Why is everything linked to inflammation now?

A recent episode of the Oprah Winfrey Podcast revealed a stunning new hypothesis in cancer research. It had nothing to do with artificial intelligence (A.I.) or a new drug’s mechanism. Instead, it was about chronic inflammation.Winfrey’s guest was Siddhartha Mukherjee, cancer researcher, oncologist and author of the Pulitzer-winning book The Emperor of All Maladies. Partway through their conversation, when she asked about the future of cancer treatment, he said, “There are thousands of dormant cancer cells sitting in your body. Then something happens — I call it the sleeping beauty kiss — that wakes them up. We are realising that that one something is chronic inflammation... It really switches around how we think about cancer... If we could test that one particular kind of inflammation, we would have a bio-marker for future cancers that could even be preventive.” Siddhartha Mukherjee, cancer researcher, oncologist and author of the Pulitzer-winning book The Emperor of All Maladies | Photo Credit: Getty Images In the longevity era, inflammation is one of the most studied biological phenomena. And increasingly, scientists are discovering evidence that chronic low-level inflammation, or extended activity of immune cells when there’s no immediate threat, is often the cause of disorders, from diabetes and cancer to autoimmune diseases and neurological conditions such as Alzheimer’s.Just last week, new research published in the European Journal of Preventive Cardiology showed that chronic inflammation increases the risk of heart attack and stroke by 43%. Scientists from MRC Laboratory of Medical Sciences and Imperial College London found that inflammation caused silent structural damage to the heart (thickened walls, smaller chambers and poorer filling) years before symptoms appeared.Is it any wonder then that inflammation is on everybody’s minds these days? No matter where you look, someone is telling you how to reduce it: from self-help guides to influencers on Instagram breaking down inflammatory foods, inflammation belly, and inflammation face in under three minutes.Inflammation | Video Credit: Hitesh Sonar Turmeric is hyped as a miracle cure, others swear by elimination diets. Then there’s parasite detoxes, ice baths, celery juice resets and monotrophic cleanses (where you eat only one food item). The more scientists link inflammation to diseases, the more the wellness industry cashes in by marketing anti-inflammatory products. But take them with a dollop of salt. Often, the advice is fed to us by A.I.-generated doctors, healers and wellness influencers.Acute and chronic: not the same thingFor most of history, doctors and the public focused on what they could see and feel: red, puffy skin around a wound, pain, fever. “I remember reading an article a few years back about how people with stressful jobs have inflammation, which could lead to illnesses as they age. And I recall closing my eyes and doing a mental body check and noting that ‘no, nothing was swollen or achy, so I’m not inflamed’. I was naive and uninformed,” says Kajal S. (name changed), a media professional in her 40s, explaining how she didn’t know the difference between acute and chronic inflammation.One evening, a couple of years later, the knuckles in her left hand swelled up, and within a few days she was handed a diagnosis of palindromic rheumatism, a rare type of inflammatory arthritis characterised by sudden, recurring flare-ups and severe joint pain. Her doctor talked her through how consistent stress, bad sleep patterns, and gut issues — and the chronic inflammation it caused (that is devoid of swelling or aches) — played the lead role in her condition.So, what’s the difference between acute and chronic inflammation? The former occurs when the body rallies to defend itself against invading microbes or to heal damaged tissue. Capillaries dilate and grow more porous, enabling white blood cells to flood the damaged site. The region swells, which can put pressure on surrounding nerves, causing pain. Chronic inflammation, however, is often silent and occurs when the immune system is over-stimulated all the time. As researchers are discovering, factors such as poor diet, air pollution, lack of sleep and stress can have a more significant impact on it than previously understood. “In modern life, inflammation has five faces: ultra-processed food, sleep debt, a disturbed gut, a sedentary body, and the one I speak of most — the red mind or a state of constant stimulation.”Arpit BansalOncology surgeon and chief scientific chair at the Longevity Summit India held last month in Mumbai Arpit Bansal Over time, in many cases, our immunity can also get so active that it starts attacking our own cells, which is what autoimmune diseases such as rheumatoid arthritis (RA), psoriasis, vasculitis, Hashimoto’s disease and others are. Inflammation can also fuel chronic diseases (without autoimmunity), like Alzheimer’s and endometriosis.