, and I just feel like, why not take  advantage of it?”

According to the article, Cleveland Clinic researchers reported no significant differences in the numbers of major or minor complications in well-screened, 216 patients, averaging 70 years of age that had undergone face-lifts, as compared to individuals averaging 57.6 years, despite an increase in such surgeries.

However, Dr. Michael Niccole, a plastic surgeon in Newport  Beach, CA. has found in his practice, “older patients may take longer to heal, and the results of plastic surgery may not last as long as in younger patients”.

As with any type of injury to the body, including surgery, the body has to heal itself when damaged.  Inflammation is the first phase of wound healing, but in some older individuals wound healing is delayed because of an impaired inflammatory response.

Healing is an immune inflammatory process requiring a balanced, immune inflammatory response to help clean up an area and rebuild damaged tissues. Pain (the result of an immune response), swelling and bruising, especially during the first few days after injury or surgery, are also involved in the healing process.

Certain specialized cells,  are then drawn into the area to lay down “biological fibers” such as collagen.  These proteins  are used by the body as scaffolding onto which to lay cells, which will replace  damaged and dead cells to regenerate healthy tissue. When the normal structure  of the skin cannot be rebuilt, and instead the collagen fibers are more closely packed and disorganized, then scarring may follow.

Just as production of collagen is essential for healing, it  is equally important for collagen production to be controlled so as to prevent  excessive scarring. Cells accumulate in the area,  collagen production is slowed, and less scar  tissue is formed. Interestingly, despite a decreased ability to heal, older individuals have less scarring than many younger individuals.

Optimal, rapid, healing — with minimal scarification– requires  a balance of the appropriate inflammatory responses. A body in immune homeostasis is body that heals well.

*http://www.nytimes.com/2011/08/09/health/09plastic.html?

 

Today’s Wall Street Journal* reports on comments by Dr. Barbara Schildkrout, a psychiatrist at Harvard, stating that there are over “100 medical disorders [that] can masquerade as psychological conditions”.  Some of these conditions are lupus, heart disease, thyroid, dementia, Parkinson’s, diabetes, and Lyme Disease. The article goes on to quote Gary Kennedy, Director of Geriatric Psychiatry at Montefiore Medical Center in Bronx, NY : “[d]epression predicts heart disease and heart disease predictsdepression”.

 We know that much of heart disease stems from excessive inflammatory responses by the body.  The science also suggests that excessive inflammation, an immune disorder, leads to depression and vice versa.  People who are depressed have higher levels of specific immune inflammatory molecules (cytokines), than individuals that are more emotionally stable.  Cytokine production results in inflammation that affects and even damage brain cells (which adds to the emotional distress).  That is why immune homeostasis is so essential.

 Unfortunately, too many individuals are convinced that only prescription medications can make a difference in their depression and anxiety.**

 There are however, some powerful life style changes that one can make which will affect emotional health.  For example:

 EXERCISE: Researchers at Duke University Medical Center, Durham, NC, report that a brisk 30-minute walk, or jog three times a week, may be just as effective in relieving major depression as antidepressant prescription medications.  In the study, patients were assigned to
three groups: antidepressant medications only, exercise only, or a combination of both medication and exercise. The scientists found that the exercise by itself was just as effective as medication, and “was equally effective in reducing depression…”. 

One reason exercise may be effective in reducing the inflammation-depression cycle is that every time a muscle contracts, it releases anti-inflammatory immune cytokines that reduce inflammation and at the same time help to decrease anxiety, and improve mood.

SUNSHINE AND FRESH AIR: Moderate  exposure to sunshine and fresh air may contribute greatly to feeling less  depressed.  This may “simply” be due to  the fact that one is exposed to sunlight which then triggers the production of  the vitamin D by the body.

Although controversial, adding  vitamin D to one’s diet may help with moodiness since Vitamin D is more like a  “hormone” than a nutritional element.  Vitamin D affects hundreds of genes, and is a powerful immune system  regulator.

*http://online.wsj.com/article/SB10001424053111904480904576496271983911668.html

 **Note: Do not reduce or stop  ANY prescription medications without consulting with the health practitioner  that prescribed them. You might  however, after consultation with a qualified health  practitioner, wish to discuss incorporating new lifestyle  changes into your daily regimen.

As predicted by microbiologists and immunologists,  the inappropriate use of antibiotics has resulted in the appearance of certain bacteria that are resistant to different types of antibiotics.  Last year an antibiotic resistant strain of E. coli was responsible for a serious outbreak of food poisoning in Europe, especially in Germany.

Now in the US, a food processor, in collaboration with the USDA, has issued a voluntary, nationwide recall of 36 million pounds of ground turkey.According to DNA analysis, the product appears to be contaminated with a multiple-antibiotic-resistant strain of Salmonella.  At least one fatality has been reported, and 38% of the individuals with this illness have required hospitalization.

