Chronic Inflammation Explained (Dietitian’s Guide to Healing)

Chronic inflammation is one of the most common underlying root causes of nearly every single chronic disease, a number of different symptoms, especially that women experience in hormonal fluctuations, and so much more. So today we're gonna dive into my perspective as a dietitian in working with thousands and thousands of women over the last 12 years and patterns that you wanna look for. We're going to talk about ways that you can combat inflammation and how to think about it from a mechanistic standpoint, getting to the root cause of your symptoms. So I am going to start with the fact that last night I was part of an amazing panel with a physician and Dr. Tara Scott and Emily, a nurse practitioner. And we got into a lot of discussion around perimenopause and menopause and hormones. And an underappreciated part is the interconnection between hormones and inflammation. So what we know is that as women are going through perimenopause and menopause, their risk for inflammatory conditions goes up. That can include autoimmune diseases like Hashimoto's fibromyalgia, and so many more. And then it can also include metabolic conditions that have inflammation at the origin. So that can be, you know, high cholesterol, changes in your total lipids, increases in insulin resistance, etc. And so there's a, there's an interconnection between inflammation and these metabolic conditions. And also from an immune standpoint, because inflammation is the is generated from a change in your immune system response that can increase your risk of autoimmune disease, but they're very closely tied to hormones. So what we know is that increases in hormonal imbalances increase the risk of chronic inflammation because as women are going through postpartum, perimenopause, menopause, and we're experiencing changes in hormones that can change our immune system and our immune reactivity to everything— toxins, foods that we're exposed to. It can change the gut microbiome, and the majority of your immune system resides in your gut microbiome, and that can generate symptoms. And at the same time, we know that having higher levels of chronic inflammation and insulin resistance can drive more hormonal imbalances. So what I typically will say is that when women are so focused on, like, the fact that they have hormonal dysregulation or symptoms, is that I'll say, let's try to make sure that you have balanced blood sugar and an anti-inflammatory protocol because that will help the downstream effect of your hormones. But I think highlighting the fact that this is bidirectional is really important because it can help make a lot of sense of why you're experiencing the symptoms that you're experiencing. Another story that I shared last night was because there was a question about like, how has your nutrition philosophy changed in the 12 years that you've been practicing? And one of the things that I talked about that I haven't shared in a very long time was that I started in 2014. Prior to that, I was at the Cleveland Clinic Wellness Institute, and in 2014, we started the Cleveland Clinic Center for Functional Medicine, which was the first hospital-based functional medicine center in the world in an insurance-reimbursable model. And what was so fascinating was that the majority of the patients that we were seeing— and we were seeing so many patients because I don't think the hospital really thought that functional medicine was going to take off. And then it— within the first month, we were like on a 500-person waitlist. Then a few months later, we were on a 2,000-person waitlist. We were hiring doctors, dietitians, nurse practitioners, and I was training all the new dietitians. And they like couldn't get enough practitioners fast enough because of the high demand from everyone wanting to come see us. And it was so interesting because majority of people were women in midlife. And so I shared that at the time, in being younger, I didn't understand why there were so many women who were like crying in front of me in their appointments, feeling so defeated and feeling like they were trying everything and still not getting the answers that they needed, and going from doctor to doctor and feeling dismissed. I didn't understand how much that hormonal fluctuation played such a role in increasing a lot of these other symptoms. And then the other thing that I I didn't fully have an appreciation for at the time was that as we were implementing or having them implement the nutrition protocols, because every person that saw a doctor had to see a registered dietitian, and we were implementing these blood sugar balance, anti-inflammatory nutrition plans that were very personalized to each person. And then in like 6 weeks, they would come back and be like, I feel so amazing. And of course, they were on supplements, and sometimes the functional medicine doctor would start them on hormone replacement therapy, but they'd be like, I just feel like I'm a new person. In such a short period of time after years and years of struggling, and actually after years of seeing providers in the same hospital that were more conventional that were continuing to feel dismissed. And so it was such a fascinating— like, I, I was just like so young at the