Dr. Hellen Greenblatt

Eczema-Itchy, Painful Skin

“Eczema” is worldwide the most common of chronic (long-lasting) inflammatory skin diseases. Also called atopic dermatitis [“itis” means inflammation], it is a condition of red, inflamed, burning, itchy patches of skin. In severe cases, people experience blistering, bloody and peeling skin and raw, excruciating pain.

In the United States alone, over 30 million people have been diagnosed with dermatitis, with almost twice as many children having the condition as adults. As with most immune disorders, more females have the condition than males, and hospitalization due to flare-ups of the conditions or associated infections is associated with an 8-year reduction in lifespan.

Individuals with dermatitis are frequently embarrassed when they have an outbreak, and the itching “drives them crazy”. They have tried every approach including medications, acupuncture, herbals, creams, ointments, and different detergents. Having dermatitis leads to at least 40% of individuals turning down an educational opportunity or job.

Caregivers especially report feeling frustrated, helpless, sad and guilty when dermatitis occurs in children, placing the entire family under both emotional and financial stress. There is no medical cure for eczema.

Atopic dermatitis is attributed to a combination of genetic and environmental factors. Foods such as dairy, certain nuts, soy, wheat, and allergens such as dust mites, pets, pollens have all been implicated. Additionally there are more than 80,000 chemicals registered for use today in the USA. The bottom line is that researchers do not know what causes dermatitis.

What is known, is that atopic dermatitis is a sign that the immune system, via its inflammatory cells, is overreacting to some agent, and in the process of trying to protect itself, damages by-stander skin cells (autoinflammatory).

In moderate to severe atopic dermatitis, high numbers of inflammatory cells are found both in inflamed and unaffected skin, as well as in the blood. Long term, chronic inflammation leads to skin lesions, blisters and the other symptoms with which people with dermatitis suffer.

As Dr. Eric Simpson, a member of The American Academy of Dermatology has said, “We may not have a cure for atopic dermatitis just yet …[but] tackling inflammation is key.”

Suggestion:

There is no medical treatment for eczema however individuals that have been able to achieve immune balance, homeostasis, have found significant differences in their skin health.

Achieve balance by being physically active 4-6 days a week, consume a smart diet, maintain a healthy weight, do not smoke, or drink in excess. Do take walks outdoors and add a proven immune balancing supplement to your daily diet and see and feel the difference.

Contact Dr. Hellen– she is there for you. No fee is charged for the first 30 minutes of consultation. She may be contacted by using this form or calling: 302.265.3870 (ET-USA).

https://medlineplus.gov/eczema.html

https://www.medicalnewstoday.com/articles/14417.php

https://www.jacionline.org/article/S0091-6749(17)30205-1/pdf

http://www.jiaci.org/summary/vol28-issue6-num1694

https://www.pbs.org/newshour/science/it-could-take-centuries-for-epa-to-test-all-the-unregulated-chemicals-under-a-new-landmark-bill

https://www.ncbi.nlm.nih.gov/pubmed/30576754

autoimmune, autoinflammatory, balance, cytokines, eczema, immune homeostasis, immune system, infection, inflammation, inflammatory responses, itchy, rash, scaly, skin

HIV-The Battle is Not Over

| Posted by in Boosting Immune Responses (Pro-Inflammatory) | Chronic Disease | Fatigue | Infections and Inflammatory Responses - (0 Comments)

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

anti-inflammatory, antibodies, balance, chronic disease, cytokines, HIV/AIDS, immune homeostasis, immune system, infection, inflammatory responses, pro-inflammatory

Lyme Disease and Inflammation

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

http://www.cdc.gov/lyme/signs_symptoms/index.html

https://www.statnews.com/2017/06/28/early-lyme-tests/

www.ncbi.nlm.nih.gov/pmc/articles/PMC3474947/

www.hopkinsarthritis.org/arthritis-info/lyme-disease/

ajp.amjpathol.org/article/S0002-9440(15)00123-6/fulltext

news.yale.edu/2012/06/25/even-after-lyme-disease-gone-its-remains-may-perpetuate-inflammation

www.news-medical.net/news/20171214/Study-Living-Lyme-disease-bacteria-found-months-after-antibiotic-treatment.aspx

anti-inflammatory, arthritis, autoimmune, autoinflammatory, fatigue, immune homeostasis, immune system, infection, joint pain, joints, Lyme, nervous system, Tick-borne, Ticks

Widespread Influenza Infections Across the Country

| Posted by in Immune Homeostasis (Immune Balance) | Infections and Inflammatory Responses - (0 Comments)

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.

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:

Eat healthful meals with an emphasis on whole grains and plenty of colorful vegetables and fruits.
Be physical active to help keep the immune system in balance; incorporate it into your daily life.
Get adequate amounts of rest and avoid fatigue.
Drink plenty of fluids to keep membranes moist and more resistant to invasion.
Wash your hands frequently and try to keep them away from your face.
Stop, or at least cut down, on your smoking—your lungs are struggling enough.
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

anti-inflammatory, balance, cytokines, exercise, fatigue, Flu, immune system, infection, inflammation, inflammatory responses, influenza, pro-inflammatory, Smoking

Good Nutrition is Not Enough. The Need for Balanced Inflammation.

| Posted by in Aging | Cancer | Chronic Disease | Immune Homeostasis (Immune Balance) - (0 Comments)

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.

