What is inflammation?
Inflammation is part of your body’s defence system. It happens when your body’s immune system fights off anything that could cause you internal harm – ‘invaders’ like viruses and bacteria, poisons, injuries, or bacteria – or when there is damage to the body – when you stub your toe or sprain your ankle. [1][2]
Symptoms of Acute Inflammation
▢ Redness at the site of the injury/invader
▢ Swelling and warmth at the site of injury/invader
▢ Pain or stiffness at the site of injury/invader
Acute inflammation can happen over a short period of time, like hours or days. This happens when, for example, you cut yourself, stub your toe, or you have a cold. The immune response focuses specifically on the area that is injured, sending antibodies (produced in the white blood cells) to fight and kill the invader. Once healing has happened, the inflammation should go away.
If inflammation lasts longer than 6 weeks, it becomes chronic inflammation. [3][4]
Chronic Inflammation
Chronic inflammation is inflammation that lasts months or years after the threat that triggered the immune response is gone. For example, some bacteria or viruses can live inside tissues, evading the immune response; or exposure to chemicals over time that continuously irritate the lungs but the body cannot break them down or get rid of them.
Chronic inflammation may not be obvious because it is happening internally often at sites with no nerve endings (like your organs) but its harmful effects are associated with serious long-term, debilitating or fatal health conditions like Type-2 diabetes, cancer, and autoimmune diseases.[1] [2] [3]
Chronic inflammation may cause flu-like symptoms such as:
▢ Fever and chills
▢ Fatigue and/or loss of energy
▢ Headaches
▢ Poor appetite
▢ Muscle stiffness
Risk factors for chronic inflammation include:
Age
Age
Getting older is correlated with increasing levels of chronic inflammation, due to the increase in some inflammatory molecules.
Obesity
Obesity
Fat (adipose) tissue is an organ in the endocrine system that secretes the hormone estrogen, a powerful anti-inflammatory chemical. The adipose tissue in obese individuals has shifted to secrete more inflammation-causing molecules than anti-inflammatory ones. This shift is correlated with chronic inflammation overall, but also with insulin resistance seen in Type-2 diabetes. [6][7][8] [9]
Diet & Nutrition
Diet & Nutrition
Eating saturated fat, trans-fats, and refined sugar is associated with producing more inflammation-causing molecules.
Smoking
Smoking
Cigarette smoking is associated with lower levels of anti-inflammatory molecules, increasing inflammation.
Stress
Stress
Both physical and emotional stress is associated with an increase in the release of inflammatory molecules. [6]
Women account for
0%of patients diagnosed with autoimmune disease
Inflammation & perimenopause
Recent scientific studies have produced more, compelling evidence that the decline of estrogen during perimenopause eventually drives a full body system inflammatory state. [7] [10] This occurs because one type of estrogen receptor (found in most cells) regulates a key part of the immune response – small structures called inflammasomes. [11] [12] [13]Inflammasomes are chemicals that play a major role in sensing inflammatory signals from the rest of the body, and triggering the immune response.
Changing estrogen levels impact the activation of the body’s normal immune response. When estrogen levels are adequate, they cause an anti-inflammatory response, but when estrogen levels decrease, the anti-inflammatory response is slowed and chronic inflammation sets in. [14] [15]
Chronic systemic inflammation directly impacts many perimenopausal symptoms.
For example, inflammation is directly connected to:
- joint and body pain
- cardiovascular issues
- brain fog
- memory problems
- abdominal issues.
Diabetes & inflammation
Diabetes is a metabolic disorder involving glucose (sugar) tolerance. If the body cannot effectively manage sugar levels , they can increase to toxic levels. This happens because insulin, the hormone that manages blood sugar levels in the pancreas, is at low levels. Chronic high blood sugar (hyperglycemia) can cause damage or complete failure to kidneys, retina, nerves, heart and blood vessels. In fact, the risk of cardiovascular disease is significantly elevated in patients with diabetes, and typically occurs one to two decades earlier in people with diabetes. [22]
There are two main types of diabetes: Type 1 and Type 2.
Type 1
Type 1 Diabetes
Type 1 diabetes happens when there is a total lack of insulin because the insulin-producing cells in the pancreas (beta cells) have been destroyed by an immune response.