time and seeing so many women in front of me just crying, feeling like they were so misled and felt made to feel so crazy. And realizing how much these changes at a certain point in your life where like what you used to do is no longer working for you and it feels like you're doing everything but you're not seeing the results and you're not getting the answers that you want from your doctor and how much that can impact you on a mental level. And then how much the nutrition and lifestyle pieces, when you can really nail them, can make such an enormous difference. So it's not that my approach has really changed all that much because I feel so fortunate that I started my career under some of the most incredible physicians of our time, between Dr. Michael Roizen, Dr. Mark Hyman, Kristen Kirkpatrick, the dietitian that trains me, and knowing that these doctors so early on were talking about the importance of blood sugar, inflammation, hormones, etc., etc., and how much those were the missing pieces. And now we're hearing more and more about the importance of this across many different channels and practitioners. But I think the thing that has shifted for me is like understanding why these things work so much more than I was able to in the very beginning. And also an interesting note is that I realized things were really working when doctors within the hospital started becoming my patients, doctors who weren't functional medicine trained but were like, oh, clearly something is working. Like I'm seeing this patient that had been struggling so much and then came comes back to us and is feeling so good. And then the doctors became my patients. And that was really interesting because then I could teach them because they had the same symptoms, right? It's like if you don't believe in these things and you're the provider and you're dismissing the people, they're coming from a genuine place of like being indoctrinated by the, the conventional medicine training system and truly not believing that these things are important. And so once they were able to see it for themselves after seeing the transformation in some of their patients, I was like, okay, we are really on to something. So all of that to say, we're going to talk about inflammation today. I'm going to take you through some of the most important underlying drivers of inflammation, is where I want to start. So the first one, underlying driver of inflammation, is poor metabolic health or high blood sugar. And like I said, there's a bidirectional correlation here, so they both impact each other. Poor metabolic health, when you have elevations in your blood sugar throughout the day where you're on this blood sugar roller coaster, every time your blood sugar is spiking, it, it generates more of an inflammatory cytokine release, which over time creates more of this chronic inflammation buildup. So we see a direct correlation there. And then there's also such a role that inflammation plays in cardiovascular health. So it's estimated, I believe I, I might have this statistic wrong, but it's around 50% of cardiovascular disease is actually driven by inflammation. A lot of preventative Cardiologists are talking about this. So there's such a connection between all of this. Number 2, excess body fat and abdominal fat distribution increases your risk of inflammation. And so a lot of times the connection can even be from eating a high glycemic diet that increases your blood sugar fluctuations, that generates more insulin resistance where you're producing— your pancreas is producing more insulin because your cells become resistant to that insulin., and that requires you to generate more for your pancreas to produce more insulin so that then you can get that glucose into the cell. When you have more insulin, it increases visceral fat, which increases the cytokine release. So when you have more visceral fat around your abdominal area, that is actually a greater marker of risk of inflammation than even total body weight. That's why we always recommend starting with a waist circumference and tracking your waist circumference over time because of how much that can impact your risk of inflammation and then your risk of every single chronic disease, from cardiovascular disease to cancer to osteoporosis to Alzheimer's disease. These are completely connected to the inflammatory response. Next, we have hormonal changes through perimenopause and menopause. Estrogen is an anti-inflammatory hormone, and as women's estrogen levels go down, it can increase increase the risk of inflammation. Your body— it's harder for your body to combat inflammation and insulin resistance as your hormones are changing. And then, like I said, the inflammation drives more of those hormonal imbalances, which is why nutrition lifestyle cannot be skipped. This has to— I said last night, the two panelists, the amazing panelists that I was talking with that were doctors, an amazing doctor who I've looked up to for so many years, and then a nurse practitioner who's incredible, you know, talking about hormone replacement therapy and all the things that they factor into hormone replacement therapy. And I kept having to go back to say, but none of these things matter if you have not changed your diet to be anti-inflammatory and insulin sensitivity