“Persistent inflammation can contribute to changes in blood vessels and metabolism and is involved in several chronic diseases. The brain is also connected to these processes,” says Dr. Vinaya Bhandari, consultant neurology and neuromuscular disorder specialist from Mumbai’s Jaslok Hospital and Research Centre. “Inflammatory signals from the body can interact with the brain and its blood vessels... and continual activation is increasingly recognised as one component of neurological conditions, including neurodegenerative diseases [Alzheimer’s, Parkinson’s].”Less inflammation doesn’t mean “healthier”It is easy to see why inflammation is such a perfect social media concept: it is invisible, frightening, scientifically legitimate, associated with many diseases, simple to attach to symptoms, as well as food and products. (Ironically, emerging research shows higher levels of inflammation associated with using social media over face-to-face interaction.)But detecting chronic inflammation isn’t as easy as going to your physician and asking how your immune system is doing. While tests such as C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) can help identify markers of inflammation, for some people such tests just come back negative.To complicate things further, not all inflammation have dire results. “Often, a person doesn’t know they have chronic low-grade inflammation because it is not always behind heart disease or endometriosis, or cancer,” says Dr. Suganya Venkat, a Coimbatore-based gynaecologist. “Chronic inflammation can manifest as brain fog or fatigue or lethargy that just won’t go away.” Gynaecologist Dr. Suganya Venkat Fringe wellness to mainstream cultureSomewhere between a turmeric shot, a cold plunge and a bowl of berries, inflammation has stopped being an immune response. It has become an explanation for why we are tired, puffy, anxious, ageing, gaining weight, breaking out and not feeling okay. Just the month of September has seen hundreds of guides on how to lower your inflammation naturally or how to reset your circadian rhythm to improve inflammation. And forums such as Reddit, with their believers, sceptics and the longevity crowd, are bandying around new terms such as ‘inflammaging’ (to describe the low-grade inflammation that occurs with ageing).But the future of inflammation is not on the world wide web. It is in labs and clinics around the world where scientists are tracking inflammation in patients over time, trying to understand what normal looks like and when it can become dangerous.The cancer-chronic inflammation link is something Indian oncologists have begun to consider. “Chronic inflammation can create a biological environment that promotes malignant transformation,” explains Dr. Aditya Vidushi, medical oncologist at Faridabad’s M|O|C Cancer Care & Research Centre. “A clear example is H. pylori, a stomach bacterium that triggers long-term irritation, a major driver of gastric cancer. Obesity-related low-grade inflammation is linked to higher risks of colorectal, breast, pancreatic, and liver cancers.”And the body of science is building. Senthilkumar Rajagopal, associate professor at REVA University in Bengaluru, who has led several research papers on inflammation, says, “South Asian populations may have a distinctive susceptibility to chronic low-grade inflammation arising from the interaction of genes, visceral adiposity, insulin resistance, environmental exposures and lifestyle factors.” The central insight emerging from his work is that targeting molecular interfaces between neuron signalling and inflammatory pathways may offer new strategies. Senthilkumar Rajagopal, associate professor at REVA University Maintaining the balanceExperts agree that combining medicine and better lifestyle habits can best prevent flare-ups. But what they prescribe can vary widely, and occasionally be controversial. U.S.-based Mark Hyman, considered the pioneer of Functional Medicine, emphasises in his books that inflammation is the common pathway for all chronic diseases. His recommended solution is an anti-inflammatory diet: omitting sugar, caffeine, beans, dairy, gluten, and processed foods, as well as taking a variety of supplements, including probiotics, fish oil, Vitamins C and D, and curcumin, a key molecule in turmeric. Meanwhile, in his book The End of Illness, American oncologist David Agus prescribes, among other things, not wearing high heels because they inflame the feet and that inflammation could possibly affect vital organs.The healing journey of Goa-based graphic designer Antima Nahar, 48, diagnosed with rheumatoid arthritis (RA) when she was 35, has taken her to doctors, nutritionists and Ayurvedic retreats. Nahar got the transformative diagnosis after a fall during a monsoon trek on the outskirts of Mumbai. Her doctors told her she would live with pain if she did not take steroids and painkillers all her life. “It started with my toes and fingers, and then became a sharp, pounding pain that kept shifting through different joints in my body. At one point, I couldn’t squeeze a toothpaste tube, couldn’t open jars or bottles, couldn’t hold a phone for long,” Nahar says. Goa-based graphic designer Antima Nahar After years of naturopathic and Ayurvedic treatments, she found a balance with lowered doses of allopathic treatment combined with naturopathy and lifestyle modifications. “The last decade has been about knowing my body. Flare-ups can be because of food, weather changes, dancing, anything. I started recording everything, thinking through everything I did.” Nahar also began making illustrations about her RA journey and is now writing a graphic novel about self-discovery through pain.Interestingly, chronic inflammatory conditions often manifest differently in men and women. Several studies in the past decade reveal that nearly 70% of all autoimmune disease patients in India are women. In men, it can manifest more as heart disease. Indian men