1. Inflammation

2. In recent times inflammation has become a buzz word It gets blamed for just about everything Is this justified? Inflammation is ultimately increased blood flow to an area that brings with it activated immune/inflammatory mediators There are two types of inflammation: acute and chronic

3. Acute Inflammation Essential for life An important role in a healthy immune system In response to – Infection – Illness – Trauma – Stress Activates immune mediators such as cytokines, interleukins, tissue necrosis factor alpha (TNF-α), interferons, complement proteins Each of these are chemical messengers that promote inflammation and increase membrane permeability (allowing things in and out), increase blood flow (delivering more WBCs, platelets etc), increase oedema (swelling) and facilitate the healing process

4. Chronic Inflammation When an infection, illness, injury extends beyond 3 months it is considered chronic Chronic disease all share an inflammatory pathway Did the inflammation cause the disease or did the disease cause the inflammation? Either way, the reduction of inflammation has significant benefits in the reduction of signs and symptoms

5. Inflammatory Contributors Many things promote inflammation – Disease – Food – Stress – Pollution – Injury – Infection – Obesity – Hormones

6. Disease Many chronic diseases share chronic inflammatory pathways – Inflammatory bowel disease – Psoriasis – Most other autoimmune diseases – Arthritis – Cardiovascular disease – Diabetes – Leaky gut (increased intestinal permeability syndrome) – PCOS – Depression – Alzheimer’s – And so many more

7. Food Sugar and processed carbs have an ability to activate inflammatory pathways (Miller & Adeli, 2008; Nomura & Yamanouchi, 2012)Miller & Adeli, 2008Nomura & Yamanouchi, 2012 Polyunsaturated fatty acids (PUFAs) are more readily oxidised than any other fat (think margarine and canola oil) Extracting oils fro their natural product increases exposure to oxygen. For this reason, seed oils (full of PUFAs) and can be rancid when we eat them Omega 6 to omega 3 imbalance promotes inflammation and contributes to disease such as heart disease and other inflammatory disorders (seed oils are full of omega 6)(Simopoulos, 2002)Simopoulos, 2002 Processed foods are likely to also contribute to inflammation

8. Stress Activates the sympathetic nervous system “fight or flight” Pro-inflammatory hormones are secreted Cortisol and epinephrine in excess are inflammatory Stress and cardiovascular disease are linked: the higher your stress the greater the chance you will develop CVD (Steptoe & Kivimaki, 2012)Steptoe & Kivimaki, 2012

9. Fight or Flight Image source: http://melcollie.com/2014/11/19/mel-collie-anxious-stuck-breathe/

10. Pollution Working in polluted environments increases inflammatory markers. This correlates to adverse cardiac events (Ruckerl et. al., 2007)Ruckerl et. al., 2007 Polluted environments are particulary inflammatory to the pulmonary system Asthma can be triggered by dirty, dusty environments and also stress – all are pro-inflammatory (Chen & Miller, 2007)Chen & Miller, 2007 COPD (chronic obstructive pulmonary disease - which includes emphysema and chronic bronchitis) is usually caused by smoking and dirty working environments Asthma and COPD are both inflammatory conditions

11. Injury Trauma to the body increases inflammation (sprain, tear, break etc.) Cellular damage triggers immune mediators to increase inflammation to start the repair process This is acute inflammation and will resolve as the injury heals However, if the injury is to an organ (particularly via ischaemia) this is a pro-inflammatory process and can contribute to low grade inflammation

12. Infection The immune system is always on alert for foreign invaders (bacteria, splinters etc.) The body recognises foreign substances due to non-self antigens on them Self antigens mean the body recognises them as ‘self’ therefore an immune response will not occur (in autoimmunity the body does not recognise ‘self’ and attacks it’s own tissues) Antigens are types of proteins found on pathogens (or what the body thinks is a pathogen) that cause an immune response to occur Pathogens are disease causing organisms Antibodies are produced in response to specific antigen (we make antibodies against colds, flus, measles etc.) Antigen and antibodies are specific to each other (think lock and key) The antibody attacks the antigen and the binding process marks that substance for destruction via the immune system This process is pro-inflammatory Recurrent and unresolved infections create low grade inflammation and can contribute to chronic disease (tooth decay and heart disease)tooth decay and heart disease

13. Obesity Adipose tissue is hormonally active Adipose is capable of secreting adipokines (lipid derived cytokines) i.e. leptin Adipokines can be pro-inflammatory (Fantuzzi, 2005)Fantuzzi, 2005 Obesity is characterized by a state of chronic mild inflammation, with raised circulating levels of inflammatory markers and the expression and release of inflammation-related adipokines generally rises as adipose tissue expands (adiponectin, which has anti- inflammatory action is an exception). (Trayhurn & Wood, 2005)Trayhurn & Wood, 2005

14. Hormones Leptin (an adipokine) – involved in metabolism regulation and suppressing appetite Many obese people are leptin resistant – leptin is also pro- inflammatory (La Cava et. al., 2003; Ikuni et. al., 2008)La Cava et. al., 2003Ikuni et. al., 2008 Many other adipokines are pro-inflammatory. “Adipokines play a significant role in the pathogenesis of a low-grade inflammation associated with obesity and metabolic syndrome, and in chronic inflammatory and autoimmune diseases such as rheumatoid arthritis (Stofkova, 2010)Stofkova, 2010 Cortisol – pro-inflammatory in excess (triggered by stress) and can contribute to heart disease (Nijm & Jonasson, 2008)Nijm & Jonasson, 2008 Insulin has anti-inflammatory roles but people who are insulin resistant will not get this effect as quickly or as efficiently (Dandona et. al., 2012)Dandona et. al., 2012

15. What can be done about this? De-stress (HIT has an ability to lower stress unlike any other form of exercise) Get fit Get more sleep Reduce caffeine intake and drink more water Eat more saturated fat (it is the most stable and least likely to oxidise i.e. become inflammatory) and omega- 3 (fatty fish and grass fed animal products) Eat less processed carbohydrate AND less processed food in general Eat less sugar (especially fructose)