promoting, that being the foundation. It has to be the foundation in order to support your hormones. The fourth is imbalances in the gut microbiome and dysbiosis. So as I said, the majority of your immune system resides in your gut, more than 70%. Of your immune system resides in your gut. So when you have changes in your gut microbiome, which also happens when your hormones change, then you may have higher levels of more dysbiotic bacteria, not as much beneficial bacteria. And this can generate something called dysbiosis, which is a very common term in the space of functional medicine, which can then increase inflammation. So what we know is that, you know, at the heart of so many of the interventions that we do, especially in when we're looking at lab results and we're looking at gut microbiome testing, is actually shifting the balance of bacteria to be more beneficial bacteria species that help to increase that anti-inflammatory release. We also see if you run a stool test— and not talking about a stool test that's done in conventional medicine where typically they're just looking at whether you have C. diff or not. It's an actual full comprehensive stool test that I've been running for the last 12 years and looking at the not only bacterial markers, but then you can also look at inflammation markers that present in the stool. So there's markers like calprotectin, IgA, secretory IgA, and EPX that will show up that can tell you if you're experiencing more inflammation in the gut that then can impact so many different inflammatory symptoms throughout your entire body. So think about fatigue, chronic fatigue, brain fog, a lot of GI issues, of course, but then also skin issues. We see this very commonly from rosacea to acne to skin dryness to psoriasis to so many different skin conditions that are a topical, visible sign of underlying inflammation that so often is tied back to our gut health. And then the fifth is gut barrier dysfunction or leaky gut. So leaky gut is so interesting. I created a course on leaky gut so many years ago because it really is the heart of so many issues that women experience and can create so many different symptoms. For a very long time, conventional medicine doctors, they hated the idea of leaky gut. They were like, leaky gut isn't a thing. And in the course that I co-created at Case Western Reserve School of Medicine about 8 years ago, I would screenshot how many— go to PubMed and then see like over the course you can see how many research studies are published every year under a specific term. So I would like search leaky gut and then see how many times leaky gut was mentioned in PubMed in the research. So leaky gut is also called increased intestinal permeability. So when we look at the number of research studies published in PubMed on intestinal permeability, it was like about 100 research studies in 1980, by 1990, like 150, by 2000, above 300. By 2010, we're looking at about 500 research studies. By 2020, we're looking at about 1,300 research studies. By January of 2021, 17,479 research studies comprehensively. And then by— if we look at all of the research that's been published from 1929 to 2026, and we have 32,646 research papers that, uh, that have the word intestinal permeability as part of the research study. So just from January of 2021, where I documented 17,479 research studies, to— let's just see the difference between 2022 to 2026. Thus far, we're looking at 2021 to 2026, and there's been 13,994 research studies. All that to say there is skepticism that has occurred in functional or in conventional medicine with the idea of there being issues with, you know, the lack of research and over-exaggerated focus. But as more and more research studies come out, it's showing that increased intestinal permeability, otherwise known as leaky gut, which means that the lining of your gut has separations, um, creating essentially like holes— I know it's not the most medical term, but holes in the lining of your intestine that can increase your inflammatory response because it essentially allows for immune cells to transfer through the gut lining, or it allows for various molecules to transfer through the gut lining, which is a single-cell layer, and then can be attacked essentially by the immune system, which is on the other side of that gut lining. So all that to say, the absence of a correlation in research studies does not mean an absence of correlation in real life. And we absolutely see that in this case. So what we know is that having a poor diet, having high levels of unresolved stress, a lot of alcohol consumption, increased exposure to glyphosate from non-organic foods can possibly alter your intestinal permeability, increasing intestinal permeability or leaky gut, which then increases your risk of food sensitivities, allergies, um, malnutrition, immune activation, which can then increase adverse symptoms and your risk of any kind of inflammatory disease. So what we know is that an increased risk of intestinal permeability could be driven by advanced disease severity. It could be driven by increases in inflammation, underlying inflammation that's already happening that creates more of this vicious cycle of increased leaky gut that then drives more inflammation. It could be caused by dyslipidemia, meaning