Type 1 diabetes is often genetic, and can appear in newborns or remain undiagnosed for years in adults until more than 90% of the beta cells have been lost.
Type 2
Type 2 Diabetes
Type 2 diabetes is much more common and includes 90-95% of all cases. The main problem in Type 2 diabetes is that the body’s cells become resistant to insulin, causing insulin deficiencies.
Type 2 diabetes has a number of risk factors, including genetic predisposition, being overweight or obese, having a poor diet, insufficient exercise and smoking.
Recent research in diabetes and immunology shows that, regardless of the types of risks a person may have, inflammation is the principal and common cause of both types of diabetes. [22]
- The main theory is that in Type 1 diabetes, the beta cells located in the pancreas become inflamed, a condition called insulitis. This inflammation ends up damaging and destroying the insulin-producing beta cells.
- Inflammation is also present in Type 2 diabetes. The initial progression of Type 2 starts with insulin resistance and the beta cells begin to make extra insulin. At some point, however, insulitis begins, the beta cells are destroyed and there is insufficient insulin for the body to manage its sugar levels. Note that abnormal insulin sensitivity can start up to 15 years before Type 2 diabetes is diagnosed.
[6] [22] [23][24] [26]
Obesity & Inflammation
Obesity is the most common cause of insulin resistance (IR), which is the underlying cause of type 2 diabetes. [18] Fat, or adipose, tissue accumulates under the skin (subcutaneous tissue). As this continues, it will start to collect in tissues surrounding the liver, pancreas, muscles, perivascular and pericardium (visceral tissues). Fat accumulation around the liver, know as “Fatty Liver”, directly precedes having type 2 diabetes.
Central or visceral fat tissues appear to be the major source of inflammatory agents in type 2 diabetes. At the same time, adipose tissue is a target for pro-inflammatory cells (macrophages and immune cells (B cells and T cells) that trigger local and systemic chronic low-grade inflammation. The accumulation and activation of pro-inflammatory macrophages in metabolic tissues is the ultimate driver of this chronic low-grade inflammation. While the macrophage is the major cell type involved, other types of immune cells also participate in these inflammatory processes. [7][22][25]
Fat Tissue (Adipose Tissue)
There are two main types of fat, brown adipose tissue (BAT) and white adipose tissue (WAT). There are similarities between these types of fat in that they both produce and secrete hormones (including estrogen), and immune factors (including macrophages and T lymphocytes that are both important elements of the immune system).
White Adipose Tissue
Metabolic Function:
- Energy storage
- Single large lipid droplet
- A few mitochondria
Brown Adipose Tissue
Metabolic Function:
- Release heat for thermoregulation
- Multiple smaller lipid droplets
- Many mitochondria
Cancer & chronic inflammation
Cancer is the result of changes to a cell’s DNA. Over time, chronic inflammation can damage DNA inside cells and this damage leads to cancer. The location of the cancer can usually be associated with the location of the chronic inflammation. For example, individuals with chronic inflammatory bowel diseases such as Crohn’s disease have an increased risk of colon cancer. [16]
A specific type of protein inside cells, called a transcription factor, is a central coordinator of immune responses. Recent research has shown that this same transcription factor plays a critical role in cancer development and progression. This protein provides a clear link between inflammation and cancer because it controls the ability of pre-cancerous and cancerous cells to resist being killed by an immune response. [17] [18] As a result, risk factors for chronic inflammation, including age, obesity, diet and nutrition, smoking, stress, and insomnia are also risk factors for developing cancers. [17] [18]
Carcinogens
A carcinogen is a substance that can cause cancer in an individual if they have been exposed to it. Some carcinogens directly change a cell’s DNA, while others cause changes that increase the chances that DNA will be damaged, such as speeding up the rate of cell division. [19]
Carcinogens do not always cause cancer but they do increase a person’s risk of getting one or more types of cancer.