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

www.ncbi.nlm.nih.gov/pubmed/17047219?dopt=Citation

www.ncbi.nlm.nih.gov/pubmed/22893204

www.ncbi.nlm.nih.gov/pubmed/22122770

www.ncbi.nlm.nih.gov/pubmed/27357102

aging, anti-inflammatory, autoimmune, autoinflammatory, balance, chronic disease, Crohn's, cytokines, depression, diabetes, immune homeostasis, immune system, infection, inflammation, inflammatory responses, joint pain, pro-inflammatory

WHO and CDC Caution Pregnant Women about Zika

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

www.scientificamerican.com/article/who-extremely-alarmed-by-zika-cases-could-reach-4-million/?WT.mc_id=SA_DD_20160128

www.wsj.com/articles/health-threats-spur-vaccine-hunt-1453337493

ecdc.europa.eu/en/healthtopics/zika_virus_infection/factsheet-health-professionals/Pages/factsheet_health_professionals.aspx

www.vox.com/2016/1/20/10795562/zika-virus-cdc-mosquitoes-birth-defects

www.wsj.com/articles/SB105768561135341800

www.cdc.gov/features/antibioticresistancethreats/

www.cdc.gov/media/dpk/2013/images/untreatable/img2_sm.jpg

www.bbc.com/news/health-35427493

anti-inflammatory, autoimmune, chronic disease, cytokines, Ebola, Guillain-Barre, immune system, infection, inflammation, inflammatory responses, MERS, pro-inflammatory, SARS, Zika

Tired of Being Tired All the Time?

| Posted by in Chronic Disease | Immune Homeostasis (Immune Balance) | Infections and Inflammatory Responses | Inflammation - (0 Comments)

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

www.ncbi.nlm.nih.gov/pubmed/26589194

http://www.the-scientist.com/?articles.view/articleNo/43120/title/Brain-Drain/

http://www.ncbi.nlm.nih.gov/pubmed/26705751

http://www.ncbi.nlm.nih.gov/pubmed/25682012

anti-inflammatory, arthritis, autoimmune, autoinflammatory, balance, brain, cancer, chronic disease, Crohn's, cytokines, depression, diabetes, fatigue, heart disease, heart failure, immune homeostasis, immune system, infection, inflammation, Inflammatory Bowel Disease, joint pain, multiple sclerosis, pro-inflammatory

Delirium and the Inflammatory Response

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/
www.mayoclinic.org/diseases-conditions/delirium/basics/definition/con-20033982
www.ncbi.nlm.nih.gov/pmc/articles/PMC2911011
intl-biomedgerontology.oxfordjournals.org/content/early/2015/07/24/gerona.glv083.full
www.sciencedirect.com/science/article/pii/S2210833511000773
www.ncbi.nlm.nih.gov/pubmed/17504139

aging, anti-inflammatory, balance, burn, C-reactive protein, cancer, CRP, cytokines, delirium, dementia, hip fracture, immune homeostasis, infection, inflammation, open-heart, pro-inflammatory, surgery, Ventilators

Eye Immune Homeostasis, Balanced Inflammation

| Posted by in Chronic Disease | Immune Homeostasis (Immune Balance) | Inflammation - (0 Comments)

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.

www.sciencedirect.com/science/article/pii/S0014483502003329
www.ncbi.nlm.nih.gov/pubmed/24174679
www.ncbi.nlm.nih.gov/pubmed/24639355
www.ncbi.nlm.nih.gov/pubmed/23608634
eyewiki.aao.org/Retinitis_Pigmentosa
www.ncbi.nlm.nih.gov/pubmed/22986109
www.ncbi.nlm.nih.gov/pubmed/21787221
www.nhs.uk/conditions/Uveitis/Pages/Introduction.aspx
www.nei.nih.gov/health/uveitis
www.nejm.org/doi/full/10.1056/NEJMoa1500306#t=article
www.nytimes.com/2015/05/08/health/weeks-after-his-recovery-ebola-lurked-in-a-doctors-eye.html?smid=tw-nytimes&_r=0

anti-inflammatory, autoimmune, autoinflammatory, balance, chronic disease, cytokines, Ebola, eye, immune homeostasis, immune system, infection, inflammation, inflammatory responses, pro-inflammatory, Retinitis pigmentosa, uveitis

The Importance of Inflammation in Wound Healing

| Posted by in Immune Homeostasis (Immune Balance) | Inflammation | Injury and Trauma - (0 Comments)

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).

www.ncbi.nlm.nih.gov/pubmed/25750642
www.nature.com/jid/journal/v127/n3/full/5700701a.html
www.rndsystems.com/mini_review_detail_objectname_mr02_cytokinewoundhealing.aspx
www.ncbi.nlm.nih.gov/pubmed/25774966
www.uweb.engr.washington.edu/research/tutorials/woundhealing.html
www.ncbi.nlm.nih.gov/pubmed/22564225
www.ncbi.nlm.nih.gov/pubmed/14766366
www.bioscience.org/2004/v9/af/1184/2.htm
www.ncbi.nlm.nih.gov/pmc/articles/PMC3467878

anti-inflammatory, balance, biofilm, cytokines, healing, immune homeostasis, immune system, infection, inflammation, inflammatory responses, injuries, matrix, pro-inflammatory, trauma, wounds

Infertility and Inflammation

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.

natural-fertility-info.com/top-10-causes-of-infertility.html
www.jimmunol.org/content/188/5/2445.full.pdf
yourfertility.org.au/for-men/smoking
www.ncbi.nlm.nih.gov/pubmed/25567620
www.ncbi.nlm.nih.gov/pubmed/25547201
www.ncbi.nlm.nih.gov/pubmed/24996040
www.ncbi.nlm.nih.gov/pubmed/24993978
www.ncbi.nlm.nih.gov/pubmed/25592078
www.ncbi.nlm.nih.gov/pubmed/24863647

anti-inflammatory, anti-sperm, antibodies, balance, chronic disease, cytokines, egg, Fallopian, immune homeostasis, immune system, infection, infertility, inflammation, inflammatory responses, ovum, reproduction, reproductive organs, seminal fluids, sexually transmitted disease, Smoking, sperm

The Role of Inflammation in Periodontal, Cardiovascular, and Alzheimer’s Diseases

| Posted by in Immune Homeostasis (Immune Balance) | Inflammation - (0 Comments)

The mouth is a unique bio-environment for bacteria and other microorganisms. The oral cavity must always be in microbial and immune homeostasis (balance).. Hundreds of types of bacteria need to be properly balanced to protect the mouth from infection or severe gum disease can result from microbial imbalances or “dysbiosis”.

