“What prompted you to come and see me today?” I asked the elderly gentleman seated next to my desk in the examination room.

“Arthur is paying me a visit,” he responded. I immediately knew what was to come next (I’ve heard the joke many times over the years), but I played along.

“Arthur who?” I asked.

“Arthur Itis!” he snapped, letting out a hearty laugh. His mood quickly turned somber, however. “It’s really not a laughing matter,” he confessed. “It’s come to the point where my joints never stop hurting. Is there anything that can give me some relief?”

He was not alone in his plight. It is said that over half of people over the age of 65 live in constant pain. This is usually due to arthritis or one of the many other conditions that are characterized by chronic inflammation. Mr. Itis comes in many forms – bursitis, cystitis, tendonitis, hepatitis, gastritis are just a few of his aliases. The suffix “itis” means inflammation and its attachment to any body part means that tissue or organ is inflamed.

Chronic (persistent) inflammation is one of the underlying causes of disease and aging. I have previously written articles about other causes of aging including free radical damage, loss of repair ability (methylation), a decrease in the ability to produce energy (mitochondrial decline), and exposure to electromagnetic radiation.

Inflammation is not meant to be harmful. It is, in fact, one of the body’s primary healing mechanisms. Inflammation is the body’s basic response to a variety of external or internal insults, such as infectious agents, physical injury, hypoxia (low oxygen levels), or disease processes in nearly any organ or tissue in the body. Signs of Inflammation include redness, heat, tenderness or pain, and swelling.

Examples of acute inflammation include a burn, an insect bite, frostbite, and the fever and aching accompanying a flu-like illness. Acute inflammation can promote healing; chronic inflammation can lead to a wide range of disease states and significantly accelerate the aging process.

Some of the conditions that are triggered or aggravated by chronic inflammation are allergies, Alzheimer’s disease, anemia, arthritis, atherosclerosis, cancer, collagen diseases (rheumatoid arthritis, systemic lupus erythematosis, scleroderma, dermatomyositis), congestive heart failure, Crohn’s disease, ulcerative colitis, fibromyalgia, Hashimoto’s thyroiditis, kidney failure, multiple sclerosis, and psoriasis. Any condition that ends in “itis” has an inflammatory cause. Calming down chronic inflammation can easily add a decade or more to a person’s life span. More importantly, keeping it under control can help assure that those extra years are characterized not by pain, but by activity.

The degree to which chronic inflammation affects longevity can be appreciated by considering that inflammation is the initial event that leads to the development of the two greatest killers in our society – atherosclerosis (hardening of the arteries) and cancer. Inflammatory injury to the lining of arteries creates the condition necessary for deposition of plaque in arteries. In November 2005 a Japanese researcher, Dr. H. Okuyama reported that supplementation of omega-3 oils is more effective in preventing heart attacks than use of cholesterol-lowering medications. Some are now proposing that popular statin drugs reduce heart attack risk not by lowering cholesterol, but by producing a separate anti-inflammatory effect. Nearly all cancers begin with inflammation. A severe sunburn triggers the development of skin cancer, inflammation caused by a papilloma virus infection leads to cervical cancer, inflammation of the mouth, bronchial tubes, and esophagus caused by cigarette smoke predisposes to cancers in those areas, and chronic inflammation in the prostate creates an environment that leads to prostate cancer. It is therefore imperative that steps be taken to identify and reverse chronic inflammation when it is present.

A number of chemical markers of inflammation exist, which can be monitored by blood tests. One of the simplest tests for inflammation is the erythrocyte sedimentation rate (ESR). The ESR indicates that proteins from an inflammatory process are in the bloodstream and are causing red blood cells to stick together. The ESR test is quite simple to do. Blood is drawn into a small tube. The tube is placed upright and after an hour the distance that the red blood cells have fallen is measured in millimeters. Since clumps of red blood cells are heavier and fall more quickly than individual red blood cells, the rate of settling rises as the amount of inflammation present in the body increases.

Sedimentation rates up to 15 mm/hr in men and 20 mm/hr in women under the age of fifty are considered normal. After the age of fifty the upper limit of normal is considered to be over 20 mm/hr in men and over 30 mm/hr in women. It is important to note that these values are “normal” only in that typically no identifiable disease process is present in that range; “normal” values do not mean that no inflammation is present. The higher levels seen in people over fifty are in all likelihood due to inflammatory processes that have not yet progressed far enough for a disease to be recognized.

