05 Jan Fighting Inflammation
It’s hard to avoid inflammation in today’s world. Here are some tips on how to manage it.
By Suzi Morales
Before she was diagnosed with osteoarthritis, Tonya Horton traveled frequently for her job as the executive vice president of central operations of education at the nonprofit New Teacher Project. Then, in 2017, she noticed some pain in her knees after one of her daily workouts.
When the pain didn’t go away, she saw her general practitioner and eventually an orthopedist, who diagnosed her with osteoarthritis.
Today, Horton, now 51, deals with her osteoarthritis with a combination of the nonsteroidal anti-inflammatory drug (NSAID) Celebrex, physical therapy, regular exercise including yoga, and acupuncture. She uses an app to track her symptoms and mood.
“What it has meant for me is the need to be more intentional in my life,” she notes. “I can’t do what I used to do.”
Horton plans her days around her disease to allow flexibility for how she might feel. “I can’t just wake up and say, ‘I’m going to go run errands today,’” she says. “I have to figure out where am I going, how long am I going to be there, and while I’m there what am I going to do, because I never know when the pain is going to be so bad that I have to pack it up and come home.”
Before the pandemic, Horton was able to scale back her business travel. She needed accommodations like extra legroom on flights and in cars. Her osteoarthritis even affected her networking, as sometimes she is not able to walk between venues and talk shop with colleagues at conferences.
What Is Inflammation?
Arthritis is one of numerous conditions associated with inflammation. With inflammation implicated in a wide range of conditions from heart disease to gastrointestinal problems, it can be hard to define.
According to Dr. Anca Askanase, director of the Columbia University Lupus Center, inflammation is “the body’s response to an invasion, to something that is changing the normal functioning and the normal state of tissues.”
“When we think about inflammation, we are describing infiltration of immune cells into various locations,” says Dr. J. Michelle Kahlenberg, assistant professor for the Division of Rheumatology in the Department of Internal Medicine at the University of Michigan Medical School.
In the past 10 to 15 years, researchers have learned that inflammation is involved in conditions like obesity, heart disease, and Alzheimer’s disease.
“The more we’ll get an in-depth understanding of these autoimmune and inflammatory diseases, we’re probably going to understand more and more that actually all of these diseases are diseases of the whole body as opposed to just the joints or the skin or the gut,” Askanase notes.
Askanase says inflammation happens “all the time. You get a scrape, you get a cut, you have a cold—the first response of the body in trying to take care of the problem is some acute inflammation.”
Although isolated inflammation can be a normal part of the body reacting to any number of stressors, chronic conditions like Horton’s osteoarthritis can affect daily life.
Kahlenberg recommends what she calls her “big five” of lifestyle changes that can help prevent chronic inflammatory disease.
Diet: Kahlenberg believes that autoimmune disease, which is frequently associated with inflammation, is on the rise, at least in part due to the rise of the simple-carbohydrate, high-fat diet. She recommends cutting down on foods that are high in simple carbs and fats as well as processed foods, which likely contain chemicals.
Kahlenberg tells her patients, “If your grandmother didn’t recognize it as food, don’t eat it,” a paraphrase of the advice made popular by food journalist Michael Pollan.
Exercise: “There is good data on the anti-inflammatory effects of exercise,” notes Kahlenberg. “You don’t have to do a HIIT workout every day, but get in your steps and avoid being sedentary.
Askanase says that maintaining a healthy weight and decreasing extra fatty tissue can help to dampen inflammation and improve efficacy of treatments
Sun: Kahlenberg warns against excessive sun exposure. Her research indicates that repetitive sun exposure in people who have risk factors for autoimmune diseases could be a factor in leading to such diseases. Further, there is no difference in the negative effects of too much sun on inflammation between people with light and dark skin.
Smoking: The lungs have a large surface area lined by cells that are involved in the body’s inflammatory response, Kahlenberg notes. She says inflammation in the lungs is a risk factor for diseases including rheumatoid arthritis and certain types of lupus. “Smoking is another way that we fill our bodies with chemicals and irritate our immune system and cause it to do things it’s not supposed to do.”
Sleep: One factor in preventing inflammation is getting enough sleep. “We don’t fully understand why,” Kahlenberg says, but “there’s a definite connection between brain signals and the rest of the body. The brain is much more connected to the body than we give it credit for.”
Kahlenberg cites a 2018 study in which researchers found that individuals with risk factors for systemic lupus erythematosus, the most common form of lupus, were more likely to develop the disease if they got fewer than seven hours of sleep a night.
However, Askanase warns against believing that lifestyle changes are a magic bullet to prevent or treat inflammatory conditions. Patients should work with their doctors to come up with the best balance of pharmacological and other treatments, as does Horton, who relies on a combination of NSAIDs and holistic measures.
“I find it very disturbing that people make these big statements where this or that cured my arthritis,” Askanase says. “It is possible in particular individuals that diet and healthy lifestyle were curative, but I think for the majority of humans that’s not going to be enough.”
Kahlenberg frequently sees patients who ask what they could have done to avoid developing autoimmune diseases. “Sometimes there’s just bad luck involved,” she says. “I don’t want to shame anyone.”
Inflammation’s Effect on Women
Kahlenberg notes that most autoimmune diseases, which are frequently associated with inflammatory symptoms, have a female bias. Lupus is the most extreme, with about 9 out of 10 lupus sufferers being women.
This discrepancy is not fully understood, but Kahlenberg says there is some indication that women’s genes are activated differently than men’s. She cites a study that found that UV light created a greater interferon response in women than in men. Such a response impacts the likelihood of “switching between inflammation with a small i to inflammation with a big I.” Ironically, the difference in interferon response that apparently leads to greater rates of autoimmune diseases also helps protect women from viral infections like severe COVID-19.
As for women who are diagnosed with inflammatory conditions, Horton recommends, “Do research on the disease and how it impacts women like you.” She also encourages them to build community and connect with advocacy organizations, like the Arthritis Foundation, with which she is involved. “And be your own advocate.” DW
Suzi Morales is a freelance writer and type A personality who writes on subjects of interest to other type As, including health, fitness, careers, and workplace issues.
Do False Assumptions about Black Women Lead to Health Disparities?
When Tonya Horton first saw an orthopedist to diagnose her osteoarthritis, the doctor remarked that she was not expecting to see someone of Horton’s age with “the knees of a 70-year-old woman.”
Horton, in her late 40s at the time, says, “I always thought arthritis was for older people.” She later found out that osteoarthritis is common for African American women of her age. “My doctor should not have been surprised.”
In the years since her diagnosis, Horton has taken a proactive approach to researching health care. In 2020, she earned a master’s of public administration from Rutgers University, completing a capstone project researching disparities in health care among Black women.
In her study of the literature around the topic, she learned that, even correcting for factors such as poverty, class, and education, Black women have higher rates of many diseases, including conditions connected to inflammation such as arthritis and heart disease. Black women also are more affected by lupus than other demographic groups, notes Dr. Anca Askanase, though the reasons for this discrepancy are unclear.
Horton’s paper cites research on biases and stereotypes leading to Black patients being treated differently than white patients, such as a belief that Black people can tolerate more pain, which results in lower levels of medication prescribed.
“Oftentimes, as Black women, we find that we’re not heard, we’re not listened to, our pain is not necessarily believed to be at the same level as other people’s pain, so we don’t get the medications that we need,” she says. “It was fascinating all the things I learned that aligned to my lived experiences.”