Functional Medicine for Chronic Inflammation

What is chronic inflammation?

Inflammation is a normal part of the body's defense against injury or infection, and in this way it helps you. It protects your tissues and helps them heal. But inflammation can cause harm when it happens in healthy tissues or lasts too long.^{1, 2}

Acute (short-term) inflammation is the kind most people know. When you get a cut, the skin swells, turns red and hurts. These are signs that inflammation is working to stop infection, and this usually goes away in a few hours. A normal inflammatory response turns on while a threat is present and settles once the threat has passed.^{1, 2, 4}

Chronic (long-term) inflammation is inflammation that does not settle. It can last for months or years. When inflammation lasts too long, it can damage healthy tissues and may add to further tissue injury and disease.^{1, 2}

Chronic inflammation is a process in the body, not one single disease, and many different conditions can cause it. It is most often caused by certain autoimmune disorders, in which the immune system attacks healthy cells and tissues by mistake. It can also happen when tissues are injured or irritated again and again, for example by smoking or chemicals in the environment.^{2, 3, 4, 5}

Researchers also describe a low-grade (low-level) type of chronic inflammation that is systemic, which means it affects the whole body rather than one spot. Certain social, environmental and lifestyle factors can promote it. It is long-lasting, often increases with age, and over time can damage tissues and organs.⁴

Research links chronic inflammation to many long-term diseases. These include heart disease, high blood pressure and type 2 diabetes. They also include autoimmune diseases such as rheumatoid arthritis, and inflammatory bowel disease. Lung diseases such as COPD and asthma, depression, Parkinson's disease and some cancers are linked, too.^{1, 4}

The evidence that inflammation plays a part in how a disease starts or gets worse is strongest for three conditions: metabolic syndrome, type 2 diabetes, and heart and blood vessel disease. Metabolic syndrome is a group of problems that includes high blood pressure, high blood sugar and unhealthy blood fat levels.⁴

Signs of chronic inflammation

The classic signs of inflammation are redness, swelling, heat and pain. But other illnesses can cause the same symptoms.⁵

Inflammation inside your body's cells or tissues may make you feel hot. It may make a part of your body work less well. Or you may have no outward symptoms at all.¹

Researchers note that inflammation can also change how you feel and act. These changes, sometimes called "sickness behaviors," include sadness, tiredness, eating less, changes in sleep and pulling away from other people.⁴

Some people with long-term conditions that involve inflammation develop anemia of chronic disease. Anemia means the body does not have enough healthy red blood cells. This type is often mild, and you may not notice any symptoms.⁶

Chronic inflammation can come from many different conditions, so its signs depend on the condition causing it. Your doctor may test for inflammation if you have symptoms such as:³

• Headaches³
• Fever you can't explain³
• Weight loss you can't explain³
• Joint stiffness³
• Neck or shoulder pain³
• Loss of appetite³
• Anemia (not having enough healthy red blood cells)^{3, 6}

How chronic inflammation is found and treated

Two blood tests that can show inflammation are the C-reactive protein (CRP) test and the erythrocyte sedimentation rate (ESR). They are commonly done together. For both tests, a health care professional takes a blood sample from a vein in your arm.^{2, 3}

CRP is a protein that your liver makes in response to inflammation. In general, healthy people have very low amounts of CRP in their blood. CRP levels rise and fall depending on how much inflammation is in your body.²

The ESR measures how quickly red blood cells settle to the bottom of a tall, thin test tube. Inflammation makes red blood cells stick together in clumps. The clumps are heavier than single cells, so they sink faster. A faster rate means more inflammation.³

These tests can show how much inflammation you have, but not what is causing it or where it is. An ESR alone cannot diagnose which condition is causing the inflammation. It is also possible to have such a condition and still have a normal ESR. To make a diagnosis, your doctor looks at the results along with other tests, your symptoms and your medical history.^{2, 3}