Oral Disease
Many microorganisms in the mouth attach to the teeth. The accumulation of microbes on the surface of teeth is called a “biofilm”, which may eventually calcify into a matrix of hard material called “plaque”.

If not removed, biofilms can lead to inflammation of the gums; a first step in the development of dental caries and “gingivitis”. This mild form of gum disease results in swollen and red gums that may exude pus and bleed easily upon brushing. If left untreated, gingivitis may escalate to periodontitis. In periodontitis, pockets of microbes form and the infection spreads and grows below the gum line, damaging bone, and loosening teeth.

Oral Inflammation
Periodontal-causing pathogens in the mouth trigger defense mechanisms resulting in defensive inflammation. However, when inflammation is not controlled, bone and connective tissues are damaged; the gums pull away from the teeth and leave them in danger of falling out.

When dysbiosis occurs, pathogenic periodontal bacterial communities may overpopulate the mouth. The bacteria are able to circumvent immune cell attacks. As the number of bacteria increase, they stimulate more inflammatory responses leading to bone loss and worsening periodontitis.
As might be expected, treating periodontitis decreases the biomarkers of inflammation throughout the body.

Atherosclerosis and cardiovascular disease
Inappropriate levels of inflammation in the mouth can lead to inflammation throughout the body. It is therefore not surprising that periodontal disease increases the risk of having other inflammatory conditions such as atherosclerosis and cardiovascular disease. Indeed, individuals with atherosclerosis and periodontitis share genes that appear to stimulate similar inflammatory pathways.

Alzheimer’s Disease (AD).
Amyloid plaque accumulation in the brain is a major feature of Alzheimer’s disease (AD); heightened levels of amyloid have been associated with greater risk of periodontal disease. Even in seemingly healthy elderly individuals, those with periodontal disease have more amyloid in their brains than those without oral disease.

Individuals with strong immune responses to periodontal pathogens are at greater risk of developing Alzheimer’s than people who have more limited responses. This has led investigators to suggest that inflammation-associated periodontal disease may be a contributor to Alzheimer’s.

Homeostasis
A major function of the immune system is to keep the numerous bacterial communities on and throughout the body in check. To accomplish this, the body maintains immune homeostasis, exquisitely balanced inflammatory responses.

One might predict that maintaining good oral health would decrease one’s risk of inflammatory diseases including diseases such as cardiovascular and Alzheimer’s Disease.

www.ncbi.nlm.nih.gov/pmc/articles/PMC3183659
europepmc.org/abstract/med/765622
www.ncbi.nlm.nih.gov/pubmed/25434071
www.ncbi.nlm.nih.gov/pubmed/25435361
www.ncbi.nlm.nih.gov/pubmed/25466412
www.ncbi.nlm.nih.gov/pubmed/23746697

Alzheimer’s Disease, balance, biofilm, cytokines, dysbiosis, gingivitis, gums, immune homeostasis, immune system, infection, inflammation, inflammatory markers, inflammatory responses, microbiome, oral, periodontal, periodontitis, plaque, teeth

Concussions, Brain Injuries, and Inflammation

| Posted by in Boosting Immune Responses (Pro-Inflammatory) | Immune Homeostasis (Immune Balance) | Inflammation | Injury and Trauma - (0 Comments)

The brain, being the “control center” of the body is cushioned by fluid, and is protected by bone and layers of membranes that support blood vessels that feed the brain.

Concussions
Direct or indirect mechanical impact to the brain may result from sports activities or workplace accidents. These may result in trauma to the brain. Rapid acceleration or deceleration, e.g., motor vehicle accidents or intense changes in pressure, e.g., blast exposures can also lead to brain damage.

The term “concussion” is commonly used to refer to a brain injury resulting from the head being hit with a great deal of force. Shaking the upper body and head violently can also cause brain damage.

Concussions alter the way the brain functions. The effects are usually short-lived, but may include being dazed, headaches, and problems with concentration, memory, balance, and coordination.

Brain injuries may result in loss of consciousness, but since the majority of cases do not end in “blackouts”, concussions often occur without the individual realizing they have had damage. The impact may seem relatively mild, and the individual may appear only to be dazed and with time and rest they may heal properly.

Serious untreated concussions can result in long-term brain damage and may even end in death.
Repetitive head injuries are a major issue especially when an individual sustains additional head injuries before the damage from the prior injury has been completely resolved.

The effects are cumulative. Cumulative sports concussions increase the likelihood of permanent neurologic disability. Complete recovery from an initial trauma can take from 6-18 months, and multiple concussions over time may result in long-term problems, including neurological deterioration, dementia-like symptoms, memory disturbances, behavioral, and personality changes, Parkinsonism, and speech and gait abnormalities.

In a minority of cases, additional trauma to the brain, even occurring from days to weeks following a prior event, can lead to collapse and death within minutes.

How quickly and completely one heals, depends on a number of factors including one’s genetic makeup. (This would be expected since genes determine a cell’s ability to withstand mechanical stress, regenerate, and heal.)

Inflammation and Concussions
For years it was thought that the membranes around the brain acted as a blood-brain barrier which stopped the brain from responding with inflammatory responses when it was confronted by infection. However, it has now been shown that concussions and other brain injuries, or infection or disease, will trigger inflammatory responses.