that you have high LDL, high triglycerides, low HDL. It could be tied to hyperglycemia or high levels of glucose, hemoglobin A1C, fasting insulin.. It can also be driven by having an elevated waist circumference or a higher waist circumference or carrying more body fat as a whole. And then the Western-style diet, meaning high alcohol, um, eating not enough nutrients, nutrient deficiencies, um, excessive energy intake that is also tied to not getting the nutrients that you need, which can then lead to a host of symptoms from abdominal distension, difficulty digesting food, abdominal pain, adverse food reactions, constipation, diarrhea, fatigue, joint pain, cognitive decline, brain fog, acne, skin rashes, and, um, so much more. It's also tied to a number of different diseases, from depression to anxiety to autoimmune diseases to inflammatory bowel disease, which is technically an autoimmune disease, type 2 diabetes, cardiovascular disease, nonalcoholic fatty liver disease, and on and on and on. So you can see how that is another common driver of inflammation that can be modified through nutrition and lifestyle. So as a recap, the 5 key drivers of underlying chronic inflammation that we see are: 1, poor metabolic health and high levels of blood sugar imbalance or insulin resistance; 2, excess body fat and abdominal fat distribution, which is also tied to insulin resistance; 3, hormonal changes through perimenopause, menopause, and even postpartum; 4, imbalances in the gut microbiome and increases in dysbiosis; and 5, gut barrier dysfunction or increases and leaky gut. The research shows that chronic inflammation is a major driver in a number of different symptoms. I already listed some of those when we were talking about leaky gut, but this can also include— generally speaking, all chronic inflammation can be tied to more than 100 symptoms that have been linked to in the research. Many, many months ago, I had Dr. Will Bulsiewicz on the podcast who had written Plant Powered Plus and cited in that the research that he had found showing that chronic inflammation is tied to over 100 180 symptoms in the research that exists. The good news is, is that with the right approach, you can actively reverse this, and it doesn't even matter your age. Last night when I was speaking on the panel, there was a number of questions about like, well, what happens to women over the age of 60? What happens to women over the age of 70? And it is still absolutely possible to combat the inflammation that has built up over the years in ways that are truly remarkable. So the— it's never too late to start. I want to say that again, it's never too late to start. And we have so many examples examples of that within our community. We have Joan who had shared, I just got lab results back after doing the one of our, our programs and continuing with the Being Collective, which is my membership, and my cholesterol, glucose, insulin, hemoglobin A1C, and inflammation are all down. I still have work to do but feeling super motivated because it is motivating. It's so motivating when you start to tie your nutrition, lifestyle, and supplement changes to the results that you can see that are off the scale. Of course everyone cares about the scale to some extent, but what we really need to be focused on is these underlying metrics of our overall health. Another example was Liddy who said, I've lost 16.8 pounds since January 13th when I started eating the Being Collective plan. I've cut inflammation in half, glucose in half, etc., etc. This stuff works. And what I want to highlight is that you don't have to be obsessively restrictive or take 10 million supplements in order to get these results, because the internet is flooded with so information about how avocados are toxic, or tomatoes are toxic, or all these foods are toxic, dairy is toxic for everyone, etc., etc. And so often the people that are on the internet don't have a lot of credentials. So essentially, I think of the buckets of information that you can get on social media and break it down to: one, conventional doctors who are, you know, now on social media and have more of a social media presence who will say, oh, nutrition doesn't matter as much. These randomized placebo-controlled trials don't show that there are specific outcomes for X and X and X. And so they refute it and they say basically, if we want a healthy population in society, then every single person needs to be on a GLP-1. And that's the place that we're headed. And I have a huge problem with the idea that GLP-1 should be used before nutrition and lifestyle interventions. And what I'm seeing more often than not is people who are walking into their doctor's office saying, I eat pretty healthy, but it's still not working. And then their doctor's saying, okay, let's just put you on a GLP-1. And just because you say that you're eating healthy— like, everyone comes into our program saying they eat pretty healthy— that does not mean that you are doing all of the things that help to offset this underlying inflammatory response, that helps to ensure that you don't have leaky gut, that helps to ensure that you're feeding your gut microbes with the bacteria that's going to help them— or feeding your gut microbes microbes in a way that helps them thrive, that