Common carcinogens include asbestos, radiation, tobacco, and alcohol. [19] [20][21]
Autoimmune diseases & inflammation
Autoimmune disease occurs when the body’s natural defence system, the immune system, attacks the body’s own healthy tissue. [27]These disorders can cause a whole-body or systemic immune reaction by attacking multiple organs, or they may only attack one specific organ, such as the skin. [28] Unfortunately for sufferers, the exact way that autoimmune conditions come on or are resolved is not well understood.
Approximately 80% of all patients diagnosed with autoimmune diseases are women.
Many autoimmune disorders tend to affect women during periods of major physical stress, such as pregnancy, or during a great hormonal change such as perimenopause linked to female hormones modulating the immune system. [28] [30]
Common autoimmune disorders include:
Sjogren’s Syndrome
Sjogren’s Syndrome
Sjogren’s syndrome is an autoimmune disease characterized by chronic dry eyes and mouth due to the immune system targeting its own salivary and tear glands. This causes difficulty swallowing, dry mouth and dry, red eyes.
Sjogren’s syndrome affects women in a 9:1 ratio relative to men.
Lupus
Systemic Lupus Erythematosus SLE
Systemic Lupus Erythematosus SLE, commonly referred to as lupus, is an autoimmune disease in which the body attacks healthy tissues affecting the skin, joints, kidneys, and the brain.
It is seen to affect women in a 7:1 ratio relative to men.
Rheumatoid Arthritis
Rheumatoid Arthritis
Rheumatoid arthritis is a chronic inflammatory joint autoimmune disease that can immobilize fingers, wrists, feet, and ankle joints.
It affects women in a 3:1 ratio relative to men. [28][29]
Type 1 Diabetes
Type 1 Diabetes
Type 1 Diabetes is considered to be an autoimmune disorder, as the immune system mistakenly attacks beta cells, stopping them from making insulin.
Hormone Therapy and Autoimmune Disorders
Estrogen plays a significant role in the immune system, and as estrogen levels drop during perimenopause, inflammation – a key part of the body’s immune response – increases. Research supports the use of menopausal hormone therapy (MHT) for some autoimmune disorders, particularly rheumatoid arthritis and lupus. [30] However the use of MHT to manage lupus is not always appropriate as it can lead to mild -moderate lupus flare-ups. [31][32][33]
MHT has been linked to developing Sjögren’s syndrome, although the exact mechanisms are poorly understood. [34]
Recent scientific studies have produced more, compelling evidence that the decline of estrogen during perimenopause eventually drives a full body system inflammatory state. [7] [10] This occurs because one type of estrogen receptor (found in most cells) regulates a key part of the immune response – small structures called inflammasomes. [11] [12] [13] Inflammasomes are chemicals that play a major role in sensing inflammatory signals from the rest of the body, and triggering the immune response.
Changing estrogen levels impact the activation of the body’s normal immune response. When estrogen levels are adequate, they cause an anti-inflammatory response, but when estrogen levels decrease, the anti-inflammatory response is slowed and chronic inflammation sets in. [14] [15]
Chronic systemic inflammation directly impacts many perimenopausal symptoms. For example, inflammation is directly connected to joint and body pain, cardiovascular issues, brain fog, memory problems, and abdominal issues. [11] [12]
Cancer is the result of changes to a cell’s DNA. Over time, chronic inflammation can damage DNA inside cells and this damage leads to cancer. The location of the cancer can usually be associated with the location of the chronic inflammation. For example, individuals with chronic inflammatory bowel diseases such as Crohn’s disease have an increased risk of colon cancer. [16]
A specific type of protein inside cells, called a transcription factor, is a central coordinator of immune responses. Recent research has shown that this same transcription factor plays a critical role in cancer development and progression. This protein provides a clear link between inflammation and cancer because it controls the ability of pre-cancerous and cancerous cells to resist being killed by an immune response. [17] [18] As a result, risk factors for chronic inflammation, including age, obesity, diet and nutrition, smoking, stress, and insomnia are also risk factors for developing cancers. [17] [18]
A carcinogen is a substance that can cause cancer in an individual if they have been exposed to it. Some carcinogens directly change a cell’s DNA, while others cause changes that increase the chances that DNA will be damaged, such as speeding up the rate of cell division. [19]
Carcinogens do not always cause cancer but they do increase a person’s risk of getting one or more types of cancer. Common carcinogens include asbestos, radiation, tobacco, and alcohol. [19] [20][21]
Diabetes is a metabolic disorder involving glucose (sugar) tolerance. If the body cannot effectively manage sugar levels , they can increase to toxic levels. This happens because insulin, the hormone that manages blood sugar levels in the pancreas, is at low levels. Chronic high blood sugar (hyperglycemia) can cause damage or complete failure to kidneys, retina, nerves, heart and blood vessels. In fact, the risk of cardiovascular disease is significantly elevated in patients with diabetes, and typically occurs one to two decades earlier in people with diabetes. [22]
There are two main types of diabetes: Type 1 and Type 2.
