It’s one of those mornings. We all have them. You know, the ones that start with the jolt of an alarm clock; scaring you awake after a fitful five hours of sleep. You manage to get dressed. As you’re scrambling to find a pair of matching earrings or socks, half of your mind is working through today’s stressors. Before you rush out the door, you pour some coffee into your to-go mug (heavy on the creamer) and grab a granola bar from the pantry. You can’t be late.
While choices like these might seem like minor everyday occurrences, they can compound over time to increase inflammation in your body. Stress, diet, and sleep are all potential sources of inflammation, and that’s not good for your overall health.
When we start our day in a mindful way, it’s easier to make healthful choices throughout the morning, afternoon, and evening. And when we start making consistent choices that reduce inflammation, it turns out it doesn’t take long to yield beneficial outcomes.
Let’s set morning goals that will lay the groundwork for a healthy, non-inflammatory day:
<ul role="list"><li>Aim to get 7 to 8 hours of sleep at night to wake up feeling refreshed. Nothing puts a damper on an entire day like waking up tired.</li><li>Set aside 20 minutes for meditation in the morning. This can help us reduce stress and increase mindfulness.</li><li>Avoid loading your coffee with sugar-heavy creamer, and reach for almond milk instead. Unsweetened almond milk contains no sugar<sup>1</sup>. If you like your coffee sweet, try adding a natural sweetener like monk fruit or stevia. We can avoid glucose spikes by swapping out sugary creamers with these alternatives.</li><li>Take time to eat a balanced breakfast of nutrient rich foods, such as steel cut oats with nuts that are low in sugar and high in complex carbohydrates, or eggs that are high in protein. This can help us maintain stable glucose, energy and focus throughout the morning.</li></ul>
While we cannot avoid all sources of inflammation in our body, day-to-day choices have a big impact on mitigating its ongoing and damaging effects (more on this below!). Understanding inflammation may be the key to gaining a better understanding of both health benefits and numerous disease outcomes.
<p class="pro-tip"><strong>Learn more about </strong> <a href="/blog/mindfulness-metabolic-health">how mindfulness can improve metabolic health</a>.</p>
What is Inflammation?
Inflammation is the basic means by which the body repairs itself. Using transport between cell walls that line blood vessels and the intestinal tract, cell signaling cascades control protective programmed cell death mechanisms and stimulate tissue regeneration. When this natural process cannot turn off, disease results. In recent decades, scientists have come to a better understanding of the signature inflammatory pathways involved in diabetes, heart attacks, high blood pressure, cancer, osteoarthritis, and depression<sup>2, 3</sup>.
Sources of Inflammation
Inflammation run amok is increasingly understood to be a major culprit in numerous chronic lifestyle and autoimmune diseases<sup>4</sup>. On a cellular level, inflammation is stress that reduces the body’s ability to protect, repair, and regulate the aging process. Even the basic function of sleep has a role to play in inflammation.
Dr. Nicolas Rohleder, PhD from the Institute of Psychology in Erlangen, Germany, has published several key studies regarding how acute and chronic stress leads to inflammation<sup>5</sup>. When people suffer from ongoing moderate to severe stress, the hypothalamic-pituitary-adrenal axis and sympathetic nervous system remain continuously activated. This part of our nervous system controls our fight, flight, freeze, or flee mechanism that is largely regulated by a hormone called cortisol. The literature has yet to define specifically when the acute phase transitions to the chronic phase, but labs show system wide low-grade inflammatory increases. Longterm, this adversely impacts cardiovascular disease<sup>6</sup>.
The Netherlands Study of Depression and Anxiety (NESDA) enrolled 2,553 adults<sup>7</sup>. Researchers collected levels of inflammatory markers such as C-reactive protein (CRP) and IL-6. Regression analysis revealed associations between long sleep duration (ie, poor sleep) and higher levels of inflammation. These associations remained statistically significant even after accounting for age, gender, education, BMI, smoking, alcohol consumption, medications, and other medical comorbidities. Other studies show that sleeping less than 6 hours or greater than 8 hours each night also causes increased levels of the following inflammatory markers: CRP, IL-6, NF-kB, and TNF<sup>8</sup>.
Studies performed on endothelial cells show that chronic dehydration and elevated sodium levels facilitate development of cardiovascular disease (CVD)<sup>9</sup>. When dehydrated, the cells that compose the inner lining of blood vessels release clotting factors and inflammatory markers. Staying properly hydrated while monitoring salt intake act as preventatives of CVD.
According to the Longitudinal Study of Adult Health in Brazil, after studying 15,000 participants from 2008 - 2010, results showed that ultra-processed food accounted for nearly 20% of total energy intake (diets in Brazil closely resemble that in the USA)<sup>10</sup>. While men did not show an appreciable increase in CRP, women with obesity saw CRP levels 14% higher than those in the lowest percentile. These findings suggest a positive association of ultra-processed food consumption with elevated levels of inflammation in the setting of obesity.
