Title: The Functional Approach to Inflammatory Conditions

Key words: inflammatory disorders, acute inflammation, injury, mediators, chronic inflammation, immune cells, corticosteroids, NSAIDs, side-effects, HPA-axis, triggers, mediators

Date: Oct 2000

Category: 16. Food intolerance/Allergy

Type: Article

Author: DJE Candlish

The Functional Approach to Inflammatory Conditions

Inflammatory disorders are a rapidly growing healthcare problem in the developed world. Recent research has greatly increased our understanding of inflammation and the inflammatory disorders. Acute inflammation is the body's normal response to injury. An injury, in this context, may be physical, as in a wound or trauma, or chemical, as in the case of an infectious agent. In response to the injury the body responds by:

· increasing blood flow to the affected area

· increasing capillary permeability to allow white blood cells better access to the injury site

· release of chemical mediators from mast cells and other inflammatory cells.

The results of these changes are heat, swelling, redness, pain and tenderness in the affected region. These inflammatory reactions are a necessary first stage in the healing process.

Chronic inflammation, the cause of inflammatory disorders, is a different situation. It appears to involve systemic, metabolic shifts in the balance of immune-messaging molecules and cells, leading to a continual, unnecessary and less localised inflammatory reaction. We now know that this type of inflammation often represents a warning signal for the entire body system.

Specific anti-inflammatory medications, such as the corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) are effective in the acute situation. However, they do not address the underlying cause of the problem in chronic inflammation and can cause serious side-effects in long term use.

From a functional medicine viewpoint, this is not surprising. Chronic inflammation, like any imbalance in the body, still has a purpose. Blocking inflammation with drugs without addressing the cause of the original imbalance is in itself an imbalanced approach. Use of prednisolone-like agents as a primary treatment for chronic inflammation can block the inflammatory process but only at the cost of suppressing the hypothalamus-pituitary-adrenal (HPA) axis and so causing specific side-effects. It does not restore the natural, adaptive control of inflammation by the adrenal glands. In the same way, chronic use of NSAIDs like ibuprofen can effectively damp down the symptoms caused by chronic inflammation in arthritis, for example, without correcting the original cause of the inflammation.

The functional approach to inflammation involves the concepts of triggers and mediators. Triggers may be inside (endogenous) or outside the body (exogenous), while mediators are always inside. Triggers can include exposure to viruses, bacteria, parasites, or a wide range of toxins and antigens, oxidative stress or dysglycaemia. Mediators are the chemicals released by the body in response to these triggers. They include hormones, neurotransmitters, reactive oxygen species (free radicals), cytokines, leukotrienes and kinins.

A SCHEMATIC OVERVIEW OF THE INFLAMMATORY DISORDERS

TRIGGERS	MEDIATORS	CONDITIONS
Toxins (endogenous or exogenous) Allergens (environmental or food-based) Oxidative stress Dysglycaemia Stress Physical injury or trauma Ischaemia and hypoxia	Essential Fatty Acid (EFA) metabolism and the Arachidonic Acid Cascade Cytokine balance Mast cell degranulation	Alzheimer's disease Arthritis Atherosclerosis Chronic Fatigue Colitis Crohn's disease Cystitis Diabetes Fibromyalgia Hyperinsulinaemia Inflammatory Bowel disease Inflammatory liver disorders Parkinson's disease Chronic Obstructive Airways Disease Prostatitis

Examples of Triggers

Exotoxins

Synthetic compounds	Natural compounds		Others
industrial chemicals household chemicals air pollution soil pollutants water-borne pollutants food additives pesticides herbicides drugs cosmetics	microbial toxins plant toxins mycotoxins animal toxins		heavy metals aromatic hydrocarbons organophosphates organochlorines volatile organics arsenicals carbamates
Endotoxins		Allergens
secondary bile acids (deoxycholate, lithocholate) deconjugated bile acids dehydroxylated bile acids ammonia aromatic hydrocarbons nitrites nitrosamines d-lactate amines		pollens mould spores house dust mites grains and grain products corn and corn products soy and soy products yeast and yeast products citrus fruits animal products

MEDIATORS

Essential Fatty Acid Metabolism

Sources	Omega-6 pathway	Enzymes	Omega-3 pathway	Sources
safflower sunflower sesame	LA alpha linoleic acid		ALA alpha linolenic acid	flax pumpkin hemp walnut soybean
	â	ßD6à delta six desaturase	â
borage evening primrose blackcurrant human milk fungi	GLA gamma linolenic acid		SDA stearidonic acid	blackcurrant
	â	ßelongaseà	â
	DGLA dihomogamma linolenic acid		ETA eicosatetranoic acid	fish oils
	â	ßD5à delta five desaturase	â
	AA arachidonic acid		EPA eicosapentaenoic acid
	â	ßelongaseà	â
	DTA docosatetranoic acid		DPA docosapentaenoic acid
	â	ßD4à delta four desaturase	â
	DPA docosapentaenoic acid		DHA docosahexaenoic acid	fish oils marine algae