- Type 1 diabetes happens when there is a total lack of insulin because the insulin-producing cells in the pancreas (beta cells) have been destroyed by an immune response. Type 1 diabetes is often genetic, and can appear in newborns or remain undiagnosed for years in adults until more than 90% of the beta cells have been lost.
- Type 2 diabetes is much more common and includes 90-95% of all cases. The main problem in Type 2 diabetes is that the body’s cells become resistant to insulin, causing insulin deficiencies. Type 2 diabetes has a number of risk factors, including genetic predisposition, being overweight or obese, having a poor diet, insufficient exercise and smoking.
Recent research in diabetes and immunology shows that, regardless of the types of risks a person may have, inflammation is the principal and common cause of both types of diabetes. [22]
The main theory is that in Type 1 diabetes, the beta cells located in the pancreas become inflamed, a condition called insulitis. This inflammation ends up damaging and destroying the insulin-producing beta cells.
Inflammation is also present in Type 2 diabetes. The initial progression of Type 2 starts with insulin resistance and the beta cells begin to make extra insulin. At some point, however, insulitis begins, the beta cells are destroyed and there is insufficient insulin for the body to manage its sugar levels. Note that abnormal insulin sensitivity can start up to 15 years before Type 2 diabetes is diagnosed. [6] [22] [23][24] [26]
Obesity is the most common cause of insulin resistance (IR), which is the underlying cause of type 2 diabetes. [18] Too much food and too little physical activity leads to fat, or adipose, tissue accumulating under the skin (subcutaneous tissue). If fat accumulation continues, it will start to collect in tissues surrounding the liver, pancreas, muscles, perivascular and pericardium (visceral tissues). Fat accumulation around the liver, know as “Fatty Liver”, directly precedes having type 2 diabetes.
Central or visceral fat tissues appear to be the major source of inflammatory agents in type 2 diabetes. At the same time, adipose tissue is a target for pro-inflammatory cells (macrophages and immune cells (B cells and T cells) that trigger local and systemic chronic low-grade inflammation. The accumulation and activation of pro-inflammatory macrophages in metabolic tissues is the ultimate driver of this chronic low-grade inflammation. While the macrophage is the major cell type involved, other types of immune cells also participate in these inflammatory processes. [7][22][25]
Autoimmune disease occurs when the body’s natural defence system, the immune system, attacks the body’s own healthy tissue. [27]These disorders can cause a whole-body or systemic immune reaction by attacking multiple organs, or they may only attack one specific organ, such as the skin. [28] Unfortunately for sufferers, the exact way that autoimmune conditions come on or are resolved is not well understood.
Approximately 80% of all patients diagnosed with autoimmune diseases are women.
Many autoimmune disorders tend to affect women during periods of major physical stress, such as pregnancy, or during a great hormonal change such as perimenopause linked to female hormones modulating the immune system. [28] [30]
Common autoimmune disorders include:
- Sjogren’s syndrome, an autoimmune disease characterized by chronic dry eyes and mouth due to the immune system targeting its own salivary and tear glands, causing difficulty swallowing, dry mouth as well as dry, red eyes. Sjogren’s syndrome affects women in a 9:1 ratio relative to men.
- Systemic Lupus Erythematosus SLE, an autoimmune disease in which the body attacks healthy tissues affecting the skin, joints, kidneys, and the brain, are seen to affect women in a 7:1 ratio.