Our intestines are constantly exposed to microorganisms that are ingested during the course of a meal. Embedded in the walls of the digestive tract is the gut-associated lymphoid tissue (GALT) network.
The immune cells in these clusters mount inflammatory immune responses to protect the digestive tract, and the rest of the body, from being overwhelmed by pathogens.

Two stages make up the immune response. The first is the production of antibodies (immunoglobulins), large protein molecules, which like heat-seeking rockets, specifically bind to the  invading organisms marking them for destruction.  Other immune cells then enter the battle, mounting an inflammatory response that hopefully will be sufficient to destroy the pathogens.

Whereas in chronic (long-acting) illnesses it may be important  to down-regulate (inhibit) inflammatory responses, in acute,  short duration infections (such as food poisoning)  the body must rapidly increase, or boost, its inflammatory immune responses in response to the challenge. (This is termed the pro-inflammatory phase.)

In a healthy person, gastrointestinal distress, such as abdominal cramps, nausea, vomiting, and diarrhea, possibly associated with a headache and fever, typically resolve within a few days.  Once the threat has been met, the body initiates a strong anti-inflammatory response to return the body to its appropriate level of immune homeostasis (immune balance).

A balanced immune response is the only way your body defends itself against infection.  Even if you are infected, you are more likely to quickly resolve the infection if your immune system is functioning optimally.

Read more about food-borne infections:
http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/
http://www.cdc.gov/foodborneburden/

Aging typically does not occur overnight. Instead, it progresses gradually until you start feeling that you are indeed “aging”. You begin to realize that you cannot work or party as hard as you once did. You don not recover from workouts as quickly and you hurt the day after a hard work out. You are stiff in the morning or after a long drive. Your skin is not as tight as it once was, and winkles appear. You experience less energy, and your sexual drive suffers as well.

I am personally affronted when people share their complaints with doctors who respond that “there is nothing that can be done–you are just getting older”.
People who age poorly, are unable to control the amount of inflammation their bodies generate. Their immune cells are producing and releasing too many pro-inflammatory cytokines (1,2). These sorts of events can result in chronic inflammation, which is associated with heart and neuromuscular disease, diabetes, dementia, Alzheimer’s and autoimmune (3) conditions such as diabetes, arthritis, Crohn’s disease, Parkinson’s Disease, and multiple sclerosis. Chronic inflammatory responses have also been associated with certain types of cancers.

One would expect that if you have a “boosted” immune response, that you would be better prepared to fight infections and cancerous cells. Instead, there is a significant decline in immune responses in people that are not aging in a healthy manner. Their immune cells are not as effective as healthier individuals in recognizing and eliminating pathogens or stopping the spread of cancer cells.

Immune homeostasis, also known as immune balance, is the key to optimum health and healthy aging. The immune system controls the amount of pro-inflammatory molecules it produces by generating the right types and amount of anti-inflammatory molecules (4) to keep excessive levels of inflammation in check.

1 Pro-inflammatory -immune molecules that “up-regulate”(increase) inflammatory responses
2 Cytokines: http://ghr.nlm.nih.gov/glossary=cytokine
3 Autoimmune- http://www.niams.nih.gov/Health_Info/Autoimmune/default.asp
4 Anti-inflammatory–immune molecules that inhibit (“down-regulate”) inflammation

Selected references (others by request):
http://www.infection-research.de/fileadmin/user_upload/Perspectives2009/April2009/INFECTION-RESEARCH_Perspectives–Infectious_Diseases_and_Aging_FINAL_20_04_2009.pdf
http://www.onderzoekinformatie.nl/en/oi/nod/onderzoek/OND1295431

Hi.  If you are time-challenged, and stressed out most of the time, but the fatigue makes it even harder to cope, there are some powerful steps you can take; the most important approach you can take however, is to control immune inflammation.

Inflammation is a yin-yang of influences.  For example, inflammation is the primary way that the body protects us from illnesses initiated by pathogens or cancer cells.  You might want to view a “pro-inflammatory” response as one in which the body is trying to “burn” the infection or cancer cells out (“up-regulate” inflammation).  [A more moderate pro-inflammatory response is also used by the body for healing when we are injured or ill.]

A person who is feeling great, both emotionally and physically, is more likely to be in optimal health. In such an individual, once an immune challenge has been met, a healthy immune system will start to down-regulate (turn-down) immune inflammation (“anti-inflammatory” response).

Both phases of an inflammatory immune response are vital for survival.  The body constantly strives for an exquisite balance of both pro-inflammatory and  anti-inflammatory responses.  This is termed immune homeostasis.

Reducing the amount of excessive inflammation that your body produces will go a long way towards helping the body return to immune homeostasis.

Comments and questions welcomed:  DrHellen@DrHellenGreenblatt.info

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