What you need to know about the chronic condition that affects us all
Inflammation is linked to everything from your immune defences to arthritis, asthma and heart disease. So how can you fight it? By Luisa Metcalfe
Yalda Alaoui was just 12 when she first experienced stomach pains, which were later diagnosed as IBS. For years, she lived with abdominal discomfort, until her late 20s when she was diagnosed with the autoimmune condition ulcerative colitis, a bowel disease where the colon becomes inflamed and develops ulcers.
She tried to uncover the root of her problems by talking to doctors and other medical experts, but to no avail. Then, just five years later, in 2012, her health took a terrifying turn: she almost died from another autoimmune disease, a rare blood disorder.
“I travelled the world to see the best doctors, but they couldn’t tell me anything,” says Yalda, 43, a former financier who lives in London. “One day I went to a haematologist who happened to look at my inflammation markers and that’s when the penny dropped: inflammation was the factor in common between my diseases.”
“Inflammation” has become something of a wellness buzzword, with lifestyle gurus promoting anti-inflammatory foods, such as açaí bowls, on their Instagram feeds; turmeric is bandied about as the must-use ingredient for its antiinflammatory properties; while juice bars offer kale and blueberry smoothies for the same magic ability.
But behind this dietary trend is a serious health issue. Inflammation is a risk factor for dementia, diabetes, heart disease and cancer, not to mention a player in debilitating autoimmune conditions such as rheumatoid arthritis and asthma.
So what is it? “Inflammation is the body’s response to an invader or to fighting infection, and it occurs in the body at all points,” says Dr Zak Uddin, a GP from Chorley, Lancashire.
When we are ill, have a cut or injury, this acute inflammation is a crucial part of our immune defence, ensuring that we heal and recover. “If you have a viral infection, your immune system’s response causes inflammation, which is why you get muscle aches and pains. Inflammation is part of the body’s normal functioning,” he says.
But inflammation can also turn bad. “This is where inflammation can trigger the body into thinking its own tissues are foreign so it attacks them. Where that’s relevant at the moment is that we see people who’ve had Covid and the virus has triggered an immune response called systemic immune response syndrome (SIRS), where the body tries to overwhelm the infection but overwhelms itself and attacks it.”
Inflammation can also silently erode health over a long period of time, creating a vicious cycle of premature ageing and damage in the body, increasing infection risk, susceptibility to certain cancers and the likelihood that we will become prone to a chronic disease, says immunologist Dr Jenna Macciochi. How can you find out if you are inflamed? Dr Uddin says a blood test via your GP will pick up the markers of inflammation: ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein). However these tests are most commonly used to detect acute inflammation, for example during an infection, or a worsening of a condition, such as rheumatoid arthritis.
But they may not pick up chronic, low-grade inflammation – usually caused by a diet high in junk food, sugar and alcohol, a sedentary lifestyle, smoking, obesity and Vitamin D deficiency – which can be a gradual process. The good news is that you can also lower inflammation markers by following a healthy diet.
Some people may find that a cluster of symptoms including fatigue, pain, gastrointestinal problems, weight gain or loss, headaches and persistent infections are the only external clue to the fact that they are inflamed.
In fact, many people don’t know they have this kind of inflammation until they are diagnosed with something else. After 10 years of research into her conditions, Yalda came to the realisation that an abrupt change in her diet and lifestyle as a child had caused inflammation, which then sparked her two autoimmune conditions.
“We all carry weak genes and I have autoimmune problems in my family,” says the Iranian-Moroccan mother-oftwo. “But there are other factors. I lived in Morocco until I was 12, then we moved to France. I went from eating a Moroccan diet where everything was homemade – even the bread – to having processed biscuits, crème caramel and cheese. That abrupt change disrupted my gut flora and that’s when I first developed IBS.”
Yet when she was diagnosed with ulcerative colitis in 2007, doctors prescribed drugs to dampen down the symptoms of her disease, rather than tackling the underlying causes. “Corticosteroids mask the symptoms; they don’t shut down the underlying inflammatory pathways. So as soon as you stop
Chronic, low-grade inflammation is usually caused by junk food, sugar and alcohol
taking them, the symptoms express themselves again,” says Yalda.
“Other drugs, such as immunosuppressants, shut down the immune system, making inflammation go down artificially, but also exposing the patient to viruses and other consequences due to lower immunity.”
Then in 2012, pregnant with her third child, her health rapidly deteriorated. The combination of her pregnancy (which alters the immune system – Yalda ended up in hospital with two colitis flare-ups while pregnant with her sons, now 12 and 14), her predisposition to autoimmune disease and – unbeknown to her – chronic inflammation sparked a very rare but near-fatal condition, autoimmune haemolytic anaemia.
“I was rushed to hospital where they discovered that my haemoglobin levels, which should be around 11-13 for women, had dropped to 4.7. At three, you’re dead. I lost my baby and I could have died at any minute from a heart attack, a blood clot – or even the complications of a common cold,” she says.
She was admitted to the haematology ward of Hammersmith Hospital in London, where she was given over 100g of intravenous inflammation-lowering corticosteroids a day, along with regular blood transfusions. After she was discharged she had to return for regular tests and blood transfusions until her condition stabilised.
“We all carry these ‘weak’ genes,” says Yalda. “When you have chronic inflammation, you can activate these poor genes. In addition, your immune response won’t be as good,” she says.
So how can we best combat inflammation? Broadly speaking, the Mediterranean diet is a style of eating that has been shown to look after our overall health and boost the diversity of our gut microbiome, the trillions of bacteria that live in the gastrointestinal tract, and keep inflammation in check.
“The reason that having a healthy gut microbiome is important in lowering inflammation is that 70 per cent of our immune system is housed in the gut,” says Yalda. “If you have poor gut health, you have a poor functioning immune system.”
“The Mediterranean diet is packed full of minerals, vitamins and plant compounds that have antioxidant properties and fibre, which helps to nourish our gut microbes,” says registered dietitian Helen Bond. “It typically includes fish (including oily fish such as sardines and mackerel, which are rich in anti-inflammatory omega-3 fatty acids), poultry, and less red meat than the usual diet eaten in the UK, plenty of vegetables, fruit, olive oil,