But there’s a more general link between eating ultra-processed foods, leaky gut, and inflammation.
Studies involving rodents on high processed food diets showed increased levels of proinflammatory effector molecule complement 5a<sup>11</sup>. This led to increased intestinal barrier permeability (leaky gut), increased risk of chronic kidney disease, and increased rates of kidney inflammation. These results demonstrated the mechanisms by which processed foods cause inflammation that lead to chronic disease.
Examples of Processed Foods
The studies above suggest we can reduce inflammation and risk of chronic disease by avoiding ultra-processed foods. According to the NOVA classification system—a system that groups foods by how they are processed they are—there are four food groups<sup>12</sup>:
- Unprocessed or minimally processed foods—fresh, squeezed, chilled, frozen, or dried fruits, vegetables, meat, fungi, and algae
- Processed culinary ingredients—vegetable oils, butter, cane sugar, cornstarch, and sea salt
- Processed foods—canned vegetables, packaged nuts and seeds, smoked meats, fruit in syrup, fresh bread, and fresh cheese
- Ultra-processed foods—most ready-to-consume products, like soft drinks, chips, crackers, cookies, candy, ice cream, mass-produced bread, butter alternatives and spreads, breakfast cereal, granola bars, salad dressing, frozen pizza, hot dogs, noodles, canned soup, and diet shakes. Foods in this group are the foods we should aim to avoid the most.
<p class="pro-tip">Learn more: why you should avoid ultra-processed foods </p>
Medications and the microbiome likely influence each other. Some studies suggest that gastrointestinal inflammation leading to ulcers from Non Steroidal Anti Inflammatory Medications (NSAIDs such as ibuprofen) occur only in the presence of infectious gut microorganisms<sup>13</sup>. Some antipsychotic medications for bipolar disorder and schizophrenia have known side effects of weight gain, and this process appears to be mediated by the microbiome<sup>14</sup>.
Why Should We Care About Inflammation?
Inflammation Promotes Insulin Resistance
According to the 2022 Diabetes Statistic Report published by the Centers for Disease Control5, 37.3 million Americans, or about 1 in 10, have diabetes. Diabetes is a disease where the body either doesn’t make insulin (autoimmune type 1 diabetes) or cannot use insulin efficiently (type 2 diabetes). Most diabetics are type 2, and most cases of type 2 diabetes are preventable and reversible in the early stages.
Inflammation promotes insulin resistance and decreases insulin secretion. This can result in a stepwise progression from impaired fasting glucose, to pre-diabetes, to type 2 diabetes. Elevated glucose levels can, in turn, cause more inflammation and result in a vicious cycle of high blood sugar and inflammation<sup>15</sup>. The phenomenon of leaky gut appears to play a role in this process.
Inflammation Can Cause ‘Leaky Gut Syndrome’
Under the influence of inflammation and stress, the intestinal barrier can become more susceptible to the entry of toxins, antigens, and bacteria7. This is known as leaky gut syndrome. Examples of stress induced leaky gut could stem from severe skin burns or excessive alcohol consumption.
Type 2 diabetes is associated with leaky gut and a more permeable intestinal barrier. In some people, leaky gut may trigger the development of autoimmune diseases, including rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus<sup>16</sup>. Leaky gut is associated with disturbances in the body’s helpful microorganisms: the microscopic universe of the intestinal microbiome<sup>17</sup>.
The human body contains a fascinating microcosm of organisms. The microbiome, also referred to as microbiota or intestinal flora, is a myriad of different microorganisms, including bacteria, fungi, and viruses that coordinate a symphony of functions which are beneficial and protective to their human hosts<sup>18</sup>. These essential functions include metabolism, protection against pathogens, and educating the immune system.
Colonies of different microorganisms are found throughout the human body, such as in the mouth, gut, skin, lungs, urogenital tract, and even the eyes. In particular, the organisms that make their home in the digestive tract are some of the most diverse and numerous microbiota in the human body.
What is the impact of the gut microbiome on health?
An unbalanced gut microbiome, or dysbiosis, can lead to inflammation and chronic disease. Inflammatory Bowel Disease (IBD) is characterized by an unstable, dysregulated microbiome, associated with a disordered immune response<sup>19</sup>. The gut is strongly associated with brain function, and new connections between the intestinal and central nervous systems continue to be discovered.
Multiple high-quality studies have shown a connection between depression and the microbiome<sup>20</sup>. One study showed the probiotic Bifidobacterium to be more effective than a serotonin medication in the treatment of anxious and depressed behaviors. Neurologic diseases such as dementia and Alzheimer disease may originate with gut dysbiosis<sup>21</sup>. Preliminary research (from my alma mater) at East Tennessee State University are uncovering the links between altered gut microbial diversity and heart failure<sup>22</sup>.
