Inflammation: the brain on fire

A patient came in very upset. She was suffering from headaches and joint pains. She had been to various physicians and had several tests done. She was told that her pain was due to her mood disorder. She felt that she wasn’t being taken seriously, that her doctors wrote it off as “all in her head”.

The reality is that mental illnesses can make you physically ill, and physical illnesses can trigger a psychiatric illness. The common pathway is inflammation

Inflammation is your body’s response to insult and injury. It is normal and necessary. It’s when a part of your body gets swollen, hot and red. Think of when you knock your knee, and it gets inflamed, you wouldn’t want to move it too much thus giving it time to heal. Or of the fever and malaise of flu which keeps you in bed for a few days. Inflammation is part of your body’s defence mechanisms.

Problems happen when inflammation is too much or carries on too long. Chronic inflammation plays a role in illnesses such as diabetes, neurodegenerative and cardiovascular diseases, chronic pain and some cancers. The so-called “diseases of affluence and longevity”.

Inflammation has been implicated in psychiatric disorders. Unless there is a major trauma, the brain does not tend to get red, swollen and hot with inflammation. Rather, inflammatory SOS signals called “inflammatory cytokines” are released. Inflammatory cytokines are higher in people with mood and psychotic disorders. These cytokines disrupt the normal production of serotonin and glutamate – key neurotransmitters involved in psychiatric disorders. The inflammation causes chemical imbalances and so contributes to symptoms.

There is further evidence for the brain disorder-inflammation link:

• People with psychiatric disorders are more vulnerable to infections and autoimmune diseases. Think about your life too: how often did you not get flu right after a stressful period?
• Drugs and situations which increase inflammatory cytokines cause depression in predisposed people. An orthopaedic surgeon friend of mine says that he knows from experience that if he had to saw through a person’s bones, he could expect them to be depressed during the recovery.
• Resistant depression sometimes responds to treatment after adding an anti-inflammatory.

What is causing brain inflammation in the first place? Powerful inflammation promotors is the modern lifestyle of high stress, low exercise and unhealthy diet.

Our modern diet is high in refined carbohydrates and refined oils:

• Refined carbohydrates include all processed sugars and starches; like sugar, corn syrup, concentrated fruit juices, white bread, pastries, breakfast cereals, the list continues. They are rapidly absorbed into the bloodstream, causing spikes (and crashes) of blood sugar and insulin, promoting inflammation. These foods are delicious, have low nutritional content and high caloric content. Simply put, they get you to crave them and then make you fat and sick.
• Refined vegetable oils were sold to us as healthy because they are low in cholesterol and saturated fat. The truth is that vegetable oils do not exist in nature. To extract them we have to use chemical methods which are loaded with omega 6 fatty acids. Omega 6 fatty acids compete with our precious omega 3 fatty acids. (We need omega 3 fatty acids to develop and function properly.) This omega 3/ omega 6 imbalance promotes inflammation.
• Another issue with vegetable oil is that food is often fried or processed with hot vegetable oil, resulting in “advanced glycation end products” (AGE’s), which are very pro-inflammatory.

Of the vegetable oils, coconut oil has the least omega 6’s and is high in omega3’s, making it a healthy choice. Canola and olive oil have less than 10% omega 6’s making them healthier (not “healthy” as such- moderation is key). Oils such as grapeseed oil and sunflower seed oil have over 60% omega 6’s- best to be avoided if possible.

• Our modern diet also adds things like artificial sweeteners, hydrogenated oils (margarine), artificial colourings and flavourants. Our poor bodies do not know how to process these, triggering a host of health issues including inflammation.

There are ways to fight inflammation and to cool your brain.

Unfortunately, while there is some evidence for omega3 and vitamin D supplements or taking of anti-inflammatories, the overall results have been disappointing. It seems as if the answer is going to be less by adding something and more by nurturing a healthy lifestyle.

• Diet: The Mediterranean diet (think veggies, fish, nuts) has proven beneficial, but so has the traditional Japanese, Norwegian and Korean diets. It seems any diet loaded with fresh produce is the way to go.
• Exercise: Exercise reduces all the markers of inflammation (such as C-reactive proteins and cytokines). Not much is needed, 20 minutes of moderate exercise seems to suffice.
• Reduce stress: Treating anxiety or depression with antidepressants such as SSRI’s, reduces inflammation.  But you can experience a great deal of stress, even without a mood disorder, in today’s world. Mind-body practices (yoga, meditation, mindfulness practices) downregulate inflammatory responses.

I am a working mom with two busy kids. Goodness knows I know how hard it is to find time to exercise, meditate and cook wholesome meals. Fortunately, the science behind these endeavours is so positive, that I am motivated to keep trying.