you are managing a, a diet that helps to support your insulin sensitivity. Like, it has to be so much deeper than just eating healthy. And I truly have such an issue with doctors jumping to this idea that everyone needs to be on a GLP-1 for the anti-inflammatory response without ensuring that they've done a full protocol diving into what people are eating in order to understand what that actually looks like. If they— if you really are eating as healthy as you think and there aren't any additional opportunities that, that you can move the needle with when it comes to nutrition, lifestyle, and supplements. The second category that we see are functional medicine doctors who are on the internet and are well-intentioned but will share very crazy things when it comes to nutrition, like every single person needs to avoid gluten, dairy, eggs, soy, etc., etc. Or like I said, avocados are toxic, or other foods— you can't eat any grains, or, or all these things that create so much nutrition confusion. And then you're in a state of paralysis that prevents you from even moving forward. So you just continue eating foods that are inherently more inflammatory. And then the third category are people who don't have any nutrition certifications, credentials, which, you know, doctors don't either, but, um, in most instances. But people who maybe were previously a hairdresser or in another profession that had results for themselves that have then taken to the internet to, to try to teach other people, again, in a well-intentioned way, but in a way that can be very harmful, where I've seen the negative effects of that, where you're, you're trying to follow something that is so far from evidence-based, and it's just trendy and popular, and maybe like compiled together from them trying to listen to other experts without fully understanding the mechanisms that can also be dangerous and harmful. So all that to say, I do think that it's important to be very thoughtful of where you're getting your nutrition advice from, because these posts that I see on social media, they have like 100,000, 500,000 shares, and I don't agree with any of the nutrition information that's in it. So not that I'm the nutrition guide, but I think it's very important that we just be mindful of where we're getting our nutrition information in order to lead to a system that is not causing or creating unnecessary restriction, that is simple enough that allows for us to be consistent. And that is really where you're going to move the needle the most. So there are certain supplements that I think can be extremely beneficial when it comes to combating inflammation. Some of the top nutrients that can help to combat inflammation are things like omega-3 fatty acids that have been shown in the research over and over again to help to support inflammation. And lower the inflammatory response. Things like turmeric or a curcumin supplement can be very helpful. You have to be careful about not getting turmeric supplements from places like Costco because not all turmeric supplements are created equal, just like not all fish oil supplements are created equal. So my, my favorite brands for fish oil are Nordic Naturals. That's what we use most commonly when we're working with clients one-on-one. My favorite turmeric supplement is Theracumin HP by Integrative Therapeutics. I'm not financially associated with any of these companies, but I do think that getting a high quality form of the supplements that you're taking can make a big difference. In addition to that, there's a number of other supplements that can be beneficial, although it does come down to your personal need. Vitamin D is also a nutrient that can support modulating your inflammatory response. Nutrients like magnesium. I just did an entire episode all about magnesium, which can help to modulate inflammation and offset oxidative stress. Quercetin can be super helpful, especially for histamine-based responses that are where you have, you know, MCAS is very popular and something that we've worked with women on for the last— I've been implementing low histamine diets with women who specifically need a low histamine protocol for MCAS. For literally the last 12 years. So quercetin can be helpful for that. And then other nutrients that you can get, of course, in supplement form, but that you can also get from the foods that you're eating— polyphenols, a variety of polyphenols that help to decrease oxidative stress and can target other inflammatory mechanisms, zinc, vitamin C, monounsaturated fats like extra virgin olive oil and avocado, and many others. So some of my favorite foods for lowering inflammation include wild salmon. Having wild salmon at least 2 times per week— wild salmon is high in omega-3 fatty acids, which help to increase the production of anti-inflammatory compounds and also reduce pro-inflammatory compounds like TNF-alpha and your reactive oxygen species. Because omega-3s are essential fatty acids, that means that the body can't produce them on its own, which means that you want to make sure that you're getting enough through both food and supplements, with wild salmon being a great source of that. There was just a recent study showing that having enough omega-3s helped to decrease risk of depression, because of depression