Inflammation is a natural part of healing. In primitive times before modern medicine, a ‘robust’ immune response was essential for survival. If you were out hunting or gathering and you had a fall, breaking a bone, the inflammatory response was vital. The swelling would ensure that the affected area was immobilised and the cytokines released would communicate with the rest of the immune system to initiate the mending process. Likewise, if you cut yourself and an infection set in, the inflammatory response would recruit immune cells to deal with it. We can see that back then, a ‘strong’ immune system would be hugely beneficial and genes that conferred the ability to heal quickly would naturally be ‘selected for’ and passed on to subsequent generations. However, nowadays genes for a ‘strong’ inflammatory response may not be quite as beneficial. They could potentially be harmful, predisposing individuals to chronic inflammation and contributing to autoimmune diseases, like rheumatoid arthritis.
Of course, a rapid acute response, appropriately triggered, is associated with healing. However, a prolonged response causing chronic inflammation is detrimental. Essentially, if the body believes it is under attack then the immune system will keep on fighting. This prolonged ‘fight’ may result in healthy cells and tissues being damaged and, in some cases, end up causing more harm than the actual precipitating event.
What causes chronic inflammation? Generally, there are two scenarios. It may occur when inflammation is triggered by a ‘threat’ that does not require an inflammatory response. Alternatively, it can be triggered by a real ‘threat’, but the immune response is unable to resolve it and just continues, making the situation worse.
Research has shown that chronic inflammation, is associated with heart disease, diabetes, cancer, arthritis and bowel diseases like Crohn’s disease and ulcerative colitis.
Chronic inflammation and heart disease
This is the classic example of how chronic inflammation causes more harm. If we have high levels of fat and cholesterol, they are deposited in the lining of blood vessels and this triggers an inflammatory response. Unfortunately, the recruitment of immune cells to the area and the inflammation, along with the fatty plaque, causes the blood vessel to narrow. This can then lead to blockages, which can cause heart attacks.
Obesity and chronic inflammation
Individuals who are overweight have more visceral fat cells. This is the fat, deep inside your body, that surrounds abdominal organs, such as the liver, pancreas and intestines. While we all have some visceral fat, larger quantities are associated with increased health risks, such as insulin resistance, heart disease and certain cancers. A useful indicator of visceral fat is waistline circumference.
Worryingly, stress has a significant effect on where fat is stored in our body. Research has shown that the stress hormone, cortisol, significantly increases the storage of visceral fat.
Obesity is associated with chronic inflammation. It is thought that the immune system may see visceral fat cells as a ‘threat’ and attack them with white blood cells. Unfortunately, this continued stimulation of the inflammatory response causes damage to nearby healthy tissues and organs. The longer an individual remains obese, the more damage from chronic inflammation.
Ageing and Inflammation
As we age our immune system, like many of other bodily functions, doesn’t work as well. This dysregulation is referred to as inflammageing and is characterised by high levels of pro-inflammatory markers such interleukins, C-reactive protein, transforming growth factor beta, Tumour necrosis factor and serum amyloid A.
Research has shown that there is a high level of these markers in the majority of older individuals, even in the absence of risk factors and clinically active disease. This indicates that these markers are not elevated due to an appropriate immune response, but seem to be a consequence of age. Furthermore, research has shown, that these raised levels predict the risk of cardiovascular diseases, frailty, multi-morbidity and the decline of physical and cognitive function in older individuals. What might be causing this increase in inflammation as we age and is there anything we can we do to limit it?
While this is a complex area and more research is needed, there are a number of factors identified that appear to be contributing to inflammageing. These include genetic predisposition, intrinsic defects in the immune system and chronic infections. Other factors appear to be related to natural ageing, with increased cellular debris and impaired clearance mechanisms contributing, as well as changes in the gut microbiome and permeability. Another major factor contributing to inflammageing appears to be visceral obesity.