- Rheumatoid arthritis, a chronic inflammatory joint autoimmune disease that can immobilize fingers, wrists, feet, and ankle joints, affects women in a 3:1 ratio [28][29]
- Type 1 Diabetes is considered to be an autoimmune disorder, as the immune system mistakenly attacks beta cells, stopping them from making insulin.
Hormone Therapy and Autoimmune Disorders
Estrogen plays a significant role in the immune system, and as estrogen levels drop during perimenopause, inflammation – a key part of the body’s immune response – increases. Research supports the use of menopausal hormone therapy (MHT) for some autoimmune disorders, particularly rheumatoid arthritis and lupus. [30] However the use of MHT to manage lupus is not always appropriate as it can lead to mild -moderate lupus flare-ups. [31][32][33]
MHT has been linked to developing Sjögren’s syndrome, although the exact mechanisms are poorly understood. [34]
Adjust Your Nutrition
Many plant based foods, especially brightly coloured ones, are rich in anti-inflammatory antioxidants. Excellent choices include: broccoli, cauliflower, carrots, leafy greens, berries, apples, beets, and peppers.
Avoid Processed Foods
These foods, especially processed sugar and simple carbohydrates, increase inflammation.
Eat Healthy Fats
Anti-inflammatory omega-3 fatty acids come from sources such as oily fish such as tuna, salmon, and sardines; flaxseeds and walnuts; and free-range chicken eggs.
Use Anti-Inflammatory Spices
Turmeric, an Indian spice used in curries, has demonstrated anti-inflammatory properties. Other helpful anti-inflammatory spices include ginger, garlic and cayenne
Manage Stress
Practice activities that are calming and soothing, such as yoga, reading, meditation, listening to music, gardening or walking outdoors. These are shown to lower inflammation markers in the bloodstream.
Practice Aerobic Exercise
Take part in regular aerobic exercise, which directly reduces inflammation, and also helps manage stress. [10]
Build Community
Having a supportive community around you will increase the chances of success with your lifestyle changes through improved sense of belonging and shared goal setting.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter NSAIDs, like aspirin, ibuprofen (Advil), and naproxen (Aleve), effectively reduce inflammation and pain in the short term. These should not be used regularly for treatment because they can cause other problems including kidney disease.
RICE (Rest, Ice, Compression, Elevation)
RICE (Rest, Ice, Compression, Elevation)
If inflammation is caused from an accident, like a sprain, it can be treated with RICE: rest; ice; compression; elevation
How do you treat chronic inflammation?
Chronic inflammation is not a healthy or normal reaction, and treatment options should be discussed with your healthcare provider to come up with a safe and healthy plan of action.
Systemic inflammation is hard to diagnose directly, although a new test, the neutrophil-to-lymphocyte ratio (NLR) blood test, is a promising sign (or biomarker) for finding systemic inflammation. [35] It is calculated as a ratio between the neutrophil and lymphocyte counts measured in blood. This blood test must be ordered by a physician. Neutrophils are the main cells that trigger a systemic inflammatory response (SIRS).
Common options your healthcare provider may prescribe for treating chronic inflammation include:
Steroids
Steroids
Corticosteroids are a class of hormones that are known to decrease inflammation and lower immune system responses. This is helpful for chronic inflammation, however the use of corticosteroids can lead to other problems such as high blood pressure and osteoporosis.
Nutritional Supplements
Nutritional Supplements
Some supplements, including zinc, fish oil and lipoic acid (found in red meat, organ meats, broccoli, tomatoes, spinach, and brussels sprouts) are thought to reduce inflammation. Research is needed to determine the exact impact of these supplements on human health (and others that may be on the market). Always talk to your healthcare provider before using any supplements, as they can interfere with other medications you may be taking.
Lifestyle Changes
Lifestyle Changes
Weight loss, dietary improvements, quitting smoking and drinking alcohol, and increasing physical activity are all associated with reducing chronic inflammation. [36]
The Science
The Immune System
Your body is constantly working to protect you from external pathogens like bacteria and viruses. To do this, your body mounts an immune response that can come via several different pathways. Your immune response can be either innate (that you were born with), or adaptive or acquired (immunity following exposure to the pathogen).
Innate
This is the immune system you were born with.