Other things can affect the results, too. Higher CRP levels can be linked to trouble sleeping (insomnia), depression, hormone therapy for menopause and obesity. Pregnancy, the menstrual cycle, aging, obesity, drinking alcohol regularly and exercise can affect ESR results. An ESR result that is not normal doesn't always mean you have a condition that needs treatment.^{2, 3}

A related test, called high-sensitivity CRP (hs-CRP), measures very tiny increases in CRP. It is used to estimate your risk of heart disease.²

There is no standard test yet for the low-level, long-lasting inflammation that researchers link to many diseases. Work on better ways to measure it is promising, but it is still in its early stages.⁴

For autoimmune diseases, the treatment depends on the disease. In most cases, the goal is to slow down the immune system and ease swelling, redness and pain from inflammation. Your doctor may prescribe corticosteroids or other medicines. Anemia of chronic disease, in turn, may get better when the disease causing it is treated.^{5, 6}

Your doctor may also use CRP and ESR tests to keep track of a condition and its treatment over time. If your CRP level falls, it's a sign that your treatment for inflammation is working or that you're healing on your own.^{2, 3}

How our care fits alongside your primary care doctor

Avicenna Functional Medicine does not replace your primary care doctor or the treatment they prescribe. Our role is to add to your care, not to take its place.

In a functional medicine visit, we look at factors that may contribute, such as gut health, environmental exposures and immune regulation, alongside the care you already receive. We also look at diet, physical activity, sleep, stress, body weight and smoking. Researchers have linked each of these to long-lasting, low-level inflammation.^{1, 2, 4}

Research on these links is still developing. Some, such as the role of the gut, are still ideas being tested, and few studies have shown that changing these factors lowers chronic inflammation.⁴

Any testing we suggest looks for possible contributors. It does not diagnose a condition or replace the tests your doctor uses to find the cause of inflammation.^{2, 3}

Please do not stop or change any prescribed medication without talking to the doctor who prescribed it. Tell your doctor about any medicines or supplements you take, because some can affect the results of inflammation tests.^{2, 3}

What to expect at Avicenna

All visits are by telehealth, for patients located in Florida and Texas. We are a cash-pay practice, and we accept HSA and FSA. Care usually follows these steps:

• A free, 30-minute discovery call to talk about your health and whether our approach is a good fit for you
• A full intake visit with our health coach, under clinician supervision, covering your history, symptoms, current treatment and goals
• Testing chosen for you, where it is likely to be useful
• A personalized plan, with follow-up visits to review how you are doing and adjust the plan as needed

When to get urgent care

Talk with your primary care doctor about symptoms such as a fever or weight loss you can't explain. Your doctor may order tests to check for a condition that causes inflammation. If you have a long-term condition, also contact your doctor if you develop symptoms of anemia, such as feeling weak or tired, headache, paleness or shortness of breath. Anemia may be the first symptom of a serious illness, so finding its cause is very important.^{3, 6}

Get medical care right away if you think you might have sepsis, or if an infection is not getting better or is getting worse. Sepsis is the body's overactive and extreme response to an infection, and it is a life-threatening medical emergency. People with long-term conditions, such as diabetes, lung disease, cancer and kidney disease, are more likely to develop it. Signs can include fast breathing and heart rate, shortness of breath, confusion, extreme pain or discomfort, fever, shivering or feeling very cold, and clammy or sweaty skin.⁷

Telehealth visits with our team are not for emergencies. Call 911 right away if you have warning signs of a medical emergency, such as:⁸

• Chest pain or pressure that lasts two minutes or more⁸
• Trouble breathing or shortness of breath⁸
• Sudden confusion, unusual behavior or trouble waking up⁸
• Fainting or passing out⁸
• Sudden dizziness, weakness or changes in vision⁸
• Being unable to speak⁸
• Severe belly pain, or sudden severe pain anywhere in the body⁸
• Coughing up or vomiting blood⁸
• Thoughts of suicide or of harming someone else (you can also call or text 988)⁸