C-reactive protein (CRP) is a protein that is manufactured in the liver and in fat cells. Low amounts are always present, but levels can rise dramatically when inflammation is present. CRP is considered an acute phase reactant, meaning that it is an important factor in the body’s immediate response to infection. CRP helps the body mark foreign substances for removal by white blood cells. It also enhances the ability of white blood cells to engulf and destroy bacteria, viruses, and foreign proteins.

It has been found that higher than usual baseline levels of CRP are associated with an increased risk for heart attack. Individuals who have a baseline level of CRP less than 1 mg/L are considered to be at low risk for heart disease, those with levels between 1 and 3 are felt to be at average risk, and people with CRP levels above 3 when no infection is present are said to be at high risk for a future heart attack.

C-reactive protein production is closely linked to a substance called interleukin-6 (IL-6). IL-6 is a member of a family of chemicals called cytokines. Cytokines are responsible for intercellular communication in the body. Interleukin-6 can play an anti-inflammatory role at times. IL-6 is released with muscle activity and stimulates burning of fat and improved usage of insulin. When an infection occurs white blood cells manufacture IL-6. The increasing amounts of IL-6 in an infection trigger increased production of C-reactive protein in the liver.

Other inflammatory cytokines that can be measured to monitor inflammation in the body include tumor necrosis factor alpha (TNF-a), interleukin-1 beta (IL-1(b), and interleukin-8 (IL-8). Low levels of cholesterol also suggest that inflammation is present. None of the inflammatory markers tell where the inflammation is or what is causing it. They simply give an indication of the degree of inflammation that is present in the body at any point in time.

Many underlying causes of chronic inflammation have been identified, and most can be addressed successfully. One of the factors responsible for chronic inflammation is lack of adequate sleep. When sleep is insufficient levels of IL-6 have been found to increase by 40 – 60 percent and levels of TNF-a by 20 – 30 percent. C-reactive protein levels rise accordingly.

Chronic stress often leads to adrenal fatigue, a condition in which the adrenal glands are unable to keep up with the body’s demand for adrenaline, non-adrenaline, and cortisol. Since cortisol is one of the body’s primary anti-inflammatory substances, adrenal fatigue results in chronic inflammation. How stress is handled is critically important, as emotions play a role in creating chronic inflammation. For example, CRP has been shown to increase in response to anger, hostility, or depressive feelings.

Since IP-6 and CRP are both manufactured in fat cells, obesity is often characterized by chronic inflammation. This is true in young people as well as older individuals. The role of chronic inflammation in the development of cancer and diseases of the circulatory system explains, at least in part, why obesity carries a higher risk for development of chronic disease and premature death.

The body uses hormonal substances called prostaglandins to regulate its maintenance and repair activities. Under ideal circumstances, the body will be able to produce whatever prostaglandin is required at any point in time. Nutritional deficiencies, however, can severely compromise the body’s ability to self-regulate its activities.

Omega-3 fatty acids are needed in the manufacturing of anti-inflammatory prostaglandins, while omega-6 fatty acids are used in the production of inflammatory compounds. Diets low in omega-3 fatty acids or having a high ratio of omega-6 to omega-3 oils, which are common in the United States, promote the production of inflammatory prostaglandins. Meats and dairy products are high in arachidonic acid, the primary omega-6 fatty acid required for the production of inflammatory prostaglandins. It should come as no surprise people who eat a diet high in animal fat experience more inflammatory conditions than those who eat diets that are predominantly plant-based.

Diets that consist primarily of cooked food also promote inflammation. They do so by depleting the body’s supply of enzymes and promoting the attachment of glucose to protein. Most people know that insulin is produced in the pancreas. It is not commonly recognized that the pancreas also produces chemicals called enzymes. Pancreatic enzymes are the body’s clean-up crew. They support the digestive process by breaking down food as it passes through the intestinal tract. Pancreatic enzymes that are not required for food digestion circulate through the body looking for sites of debris and inflammation. When inflammation is encountered the enzymes go to work clearing debris from the area so that healing can take place.