The types of immune cells found throughout the body are also found in the brain, but additionally, the brain has unique immune cells. When activated, brain-specific microglia and astrocytes, produce inflammatory cytokines that remain localized in the brain.

In response to brain injury, the immune system releases a tidal wave of pro- and anti-inflammatory cytokines, molecules that trigger and/or stop an inflammatory response depending on what is needed.

In small amounts, these cytokines help protect the brain and heal it. However, prolonged exposure to inflammatory cytokines, or too high a level of these proteins, will result in damage that accumulates after injury. High levels of inflammatory cytokines are localized at the injury site, and may be found on the opposite side of the head from the side that was hit.

There is increasing evidence suggesting that much of the neurological damage that occurs after the brain is injured is the result of a delayed inflammatory response that lasts hours, days, or even for months after the injury. This chronic inflammatory response may cause more damage to the brain tissue than the mechanical impact itself.

Immune Homeostasis, Immune Balance is the Key
Unfortunately, pharmaceutical treatments known to reduce inflammation appear to interfere with the brain’s natural repair mechanisms. Therefore it is necessary for the body to control its inflammatory responses. It has to produce enough of a response to help brain tissue heal, but not an overly exaggerated inflammatory response which may cause more damage after injury.

In order for the brain to heal after trauma, the immune system must generate the proper balance, and types, of pro-inflammatory and inflammatory cytokines. For those with brain injuries, maintaining immune homeostasis, immune balance, may be the best way to minimize damage.

Dr. Hellen is available at 302.265.3870 for discussion on the role of inflammation and immune homeostasis in our health. She may be contacted at: drhellen@drhellengreenblatt.info, or use the contact form. Thank you.

emedicine.medscape.com/article/92189-overview#a0107
www.ncbi.nlm.nih.gov/pmc/articles/PMC2945234/
emedicine.medscape.com/article/92189-overview
www.headcasecompany.com/concussion_info/stats_on_concussions_sports
www.ncbi.nlm.nih.gov/pmc/articles/PMC3520152/

anti-inflammatory, astrocytes, balance, brain injuries, cognition, concussions, cytokines, dementia, immune homeostasis, immune system, infection, inflammation, inflammatory responses, injuries, memory, microglia, Parkinson's, pro-inflammatory, trauma

Inflammation is like Real Estate: Location, Location, Location.

During the 1970′s and 80′s, the saga of the “boy in the bubble” was followed with great interest. David Vetter, a young Texas boy had severe combined immunodeficiency (SCID), a disease caused by life-threatening defects in his immune system. His immune system was unable to protect him from infection, resulting in the necessity of having to live in a germ-free, isolation containment center designed by NASA engineers. He lived in this plastic bubble from the time of this birth until he died at the age of 12 following a failed bone marrow transplant.

The containment center was supposed to keep David separated from any pathogens that might harm him. Unfortunately, it was likely that it was a virus-contaminated bone marrow transplant that resulted in lymphoma, an immune system cancer, which ended David’s life.

Living in a sea of pathogens, a functional immune system is essential for our survival. Inflammation is among the first steps the body takes to heal after injury or disease and it uses immune inflammatory responses to protect us from cancer cells and pathogens. But too much inflammation is as serious a problem as too little inflammation. The body constantly struggles to limit the amount of inflammation that it produces, with uncontrollable amounts of inflammation acting like as if it was an out-of-control forest fire, destroying healthy cells in its path.

The four letters “itis” indicate an inflammatory condition. Typically, the name of the disease depends on the location in which the inflammation occurs. For example, arthritis (inflammation of the joints), colitis (inflammation of the intestinal tract, the colon), dermatitis (inflammation of the skin), nephritis (inflammation of the kidney), pancreatitis (inflammation of the pancreas), and uveitis (inflammation of a part of the eye).

Most immune cells do not have specialized names, however some organs have specialized inflammatory immune cells that detect infection and help resolve infection or injury to the body. Kupffer cells are most often associated with the liver. Microglia are associated with the brain and are involved in repairing damaged brain tissue and protecting the brain against disease. Dust cells, also known as alveolar macrophages, carry out similar functions in the lungs.

Inflammation is like real estate: location, location, location. The process of inflammation is substantially the same no matter where in the body the inflammation occurs. The intensity of the inflammatory response is determined by a balance between pro-inflammatory (molecules that cause inflammation) and anti-inflammatory (molecules that dampen inflammation) cytokines, immune messages that are released by immune cells.

The key to healthy immune responses is to be in immune homeostasis, immune balance. We must maintain the balance of enough inflammation to defend ourselves from pathogens, stimulate repair, and healing against the need to limit the amount of inflammation that too often leads to inflammatory diseases.

Contact Dr. Hellen for guidance in utilizing natural means to help the body return to immune homeostasis. She may be reached at: DrHellen@DrHellenGreenblatt.info or or at 302.265.3870.

www.ncbi.nlm.nih.gov/books/NBK22254/
www.ncbi.nlm.nih.gov/pubmed/23720329
www.thedoctorwillseeyounow.com/content/mind/art3792.html?getPage=2
www.hindawi.com/journals/cherp/2012/490804/

anti-inflammatory, arthritis, balance, colitis, dermatitis, immune homeostasis, immune system, infection, inflammation, inflammatory responses, Kupffer, microglia, nephritis, pancreatitis, pro-inflammatory, uveitis

Ebola Virus: Immune Imbalances and Inflammation May Be Major Factors

Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, is a severe, often fatal illness in humans. As of this post, the virus has spread through many African nations, and is the worst Ebola outbreak every recorded. The virus has infected over 1200 people and abuot 60% of these individuals have died from the disease.

Health practitioners have put themselves at great risk caring for those who have become infected. According to the BBC, one hundred health workers have been affected and half of them have died. At least three high-profile physicians in the forefront of care have succumbed to the virus, and three nurses who worked in the same treatment center as one of the physicians, are believed to have died from the virus.