Some very good news is that our routines - diet, environment, and medications - have a much bigger impact on microbiome than genetics<sup>23</sup>. Patients with obesity were found to have decreased amounts of the beneficial gut bacteria Bacteroidetes, however, they were able to increase their proportion of this beneficial gut bacteria naturally with weight loss<sup>24</sup>.
<p class="pro-tip"><strong>Learn about </strong> <a href="/blog/blood-sugar-immune-system">how blood sugar affects your immune system</a>.</p>
6 Ways to Reduce Inflammation
1 - Try an Elimination Diet
Elimination diets are a systematic method of identifying inflammatory foods and additives. A major advantage is that no lab testing or other diagnostic tests are required. Symptoms of food intolerance and inflammation can include headaches, hives, itching, skin rashes, fatigue, or difficulty concentrating.
While food intolerances vary greatly from person to person, common problem foods include eggs, gluten, soy, beef, corn shellfish, dairy, processed sweeteners, and artificial food coloring agents. A trained healthcare provider can work with you to eliminate these common culprits completely for 2 to 4 weeks. During this time, potentially bothersome foods must be completely avoided, otherwise inflammatory cellular factors will rise and the elimination period will need to re-start from day one. Next, you can reintroduce the eliminated foods one at a time, while keeping a food diary to record your responses and reactions.
This method of phasing out inflammatory foods, when applied to a group of patients with IBS, resulted in improved symptoms and increased levels of beneficial flora<sup>25</sup>. An elimination diet also helped reduce symptoms in eosinophilic esophagitis, an upper gastrointestinal condition characterized by problems swallowing and heartburn<sup>26</sup>.
You can use an elimination diet to find foods that trigger inflammation in your body.
2 - Eat More Anti-Inflammatory Foods
When it comes to anti-inflammatory diets, there is no one size fits all. This is because individuals differ in their genetic makeup, environmental factors, and the microbiome that has been cultivated over the course of their lifetime. One study showed that 100% of patients with IBD were able to discontinue at least one of their IBD medications if they ate an anti-inflammatory diet, restricted certain carbohydrates, ingested prebiotic and probiotic foods, and modified dietary fatty acid intake<sup>27</sup>.
How can the dietary choices we make change our microbiome health for the better?
There are many ways to feed, cultivate, and enhance your microbiotic flora. Prebiotics are carbohydrates that your body cannot digest, but provide fuel to feed your microbiome. Sources of prebiotics include chicory, dandelion greens, garlic, onions, leeks, asparagus, and bananas. Probiotics are live bacteria and yeasts found in fermented foods like yogurt and dietary supplements. Alcohol disrupts the microbiome, but interestingly, some studies show that this balance can be restored through probiotics and other supportive interventions<sup>28</sup>.
<p class="pro-tip">Recommendation: Eliminate alcohol for a few weeks. As tolerated, try anti-inflammatory foods such as olive oil, green leafy vegetables, nuts (almonds and walnuts), fatty fish (salmon), and colorful fruit (blueberries).</p>
3 - Eat Less Processed Foods
In two groups of patients with similar levels of gingivitis and periodontal disease, those who changed to a diet with low processed foods and animal proteins, and high omega-3 fatty acids, Vitamin C, Vitamin D, antioxidants, and plants, showed a significant reduction in gingival bleeding in just 4 weeks<sup>29</sup>.
<p class="pro-tip">Recommendation: Try incorporating a salad topped with lean meat—like chicken or salmon—for lunch at least three days a week.</p>
4 - Create a Consistent Exercise Routine
In addition to reducing inflammation through diet changes, exercise also promotes anti-inflammatory effects<sup>30</sup>. Talking to your doctor and working with a dietician can help you design a sustainable anti-inflammatory diet that is right for your health and lifestyle.
<p class="pro-tip">Recommendation: Guidelines recommend vigorously exercising for approximately 20-30 minutes at least three times a week.</p>
5 - Practice Meditation
<p class="pro-tip">Recommendation: Start meditating each morning for just one minute. After a few days, increase this to five minutes, then 10, and so on, until you can comfortably manage 20 minutes a day. I personally begin and end each day with meditation.</p>
6 - Get More Regular Sleep
In comparison to people who work during the day and sleep at night, rotating shift workers were 50% more likely to have metabolic syndrome<sup>32</sup>. The value of a good night’s sleep cannot be underestimated.
<p class="pro-tip">Recommendation: Go to bed and wake up at the same time each day. Do not eat or drink alcohol two hours before bedtime. Aim to get six to eight hours of sleep each night by developing an evening and morning routine.</p>
The Bottom Line
Most diseases are inextricably linked to inflammation. Leaky gut is one element of the overall inflammatory process found in multiple chronic disease states. Our intestinal microbiome holds great promise for maintaining health, recovering from chronic diseases, and preventing the inflammatory cascade from ever starting. By making small changes in diet, you can reduce any steady states of inflammation, improve gut health, and lead a healthier life.
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