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

 

D6

delta six desaturase

 

borage

evening primrose

blackcurrant

human milk

fungi

GLA

gamma linolenic acid

 

SDA

stearidonic acid

blackcurrant

 

elongase

 

 

DGLA

dihomogamma linolenic acid

 

ETA

eicosatetranoic acid

fish oils

 

D5

delta five desaturase

 

 

AA

arachidonic acid

 

EPA

eicosapentaenoic acid

 

 

elongase

 

 

DTA

docosatetranoic acid

 

DPA

docosapentaenoic acid

 

 

D4

delta four desaturase

 

 

DPA

docosapentaenoic acid

 

DHA

docosahexaenoic acid

fish oils

marine algae