It includes:
- Physical barriers (like your skin)
- Chemical barriers (like tears)
- Cellular barriers (like general cellular immune responses that identify and destroy any substance that is a potential pathogen)
Adaptive/Acquired
This is immunity developed during your lifetime in response to a specific pathogen.
It includes:
- B lymphocytes (or B cells)
These produce antibodies specific to new antigens they encounter, as well as memory cells to detect the specific pathogen again in the future- Memory cells survive for long periods of time (decades or in some cases, your whole life)
- T lymphocytes (or T cells)
When a pathogen enters a cell, these notify B cells to make an antibody, and also activate a specialized type of T cell called a killer T cell- Killer T cells destroy any cells invaded by pathogens, and also target cancer cells
Adaptive immunity can be active or passive.
- Active immunity happens when your own body’s B cells generate the antibodies needed to identify the pathogen in the future. This can happen either when you get sick naturally and make antibodies, or when you receive a vaccine containing the pathogen, which then triggers your immune system to make antibodies.
- Passive immunity happens when you receive the antibodies from another source. This can be either through your mother’s breast milk when you were nursing, or through the injection of existing antibodies from a different source as in a vaccine. [9]
White Blood Cells
White Blood Cells
- Macrophage: surrounds and kills bacteria, viruses, removes dead cells, and stimulates the action of other immune system cells
- T lymphocytes / (T) cells: directly attack and kill infected cells and tumor cells. These originate in the bone marrow and mature in the thymus gland, part of the endocrine system.
- B lymphocytes / (B) cells: make antibodies and memory cells.
- Neutrophils: destroy the bacteria and viruses by ingesting them and releasing enzymes that kill them. Also boost the response of other immune cells
- Plasma cells: develop from activated B cells, and make specific antibodies.
Proteins
Proteins
- Antibodies: target viruses, bacteria and other foreign invaders
- Cytokines: can stimulate or slow down the immune system
- Enzymes: help speed of chemical reactions in our bodies
- Transcription factors: regulate a cell’s fate – growth and death.
Multiprotein Complexes
Multiprotein Complexes
- Inflammasomes: detect stimuli and activate inflammatory responses
Growth Factors
Growth Factors
- Growth factors: usually a protein or steroid hormone. Affect the growth of cells, help with wound healing.
Invaders (Antigens)
Foreign Invaders (Antigens)
- Antigens: any type of foreign invader. Stimulate the immune system.
Acute inflammation is the body’s way of trying to isolate and eliminate the ‘threat’. When your immune system identifies an ‘invader’ in your body, your white blood cells (one part of your immune system) start working to protect you. The molecules made by your white blood cells (such as antibodies and special proteins) enter into your bloodstream and travel to the site of the invader (which can be in your blood or in your body tissues and organs). These antibodies recognize the invaders and stick to their surface, triggering the invader to self-destruct or lose function.
This movement of antibodies and proteins increases the blood flowing to the site of the injury or infection, causing redness, warmth and swelling. The whole process (the extra blood flow and the swelling) can push against nerves and cause pain in the area. 
Chronic inflammation is seen when longer-lived white blood cells, like macrophages, replace short-lived neutrophils seen in an acute inflammatory response. Thus the hallmarks of chronic inflammation are the infiltration of the primary inflammatory cells such as macrophages, lymphocytes, and plasma cells in the tissue site, producing inflammatory cytokines, growth factors, enzymes and hence contributing to the progression of tissue damage.
False – Estrogen plays a significant role in the immune system, and as estrogen levels drop during perimenopause, inflammation – a key part of the body’s immune response – increases.
True – research has shown that people who are obese or overweight have different levels of inflammatory cytokines compared to non-obese people. However, changes to your diet, restricting calories and getting more exercise is proven to reduce the inflammation associated with obesity.
Not really.
Supplements like vitamins can be good for you if you lack vitamins and minerals in your diet. Otherwise, there is no proof that supplements of any type help or improve the actions of the immune system
False – high quality sleep is necessary to support your body and the actions of the immune system.
References
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[4] Hannoodee S, Nasuruddin DN. Acute Inflammatory Response. 2024 Jun 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32310543.
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