Two Americans working to battle Ebola in Liberia, one a physician, have tested positive for the virus and are undergoing intensive treatment and workers from Doctors without Borders and the Red Cross are “overwhelmed” for the virus that has no cure.

Depending on the type of Ebola virus, up to 90% of those infected can die a rapid and difficult death. The onset of symptoms may be characterized by a sudden spiking fever, headache, joint, muscle, and stomach pain, diarrhea, vomiting, and in some cases, uncontrolled internal and external bleeding. Infected individuals die from failure of multiple organs in the body such as the nervous system, liver, and kidneys.

The disease is characterized by abnormal immune responses in which the Ebola viruses appear to evade attack of immune cells; dramatic immune imbalances occur in response to infection. There is evidence that the immune system responds with a “cytokine” storm during which certain immune cells “dump” large amounts of pro-inflammatory molecules, cytokines, into the body. Other biological compounds are released as well that contribute to the confused immune response.

Additionally, specialized cells produce insufficient amount of anti-viral cytokines, while at the same time, there is a significant increase in death of other types of immune cells. Scientists at the National Institute of Allergy and Infectious Diseases call this “a mixed anti-inflammatory response syndrome (MARS)”, and suggest that this “catastrophic uncontrolled immunological status contributes to the development of fatal hemorrhagic fever”.

Perhaps some of the symptoms that patients experience are due to autoimmune responses against individual classes of lymphocytes. This would account for the loss of certain immune cells, such as CD4 and CD8 cells. If they were available in higher numbers, they might be able to help the body fight the infection.

Many immunological factors contribute to Ebola virus fatalities. It is my contention that if individuals were able to achieve immune homeostasis, immune balance, they would be better equipped to mount controlled inflammatory responses which might help control the course of the disease.

www.cdc.gov/vhf/ebola/pdf/fact-sheet.pdf
www.cdc.gov/media/releases/2014/t0728-ebola.html
www.who.int/mediacentre/factsheets/fs103/en/
www.nasw.org/users/mslong/2010/2010_09/Ebola.htm
www.vox.com/2014/7/23/5930311/ebola-virus-disease-outbreak-africa-facts-guinea?utm_medium=social&utm_source=facebook&utm_campaign=voxdotcom&utm_content=Sunday
www.ncbi.nlm.nih.gov/pubmed/20957152
www.ncbi.nlm.nih.gov/pubmed/21987781
www.ncbi.nlm.nih.gov/pmc/articles/PMC368745/

anti-inflammatory, autoimmune, autoinflammatory, balance, cytokines, Ebola, immune homeostasis, immune system, infection, inflammation, inflammatory responses, pro-inflammatory

The Role of Inflammation in Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) occurs in some individuals that are exposed to emotionally disturbing events such as combat, rocket, and terrorist attacks. Individuals that have suffered traumatic brain injury (TBI) or experienced natural disasters and sexual assault are also at higher risk of having this disorder.

Symptoms may include quality of life issues such as explosive outbursts of anger, difficulties in concentrating, being easily startled, feeling constantly “on guard”, expecting a threat to occur at any moment, depression, problems sleeping, avoiding people and circumstances that can trigger unpleasant memories or outbursts, limiting emotional relationships, and avoiding crowded locations.

Up to twenty percent of veterans serving in Iraq and Afghanistan, 10% of Gulf War (Desert Storm), and 30% of Vietnam Veterans have been diagnosed with post-traumatic stress disorder.

PTSD is not only a psychiatric issue. Individuals suffering with PTSD are at higher risk of being physically ill, and at increased risk of death from a multiple of causes.

PTSD is Associated with Inflammatory Responses.
Clinical studies suggest that individuals with post-traumatic stress disorders suffer from chronic low-level inflammation. This is reflected in their greater propensity to have inflammation-associated diseases such as autoimmune, cardiovascular, gastrointestinal, musculoskeletal, and respiratory diseases.

A combination of high blood sugar, cholesterol, and blood pressure, coupled with excess fat around the abdomen (abdominal visceral fat), increases the risk of individuals for stroke, heart disease, and diabetes. This cluster of symptoms, metabolic syndrome, is associated with inflammation and is found in 48% of individuals with post traumatic stress syndrome compared to 25% of controls. Such clinical issues result in patients with PTSD utilizing a greater proportion of medical services and prescription medications.

IL-6 is a cytokine, an immune messenger, which plays a major role in inflammation, helping the body heal after tissue injury, and defending the body from pathogens. C-reactive protein (CRP) is another biological marker that is strongly related to heightened levels of inflammation. Elevated levels of IL-6 and CRP are associated with an increased risk of heart attacks and other cardiovascular events that are inflammatory in nature.

Reports of increased presence of inflammatory cytokines in individuals with PTSD are inconsistent. However, the evidence suggests in military personnel with PTSD or depression, IL-6 levels are higher than found in control subjects, and that the quality of life of these soldiers is poorer as well. Similarly, individuals with PTSD are more likely to have significantly higher amounts of circulating CRP than those not diagnosed with PTSD.

Intermittent explosive disorder is one of the more troubling aspects of some individuals with post traumatic stress disorder. This condition involves repeated episodes of impulsive, angry, verbal outbursts, and violent and aggressive behavior. CRP and IL-6 levels are significantly higher in personnel with intermittent explosive disorder compared with normal or other psychiatric controls, suggesting a direct relationship between inflammation and aggression.

Summary:
Fifty percent of individuals with post traumatic stress syndrome do not seek treatment, and of those that do, only half of these persons will get “minimally adequate” treatment. Until now, the primary treatments for PSTD are psychological counseling and psychiatric medications.