Raw foods contain enzymes that aid in their digestion. If a fresh peach is allowed to sit on a counter it will quickly begin to rot. The rotting is due to enzymatic action breaking down the pulp to release the seed. If the peach is sliced and baked in a pie, however, it can sit on the counter indefinitely without rotting. It may mold or spoil in other ways, but it will never rot because the enzymes in the fruit were destroyed when the peach slices were heated in the baking process.

When cooked food is eaten the body must use more pancreatic enzymes in the digestive process than when food is eaten raw or lightly steamed. As a result there are fewer enzymes available to deal with inflammation throughout the body.

The mechanism by which glucose is attached to proteins is called glycosylation. Glycosylation accelerates the aging process by causing proteins to stiffen. A common test of blood sugar control in diabetes is called a glycosylated hemoglobin or A1C test. The test looks at the stiffness of red blood cells. The higher the blood sugar over time the faster the glycosylation process progresses. Therefore, the degree to which red blood cells have stiffened is a reflection of the average blood sugar over the two to three month time frame preceding the test. Protein glycosylation increases inflammation in the body by triggering the release of inflammatory cytokines such as IL-6.

Deficiencies of vitamin D and copper also predispose to the development of inflammatory conditions. As vitamin D levels fall, amounts of the inflammatory cytokine TNF alpha rise. Relatively small amounts of vitamin D in the 400 IU daily range have been shown to lower TNF-alpha levels. Copper is needed to help the body produce a proper balance of prostaglandins. This is at least a partial explanation why wearing a copper bracelet will often improve arthritic symptoms.

Persistent, low-grade infections are another cause of chronic inflammation. Some of the entities that are capable of causing chronic infection are chlamydia pneumonia, helicobacter pylori, herpes simplex, cytomegalovirus, and the human papilloma virus. If inflammatory markers such as C-reactive protein are found to be elevated, a careful search for the presence of chronic infections should be conducted.

Steps that can be taken to control chronic inflammation include reducing stress, maintaining a positive outlook, losing weight, eating a wellness diet, increasing the percentage of raw or lightly steamed foods in the diet, finding and addressing chronic infections, and providing nutritional supports. The two supports critical to control of chronic inflammation are omega-3 fatty acids and enzymes.

Non-steroidal anti-inflammatory drugs work by blocking the production of inflammatory prostaglandins. Unfortunately, they also block the protective mechanisms of the stomach, compromise kidney function, and place people at risk for heart failure. In nearly all instances it is not necessary to accept the risks of NSAIDs. All that is required is to provide the body with ample amounts of omega-3 fatty acids so it can shift production from inflammatory to non-inflammatory prostaglandins. Animal sources of omega-3 oils include cold water fish oils, krill oil, cod-liver oil, and green-lipped mussel oil. I find fish oils to be the most economical and recommend that enough be taken to provide 600 mg. of EPA (eicosapentaenoic acid) and 400 mg. of DHA (docosahexaenoic acid) daily. Plant based sources include flaxseed oil, borage oil, evening primrose oil, walnut oil, and hemp oil. Of these, flaxseed oil is the most economical.

When using flaxseed oil it is important to recognize that the optimum amount is 1 to 2 tablespoons daily. I do not recommend flaxseed oil capsules for a very simple reason – the capsules do not provide nearly enough oil to obtain significant benefit. Fourteen capsules are required to provide one tablespoon of oil. Therefore, 14 – 28 flaxseed oil capsules must be taken to obtain an optimum daily serving, an amount that few would be willing to swallow on a daily basis.

For pancreatic enzymes to be effective in reducing inflammation they must be taken on an empty stomach. If taken with food they will go to work cleaning up the first thing they find, which will be the food in the stomach. If taken at least an hour before or two hours after eating the enzymes will be absorbed and go to work clearing sites of inflammation around the body. Four to six tablets or capsules should be taken two or three times daily to achieve results.

Calming down Mr. Itis is one of the most significant steps that can be taken to improve the chances of living a long life free of degenerative conditions that make it difficult or impossible to pursue enjoyable activities. It is an issue that must be faced in reaching the goal of optimum wellness . . . dying young as late in life as possible.