Most of us are at least somewhat familiar with the concept of inflammation. Usually, we think of it in the context of something like an injury, where we’ll see the affected area get red, hot, and swollen. In general, we can understand it as a result of our immune system recognizing something inside the body that is not where it’s supposed to be. This does not necessarily have to be something foreign to the body like bacteria or viruses (known as pathogens). Going back to the injury example, if someone twisted their ankle without an open wound and it became swollen, it would most likely not be due to infection from an outside invader. Rather, there could have been damage to the underlying tissue that resulted in leakage of cellular components into undesired areas, triggering the inflammation. So, from there it’s clear to see how inflammation can occur in countless differing circumstances within the body.
Taking this point, it’s important to then ask ourselves: is it always harmful? The term ”inflammation” has certainly become a buzzword in recent years, with many in the health community taking the position that all inflammation is bad, constantly seeking remedies to “reduce inflammation” across the board. However, what we tend to find in medicine is that there is very rarely a black-and-white, good-or-bad dichotomy when it comes to a single concept. It’s equally rare that we ever see something so consistently conserved over the course of our evolution be harmful overall. Inflammation is a complicated topic that appears in many different contexts. In many circumstances, I would agree that it can be harmful. However, I feel that it’s critical to distinguish between acute and chronic inflammation.
Starting with the bad (which most of us can probably agree on), there has clearly been an abundance of evidence incriminating chronic inflammation in a number of the most devastating chronic diseases: cardiovascular disease, cancer, Alzheimer’s disease, a number of respiratory diseases, etc. Of course, the prevention of these diseases is a key cornerstone of my approach to health and longevity, which is why I do my best to reduce sources of chronic inflammation. One such example of this that I’ve written about in the past is my efforts to stimulate autophagy, whether it be through fasting, exercise, etc. In short, this process acts to rid one of damaged cellular components and debris that could kick off an immune response. Johns Hopkins recommends anti-inflammatory strategies such as exercising, avoiding smoking and processed foods (which contain things our body thinks of as “foreign”), and controlling weight/visceral fat for heart disease prevention.
Intuitively, it makes sense that inflammation would not have been evolutionarily intended to occur chronically. Disposing of a pathogen or something similarly harmful, the type of “damage control/repair” that inflammation is, should hopefully be a quick fix. If you’re trying to resolve a problem and it’s taking a really long time to do so, though, that tends to lead to bigger problems.
It’s important to recognize that while inflammation did not confer an evolutionary advantage in this sense, it certainly must have done so acutely. This makes sense as well, as we have constantly been exposed to pathogens, suffered damage to tissues, etc. throughout our evolutionary history. When we get an infection, when we get hurt, when we get a vaccine, etc., we want to see that inflammatory response.
Figure 1: Whereas inflammation (top right) can disrupt the composition of normal muscle tissue (top left), exercise can help reduce these harmful effects to preserve muscle fiber structure (bottom left) and strength (bottom right). (Image: Duke)
Even during exercise, we very much depend on this response. But, haven’t we already mentioned the benefit of exercise as anti-inflammatory for chronic disease prevention? Yes, which is a perfect example of why we must distinguish between acute and chronic inflammation. While exercise is considered a stressor that triggers inflammation, it comes at a small enough magnitude that, longer-term, it is beneficial because we adapt to it. So, even though exercise temporarily raises metrics we’d chronically consider to be bad (inflammation, heart rate, blood pressure), in the grand scheme of things it actually lowers them.
In this way, inflammation can be thought of as generally beneficial when acting in the short-term, not so much in the long-term. Rather than lump all instances of inflammation into the “harmful” category, it’s important to recognize that acute inflammation can actually be crucially beneficial to our health, while also taking appropriate measures to reduce overall chronic inflammation and subsequent disease risk. A better ability to distinguish good from bad circumstances of inflammation can help us better understand the right course of action, either proactively as prevention or reactively as treatment. Most importantly, an all-encompassing “good” or “bad” is almost never the answer.
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