Inflammation is the result of a delicate balance between inflammatory and anti-inflammatory responses, and the body constantly strives to maintain a state of “immune homeostasis”, immune balance.

As in most disease, chronic low-grade inflammation is a likely contributor to post traumatic stress syndrome. If individuals with PTSD better controlled the amount of inflammation produced by their bodies, their quality of life would improve, both emotionally and physically.

There is no cost to speak with Dr. Hellen. She can be reached at 1.302-265.3870 ET [USA] or contacted at: drhellen@drhellengreenblatt.info.

www.ncbi.nlm.nih.gov/pubmed/23806967
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Afghanistan, aggression, anger, anti-inflammatory, autoimmune, balance, C-reactive protein, chronic disease, combat, cytokines, depression, fat cells, Gulf War, healing, IL-6, immune homeostasis, immune system, infection, inflammation, Inflammatory Bowel Disease, inflammatory responses, injuries, Iraq, metabolic syndrome, military, Obesity, post-traumatic stress disorder, pro-inflammatory, PTSD, QOL, terrorist, veterans, visceral fat

Inflammation Is the Root Cause of Arthritis

Nearly every day people tell me that their joints are swollen and stiff, they hurt all over, and that they look and feel older than their chronological age. Most of these individuals have been diagnosed with rheumatoid arthritis.

Arthritis is a sign of a “boosted” immune system with excessive inflammation leading to joint damage. People report pain in areas such as their backs, fingers, hands, wrists, knees, and shoulders.

Rheumatoid arthritis typically affects the joints of the body. However sometimes even before joint symptoms appear, rheumatoid arthritis can involve other parts of the body including the lungs or eyes. Long-term inflammation of the lungs leads to scarring and shortness of breath, fatigue, weakness, and an on-going, chronic dry cough. If the pleura, the tissues around the lungs, become inflamed, fluid buildup may result in fever, pain when taking a breath, and difficulty in breathing.

Inflammation Is Essential for Our Survival:
Clinicians, and most lay people, focus on the harmful aspects of inflammation and try to stop the inflammatory response at all costs. Instead, all that is needed is to control the this immune response. The process of inflammation is normal, protective, and absolutely essential for our survival. Inflammation is the first step to healing after an injury or when the body is gathering its forces to stop an infection. Immune inflammation also helps the body destroy cancer cells before they grow and multiply.

When the body recognizes it has been injured or infected, the immune system releases antibodies and cytokines, smaller proteins that attract different types of immune cells into an area, to help eliminate and destroy threats to the body.

Once healing has started, the amount of inflammation that the body produces must be controlled. The genes that control inflammation have to be “turned off”, down-regulated, so that inflammatory responses are limited.

Arthritis is an Autoimmune Disorder:
Arthritis is one of many autoimmune disorders in which the body mistakenly produces autoantibodies, antibodies against its own tissues that attach to joint linings, and cartilage which acts as a shock absorber. The presence of autoantibodies may trigger immune cells to release inflammatory molecules that cause damage to the joints and other organ systems.

The Effect of Stress and Weight on Arthritis:
There are many factors that contribute to the discomfort experienced by individuals with joint issues. Two of these most recently investigated are: stress and weight.

Stress:
The body increases the amount of inflammation it produces when it is exposes to constant stress and the stress of pain. It becomes part of a vicious cycle. Stress causes inflammation, and inflammation leads to more stress. There is crosstalk between the nervous, hormonal, and immune systems. Changes in one system effects the other system.

Stressed individuals suffering from rheumatoid arthritis produce much higher levels of most cytokines than people without arthritis. Immunologically they respond differently to stress.

Weight Issues:
Overweight and obese patients with rheumatoid arthritis have more pain and respond less well to medication, as compared to normal weight patients. Obesity is an inflammatory disease during which fat cells, especially those concentrated around the inner organs, pump out large numbers of inflammatory molecules. Certain inflammatory proteins are found in high number in the abdominal fat tissue of overweight and obese individuals.

Importance of Immune Balance/Immune Homeostasis:
Immune inflammation is tightly regulated by the body. It consists of a) triggering and maintaining inflammatory responses, and b) producing immune messages that decrease and/or entirely stop the inflammation. Imbalances between the two phases of inflammation results in unchecked inflammation, loss of immune homeostasis, and may result in cell and tissues damage like that experienced in rheumatoid arthritis.

The key is to incorporate lifestyle changes to help the body maintain immune balance.

Help your body return to immune balance. Dr. Hellen may be contacted at: 302.265.3870 ET USA, or use the contact form. Thank you.

www.mayoclinic.org/diseases-conditions/arthritis/basics/definition/con-20034095
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ard.bmj.com/content/early/2014/05/12/annrheumdis-2013-205094
www.fasebj.org/content/27/12/4757

anti-inflammatory, antibodies, arthritis, autoimmune, balance, cytokines, exercise, fat cells, healing, immune homeostasis, immune system, immunoglobulins, infection, inflammation, inflammatory responses, injuries, joint pain, multiple sclerosis, Obesity, pain, pro-inflammatory

Obesity and the Inflammatory State

People who are heavy and are not physically active, are at greater risk for conditions such as: increased blood sugar, higher pressures on their artery walls (high blood pressure), increased rate and workload on the heart, stroke, joint problems, sleep disorders, difficulty breathing, and even certain types of cancer.

There are other posts on this blog relevant to the issue of being overweight or obese, but there is little question that most individuals would feel a lot better if they were only 5 or 10 pounds lighter.

When compared to leaner people, adipose tissue, the fat deposits of obese individuals, have higher numbers of, and larger, fat cells. These cells produce cytokines, immune factors, that are inflammatory in nature and trigger numerous inflammatory conditions including many mentioned above.