face a cardiovascular death rate (349 per 100,000) that is significantly higher than that of men in Western nations, according to the National Noncommunicable Disease Monitoring Survey (NNMS).Women take noteHormonal volatility, especially after menopause, makes women the easiest target for inflammation. Dr. Venkat says her priority in women’s health is to check inflammatory markers. “Once a diagnosis of chronic inflammation is established — and it almost always is with women with endometriosis, PMOS and during menopause — a diet rich in antioxidants, better quality of sleep, and regular, moderate exercise always work,” she says. But her advice for women of any age: “Too much exercise drives up inflammation. Follow an exercise routine that you can sustain after menopause and into your 80s.”Kochi resident Jai Krishnan Sambasivan, 62, says he wouldn’t be able to function well if it were not for steroids. At 42, he was running his own business in Alappuzha, Kerala, when he developed a high fever that lasted months without a diagnosis. Admitted in hospital for over a month, he says he “fit into the category of patients who was clinically well [all tests came back negative], but not well”. What finally led to a diagnosis of vasculitis were two high inflammatory markers: hs-CRP and ESR. Jai Krishnan Sambasivan just moths before his diagnosis Vasculitis is an autoimmune disease that inflames blood vessels, often leading to blockage of capillaries and eventually causing cardiac failure. He has managed to control the disease with Prednesol, a steroid drug, and lifestyle modifications. “But what keeps me alive is not medicine, it is breath control,” he believes. “I can say I have mastered it. I have learnt to be fearless.”What you eat mattersFood plays a major role in managing/ preventing inflammation. According to Delhi-based nutritionist Shonali Sabherwal, a seasonal, pesticide-free, freshly-cooked plant diet is most effective in reducing chronic inflammation. “You need to question staples: the atta that you are using, is it a hybrid variety? Do we know what we are really stocking in our kitchens?” Nutritionist Shonali Sabherwal | Photo Credit: The Collective Image Sabherwal’s approach, commonly used around the world for conditions such as allergies, autoimmune diseases and other chronic conditions, aligns with Ayurvedic prescriptions for excess agni (fire/ inflammation in the body). Dr. Nitin Kochar, a Mumbai-based Ayurvedic practitioner who specialises in cancer and inflammation, says that “depending on the specific dosha [vata, pitta or kapha, the Ayurvedic way of categorising the human body’s biochemistry], I prescribe fasting, specific plant foods and spices like ginger, cumin, giloy to weaken the fire”.How do you treat it?One of the frustrations of treating inflammation is that treatments are so imprecise. Dr. Shreevidya, medical director–preventive health, Apollo Hospitals, says chronic inflammation is usually identified not because someone felt it, but because it surfaced during a preventive health assessment. “Two drivers deserve more attention. One is chronic hidden infection, especially gum disease [untreated periodontitis keeps the whole system inflamed]. The other is air pollution. Long-term exposure to fine particulate matter is consistently associated with higher inflammation,” she says. Dr. Shreevidya, medical director – preventive health, Apollo Hospitals Dr. Divya Gopal, additional director of internal medicine at Mumbai’s Sir H.N. Reliance Foundation Hospital, says people should start with lifestyle changes. “Pain relievers like ibuprofen and naproxen reduce inflammation, but taking them long-term brings risks,” says Gopal. “For serious cases, I prescribe newer medications that block inflammation pathways.”What to checkDr. Shreevidya (Apollo) highlights tests that can help detect chronic inflammation markersCRP: “This is what I order first. Your liver makes this protein when inflammation happens. Higher levels suggest inflammation is active.”ESR: “This is a test to measure how fast your red blood cells settle in a tube. If they fall very quickly, there may be inflammation.”Interleukin-6 and TNF-alpha: “These are messengers responsible for inflammatory processes. They are more specific tests but give a clear picture.”Homocysteine and Fibrinogen: “Increased levels indicate the presence of inflammation and heart problems.”As research into inflammation intensifies, new methods are being discovered. Earlier this year, researchers at University College London uncovered a key mechanism that can help the body switch off inflammation and prevent harmful immune cells from building up. Elsewhere, several clinical studies have shown that, independent of weight loss and diabetes, GLP-1 receptor agonists such as Ozempic and Mounjaro can significantly reduce systemic inflammation markers such as CRP and TNF-alpha. There’s also talk about non-invasive continuous inflammation monitors, much like glucose monitors.Science may be on the threshold of cures for several diseases that inflammation drives, but it is important to remember the nuance of it all: inflammation is part of our maintenance and repair system. Without inflammation, we can’t heal. The challenge is to master the balance between the healing short spells and the stubborn, prolonged simmer that has profound implications for our health.The Mumbai-based writer and journalist is behind @the_slow_fix on Instagram.With inputs from Surya Praphulla Kumar