What happens in natural ageing
Increased cellular debris & impaired clearance
Throughout our life our cells are continually replacing themselves. When they lose the ability to divide, which can be because of DNA damage or telomere shortening, they go into a period of decline (senescence) or they self-destruct and are eliminated. Cellular senescence is very complex and depending on physiological context, can be seen as both protective (tumour suppressor mechanism) and damaging (age related pathologies). In simple terms, as we age we have an increased number of senescence cells, due both to an increased production of them and a reduced ability to get rid of them. Research has shown that as we get older senescent cells accumulate exponentially in different tissues and organs, which compromises repair and regeneration contributing to age related damage of tissues and organs. Remember, the normal function of the immune system is to detect damage and repair it. Unfortunately, as we age and everything works less well, there is impaired recycling and elimination of degraded cellular material, compounded by an increased production of cellular debris. This inability to efficiently deal with cell debris, means it accumulates triggering inflammation – contributing to inflammageing.
Changes in the gut microbiome and permeability
It has been shown that as we age there are changes in both our gut microbiome and gut permeability. These changes are associated with increased levels of inflammatory cytokines. There appears to be a reduction in beneficial microorganisms, which is a problem as there are no-longer sufficient to counteract the expansion of pathogenic microorganisms. Furthermore, these beneficial microorganisms are normally responsible for maintaining the intestinal barrier integrity, which they do by fermenting starches and dietary fibres to produce mucus and lipid metabolites. A ‘leaky’ gut will result in ‘foreign’ particles, such as gluten proteins and intestinal organisms getting in the bloodstream and triggering an immune response.
Inflammageing is a problem
We know that dysregulation of the immune system as we age causes chronic inflammation and epidemiological studies have found that inflammageing is a risk factor for heart disease, cancer, chronic kidney disease, dementia, and depression, as well for global indicators of poor health status, such as multimorbidity and frailty. Furthermore, it has been suggested that inflammageing is a marker of accelerated ageing, highlighting the importance of keeping inflammation under control.
What can we do to help us age well and reduce inflammation
We know that taking care of our health and wellbeing, is important for the functioning of our immune system.
To reduce inflammageing we can exercise and eat a good diet maintaining healthy gut diversity. In addition, we know that obesity, particularly central obesity, indicating visceral fat is strongly associated with a pro-inflammatory state. So, it is imperative that we limit ‘truncal’ obesity. Clearly, diet and exercise are important, but we should also manage stress as we know that the stress hormone cortisol influences where we distribute fat. Furthermore, stress is known to be a factor leading to premature ageing.
Not surprisingly, there is a lot of interest in ageing well with an increasing number of diverse studies. There are currently research proposals to look at mindfulness as an attenuator for inflammageing. It will be exciting to watch these developments.
At Mindlab, we offer yoga, mindfulness and clinical hypnotherapy. How might these be helpful as part of your strategy for ageing well?
- Yoga, mindfulness and hypnotherapy are proven to reduce stress. A factor that is known to contribute to premature ageing and visceral fat.
- If you are struggling to get back to exercise or stick to a healthy diet/weight then hypnotherapy can help.
- Research has also shown the benefits of yoga and mindfulness in reducing inflammation and improving immune function.
So why not get in touch and take action now to future protect your health and age well.
Baily-Kroll Lilith (2021) Inflammation +Aging = Inflammageing. Yoga Therapy Today Winter edition – published by International Association of Yoga Therapists.
Ferrucci L. and Fabbri E. (2018) Inflammageing: Chronic inflammation in ageing, cardiovascular disease and frailty. Nat Rev Cardiol. 15(9): 505–522.
Furman D., Campisi J., Verdin E. et al. (2019) Chronic inflammation in the etiology of disease across the life span. Nat Med 25, 1822–1832.
Jing Lv., Haining Peng., Tengbo Yu. and Xiaohong Huang (2023) The effect of the mindfulness-based interventions on inflammageing: Protocol for a systematic review and meta-analysis. Plos one. 18(4): e0284228
Lin J. and Epel E. (2022) Stress and telomere shortening: Insights from cellular mechanisms. Ageing Research Reviews 73 101507