Adipose tissue has “immune-like” properties. For example, macrophages, white blood cells which alert the body to the presence of invaders, are found in high numbers in fat cell clusters. Additionally, obese individuals have been shown to have increased levels of proteins in the blood stream that stimulate inflammation. Overweight or obese people do not fight infections or heal as well as individuals at more appropriate weights.

The following hypothesis may have validity. The immune system may “see” components of adipose tissue as “foreign material” that must be eliminated from the body. If this scenario is correct, when the body “battles” adipose tissue an autoimmune response is triggered, a response in which the immune system destroys its own tissues, resulting in high levels of inflammation. My hypothesis is supported by the fact that obese individuals produce high levels of autoantibody, antibodies against their own tissues. Rather than resulting from inflammation, these autoantibodies may be the trigger for inflammation.

Muscle cells, like fat cells, secrete cytokines, molecules which help the body regulate inflammatory responses. In response to exercise, many different types of cytokines are produced by muscles and other cells. Cytokine measurements taken after a marathon demonstrated 100 fold increases of certain cytokines, whereas other cytokines were produced that typically dampen an inflammatory response.

The wide spectrum of immune factors that the body produces in response to physical activity helps the body maintain a steady state of inflammation, an immune balance that helps the body defend itself against infection and helps healing, but not so much that innocent by-stander tissues are damaged. In fact, studies have shown that individuals that are overweight, nevertheless may be healthy, if they are maintain a level of physical fitness.

The bodies of overweight and obese individuals are consistently exposed to self-generated, inappropriate levels of inflammation. Helping the body return to a healthy balance of immune responses, a state of homeostasis, will go a long ways towards changing their quality of life.

I would be pleased to hear from you if you are interested in changing your quality of life. I can be contacted at: drhellen@drhellengreenblatt.info or at: 302.265.3870 USA ET.

diabetes.diabetesjournals.org/content/56/6/1517.full
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anti-inflammatory, antibodies, autoimmune, balance, chronic disease, cytokines, fat cells, immune homeostasis, immune system, immunoglobulins, infection, inflammatory responses, Obesity, overweight, pro-inflammatory

Microbes, Gluten, Celiac Disease, Diabetes, and Inflammation

We humans exist in sea of microorganisms. According to the American Society for Microbiology, there are 10 fold the number of bacteria living in and on our bodies as cells that make up our bodies. Wherever our bodies are exposed to the outside world, for example our digestive tracts, skin, mouth, vagina, etc. we find specific varieties of bacteria and other organisms.

The totality of all the bacteria and other microorganisms that populate our bodies is called the microbiome. The microbiome is highly individualized, with the spectrum of bacteria differing from one person to another; much like an individual’s fingerprints. All people display wide variations in the kinds of bacteria that inhabit them. The types and numbers of bacteria in and on our bodies differ depending on our genetic makeup, our diet, and environmental factors.

Immune cells are found throughout the body where they are always on alert defending the body against infection. Inflammation is the primary way that the immune system controls infections and healing, but overactive immune responses can lead to debilitating inflammatory diseases such as atherosclerosis, diabetes, and bowel disorders.

There is considerable “cross-talk” between the microbiome and the immune cells. Microorganisms influence the responses of the immune system, and the immune system in turn affects the populations of the organisms that inhabit us. For example, evidence suggests that certain bacteria in the gut can decrease inflammation in the gut and decrease chronic disease. [Whether the organisms themselves are producing these molecules, or whether they are triggering immune cells to release anti-inflammatory compounds is not clear.]

Celiac Disease and Diabetes:
Individuals with celiac disease are highly sensitive to foods containing gluten, a protein found in barley, rye, and wheat. People with celiac disease have significant quality of life issues such as bloating, diarrhea, and/or constipation.

When the immune cells of celiacs see gluten, they mount an inflammatory response to try to eliminate the gluten from the intestines. The immune cells produce antibodies that attach to the inner surface of the gut and through inflammatory responses cause direct damage of the gut lining. Inflammatory responses against the body’s own tissues lead to autoimmune (against oneself) disease.

Diabetes is also the result of an autoimmune condition. Inflammatory immune cells destroy specialized cells in the pancreas that produce insulin, a hormone needed to control blood sugar.

Individuals with celiac disease have more than digestive issues, since they have almost 2.5 times a greater chance of developing diabetes than those without intestinal problems. Such conditions are associated with antibodies directed against the insulin-producing cells. When Individuals with celiac disease go on a strict gluten-free diet, they produce fewer anti-insulin-antibodies, suggesting that they are producing less of an inflammatory response.

Gluten intake changes the kinds of bacteria found in the gut. Diabetic-prone mice that eat regular mouse chow containing gluten are more likely to get diabetes than diabetic-prone mice on gluten-free chow. In addition, when the gut bacteria are analyzed, the diabetic-prone mice on gluten have the type of bacteria more often associated with inflammation, than the mice not on gluten. Thus, diet affects the responses of the immune cells and the microbiome.

As followers of this blog are aware, in the face of constantly changing external and internal challenges, the immune system of a healthy person makes adjustments to maintain immune balance, immune homeostasis.

One would expect that if inflammatory and autoimmune responses were better controlled by the body, that individuals with celiac disease and diabetes would experience a far better quality of life.

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anti-inflammatory, autoimmune, balance, C-reactive protein, celiac, chronic disease, Crohn's, cytokines, diabetes, gluten, gut, immune, immune homeostasis, immune system, immunoglobulins, infection, inflammation, Inflammatory Bowel Disease, inflammatory responses, insulin, microbes, microbiome, pro-inflammatory

Alcohol Abuse, Immune Balance, and Inflammation

Alcoholism is a condition in which individuals drink alcohol in excess despite the fact that their habit causes physical and mental health problems, and social, family, and/or job-related issues. Heavy alcohol consumption results in damage to many parts of the body including the brain, liver, digestive system, and joints. Alcoholics also suffer with dementia, memory loss, depression, emotional instability, and are at increased risk of cancer of the colon, liver, and esophagus.

