is associated with poorer outcomes , increased risk of cardiovascular disease and so on . Research in 2020 that examined the role of perceived loneliness in inflammation found that individuals who perceived themselves to be lonelier actually had higher levels of the inflammatory cytokine IL-6 . And so I just find that really , really interesting because when we have patients in clinic , we ' re often very focused on diet , and I think we look less at trauma , and stress , and things like that . But it ' s such an important factor to consider when trying to reduce inflammation , too .
Tim : Yes . Loneliness is really considered to be approaching epidemic proportions in Western society . The UK now has a Minister for Loneliness . They ' re treating it so seriously because of all of the health problems that go with it . Loneliness can be related directly to stress , but it can also mean your diet could be less than optimal because you are eating alone and you don ' t have as much motivation to make changes . Once depression kicks in , that will aggravate a whole lot of problems . So , yes , loneliness both aggravates other stress factors , but also of itself will contribute to inflammation .
Lisa : What about sleep ? Because a lot of my clients really struggle with getting to sleep . They tend to stay up very late . Does that contribute to inflammation ?
Tim : Absolutely . A lot of research has been done on sleep , particularly on shift workers , which provides a great model for understanding the effect of sleep deficit on inflammation : shift workers have a much heightened risk of obesity and metabolic disease , and insulin resistance , and all of that is underpinned by inflammation . Shift work and poor sleep habits could also be a marker for poor diet , which , of course , in turn will affect gut microbiome and inflammation . All of it ' s related .
Poor sleep habits affect all of our systems . They can affect mental health and play a part in depression as well - all related . So , yes , getting good sleep habits is really a cornerstone . Diet , sleep , exercise , probably the Holy Trinity of good health . Plus , of course , social connection .
Lisa : So , we ' ve talked about some of the things that cause inflammation . A lot of conditions are characterised by unresolved chronic low-grade inflammation , right ? Can you take us through some of those ?
Tim : Okay . Let ' s go through a list . Cardiovascular disease , type 2 diabetes , metabolic syndrome , autoimmune diseases , so , rheumatoid arthritis , Hashimoto ’ s disease , inflammatory bowel disease , that ' s going to be Crohn ' s and ulcerative colitis . And then there are neurological conditions , so potentially Alzheimer ' s disease , multiple sclerosis . Then cancer , particularly colorectal and breast cancers , have some inflammation as part of that as well . So , there we go . All the big ones .
Lisa : Yes . So , we ' ve really got to be considering , I guess , resolving chronic inflammation in pretty much every client that comes in , don ' t we ?
Tim : Yes , correct .
Lisa : Yes , and I think a lot of practitioners really focus on trying to reduce inflammation in clients who display obvious chronic inflammation . But is there a difference between just reducing inflammation and resolving it ?
Tim : There certainly is . So , maybe a good analogy would be a raging fire burning in a closed space : if you reduce the oxygen to it , the fire will dampen down , but it will likely still be there . So , that ' s helping to reduce it . But if you want to resolve it , you throw a bucket of water on it and you get rid of the inflammation .
My own research program has been a lot of work in pressure ulcers . Pressure ulcers are a chronic inflammatory condition : that constant blocking of the blood supply , say , to the hip , or the leg , or the heel , results in a wound . But that wound doesn ' t heal because the inflammation just persists and persists . Helping to resolve the inflammation allows the body to heal itself , and to heal the wound . So it ’ s one thing to help reduce inflammation - and there are lots of lifestyle interventions to contribute to that - but it ' s another thing to resolve it completely . And that ' s getting into , I guess , a lot of the chronic diseases . So , yes , there ' s a subtle difference : reducing is good , but resolving is just as important .
Lisa : I ' ve read in some research that there are broken pathways , that some of the pathways that help to reduce our inflammation aren ' t doing that properly .
Tim : Yes .
Lisa : And it ' s typically in a lot of those clients you mentioned , the ones who are obese or have that chronic inflammation , metabolic syndrome , and so on .
Tim : Exactly . This is very much emerging research , but when looking at those metabolic pathways we ' re talking about our essential fatty acids of the omega-3s and omega-6s . They are metabolised in the longer chain forms . For the omega-3s , it ' s going to be EPA and DHA . For the omega-6s , it ' s arachidonic acid . But it doesn ' t end there . There ' s a whole cascade of further metabolites of those fatty acids , which are involved in helping to resolve inflammation . And it ' s pretty complex stuff . It ' s emerging research , but there ' s interest in these metabolites ’ potential to help nip inflammation in the bud . These are called specialised pro-resolving mediators , and it ' s something we ’ ll be hearing more about . So , it ' s really the next step from our fish oil and arachidonic acid . It ' s really what they ' re metabolised into . And there ' s a whole very complex pathway that I still struggle to understand . It ' s fascinating stuff .
Lisa : Totally . Yes , my understanding from my reading is that we all produce them naturally in that acute inflammation .
Tim : Yes , correct .
142 | vol29 | no3 | JATMS