being thought as— in many research studies— as a manifestation of inflammation in the brain. Oysters are another amazing fish source. It doesn't even need to be fresh oysters, but could also be canned oysters that are very high in zinc. Which is a nutrient that also helps to combat inflammation. We have things like Brazil nuts that are high in selenium, which can help to support this anti-inflammatory function. We have things like almonds that are high in vitamin E. And so thinking about certain foods and their ability to exert pro-inflammatory or anti-inflammatory effects, thinking about your total dietary pattern and its ability to move the needle closer to lowering these levels of inflammatory markers being so key. We can't just jump to supplements because you cannot supplement your way out of an inflammatory diet. You want a diet that is rich in colorful vegetables and fruits, fatty fish, things like leafy greens and other non-starchy vegetables, omega-3 rich seeds like chia seeds and ground flax seeds, beans, lentils, extra virgin olive oil, fermented foods like sauerkraut and kimchi, spices, bone broth, organic soy, and so much more. I've compiled a list if you're interested in a place that you can start from the nutrition side of things, in addition to being able to calculate your own inflammation score and then getting a list of labs to ask your doctor to run. I've compiled a list that is included in my free inflammation guide, The Science of Inflammation. We'll have a link in the show notes for you to be able to download that. The important message that I want to leave you with is that chronic inflammatory symptoms are modifiable through nutrition, supplements, and lifestyle. I have reviewed thousands and thousands and thousands of labs because of working in the field of functional medicine over the last 12 years and starting out my career with running so many lab tests under the functional medicine doctors that I trained under, and then continuing to do that that on my own in my own nutrition business and teaching my dietitians how to do that as well. And I will say that the power— when I even see like a stool test of looking at someone's extremely high levels of inflammation in their gut that we can see in stool testing, from secretory IgA to EPX and calprotectin, and then 6 months later looking at a stool test from the same exact person showing very normal levels. Or when I remember this one woman that we worked with that her hs-CRP was in the 40s. It was one of the highest hsCRPs that I've ever seen. She had weight loss resistance, she had horrible acne and skin issues, and in a matter of just a few months of her being diligent from a nutrition and supplement side of things, was able to cut that number in half, and then a few months later cut that number in half again, which was super— I mean, it was incredible because a number of 40 for an hsCRP is extremely, extremely high. Nutrition— it doesn't matter how high your number is, I guess is my point— that nutrition, lifestyle, and the right supplements can play a role in bringing those levels down and helping to support your body's own capacity to heal. I have an episode coming up with Dr. Terry Walls, who I just interviewed, who's a physician that has done so much important work in the field of functional medicine, sharing her own story of coming back from a diagnosis of multiple sclerosis, being wheelchair-bound in a tilt-recline wheelchair because she got to the point that she couldn't even hold her own head up, and how much she had been able to heal herself to the point that she's biking to work on a daily basis. And a lot of that work that she's done tying back to reversing the inflammation and mitochondrial decline that was happening underneath the surface. My point here is that there is so much that's in your control. You have the capacity to heal. And I know the information on the internet is overwhelming. I know that trying a million different things and never seeing the results can feel super frustrating. But my message is don't give up. When you find the right approach that is science-based, that I truly believe we've done a great job of creating and have been able to demonstrate in the 29,000 people that we've worked with, you can change the trajectory of your life. And actually wake up, and actually wake up feeling good in your body. So do not give up hope. If this episode was valuable, please share it with a family member or friend. We— I'm still completely self-funding this podcast because I have so many conflicts internally with the idea of using my credibility to then sell different food or supplement brands. Brands, which I know is very popular on every— and every other person that's building a brand on the internet. But my goal is to really be able to support you to the best of our abilities in our programs. And if this episode was valuable, please share it with a family member or a friend. It would mean so much for supporting the show. Leave a comment, make sure you're subscribed, whether you're listening to us on Apple, Spotify, or whether you're watching on YouTube. And leave a comment, let me know how this episode has impacted you and any big takeaways that you have. Thank Thank you for tuning in to the Being Brigid Show, and I'll see you next time.