Immune System Effects

Prolonged, heavy alcohol consumption negatively affects immune cells and their production of cytokines, immune messages. Alcoholics have significantly higher rates of bacterial and viral infections and when hospitalized remain hospitalized longer than those that do not abuse alcohol. Alcohol not only kills key immune cells, but excess amounts of alcohol results in an increased risk of autoimmune responses in which the body’s immune cells mistakenly attack the body’s own healthy cells as foreign.

The body constantly strives to maintain immune inflammatory homeostasis; to balance the amount of inflammation it produces to protect the body from infection. Imbalances of inflammatory responses, loss of immune homeostasis, result from excessive alcohol consumption. For example, white cells, immune cells, search out and destroy and remove pathogens from the lungs. After alcohol consumption, fewer immune cells respond to the call for “help”. Those cells that do enter the lungs are unable to kill microbes as effectively as cells from non-alcoholic animals.

The inefficient immune responses of alcoholics lead them to be more vulnerable to viral infections such as hepatitis C, influenza, and HIV and bacterial infections including tuberculosis and pneumonia. Especially after experiencing trauma, e.g., surgery, alcoholics are more likely than non-alcoholics to get pneumonia.

A mouse study is one of many that demonstrates the decreased ability of alcohol-imbibing animals to fend off infection. Sixty percent of mice that were exposed to the flu after imbibing alcohol for two months died of the flu as compared to a 15% mortality rate of mice that had not been drinking alcohol prior to exposure.

Hormone Effects:

Cortisol, the “stress-response hormone” affects nervous, immune, circulatory, and metabolic systems of the body. After surgery, chronic alcoholics have higher cortisol levels compared to non-alcoholic patients. The increased inflammation that accompanies stress also leads to higher levels of depression, other addictions, and mood disorders.

Other hormones effected by alcohol consumption are those a)that may interfere with the a women’s menstrual cycle, b) the ability for men and women to enjoy sex, or c) control blood sugar.

Nervous System Complications:

Alcohol is neuro-toxic to brain cells interfering with the development, repair, and communication of nerve cells. Consumption of large amounts of alcohol leads to shrinkage of white matter in the brain, adding to depression, confusion, short-term memory loss, “fuzzy” thinking, and a greater risk of getting dementia. Alcohol also directly affects the nervous system in other ways, causing numbness, tingling, and pain in hands and feet.

Additionally, too great a consumption of alcohol, especially over a long period of time, results in problems with absorption of nutrients, the lack of which can become so severe that certain forms of dementia are triggered.

Bone Loss

Alcohol damages osteoblasts, the cells needed to grow and maintain bone. Destruction of osteoblasts results in decreased bone mass and susceptibility to fractures and other orthopedic problems. When a bone fracture occurs, immune cells rush in to start the healing process. They release immune signals, cytokines that start the inflammatory process that recruits more cells into the area. However, when there is too much inflammation, healing, and bone growth is delayed with the result that bones become brittle, thin, or misshapen.

Vitamin B12, vitamin D, phosphate, and magnesium are needed to grow bone. Excessive intake of alcohol is associated with low or subnormal levels of these elements, further inhibiting the growth of and repair of bones.

Skin and Injuries

The cells in the skin help defend the body from pathogens, and keep the skin healthy, youthful, and supple. The immune cells in the skin interact with the microbes that live on the surface. Although the numbers of bacteria on healthy skin stays constant, the types of bacteria that exist change depending on environmental and immune interactions

Heavy use of alcohol significantly slows the movement of immune cells, upsetting the balance, the homeostasis of the skin. Alcoholics experience a greater number of severe skin infections than individuals that drink responsibly.

Almost half of all patients coming into an emergency room with an injury, trauma cases, have high levels of alcohol in their blood. Drunken patients have more severe symptoms, and take longer to recover. They also have higher rates of death as compared to non-intoxicated patients.

Because these patients have imbalances of inflammatory response, it takes them longer to heal, and wounds may become more severe, more quickly. Alcohol damage to the skin continues even after they stop drinking. Alcoholics experience longer hospital stays, especially if they are patients in an intensive care unit.

In a study of two groups of animals with burns, 50% of the animals that had not consumed alcohol survived, compared to 20% of the alcohol-consuming animals.

Summary:

Although not discussed in this post, moderate intake of alcohol has a beneficial effect on inflammatory markers. However, heavy drinking results in uncontrolled amounts of inflammation leading to a myriad of health consequences. Controlling the amount of inflammation the body produces will make a major difference in the quality of life of an individual.

Some steps abusers of alcohol can take to help their body modulate inflammation are:

Limit the number of drinks consumed*
Exercise 30 minutes/day for 5 days a week (150 minute minimum/week)
Have smaller food portion sizes.
Consume more fruits and vegetables.

*It is recommended that women limit their alcohol intake to one drink** per day, and men to two drinks/day. [Women absorb and metabolize alcohol differently from men and are more susceptible to alcohol-related organ damage and trauma than men.]

**One drink is defined as 1.5 fluid ounces of 80-proof distilled spirits, 12 ounces of beer, or 5 ounces of wine (a pinot noir wine glass about 1/4 full).

Dr. Greenblatt looks forward to assisting you in reaching your goals: http://drhellengreenblatt.info/contact-dr-hellen or 1.302-265.3870 [USA, ET].

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alcoholism, anti-inflammatory, autoimmune, balance, cancer, chronic disease, cytokines, depression, exercise, gut, healing, immune homeostasis, immune system, infection, inflammation, inflammatory responses, injuries, joint pain, microbes, pro-inflammatory