Podcast 40 - Inflammation: Good or Bad?

Transcription

Doctor Chad: This is Doctor Chad Edwards and you are listening to podcast number 40 of Against The Grain. Are you tired and fatigued? Are you frustrated with doctors because they just don’t seem to listen? Do you want to fix your pain without surgery? If you answered yes to any of this questions then we are the clinic for you. We offer Tulsa prolotherapy, PRP or platelet rich plasma therapy and stem cell injections, IV nutrition therapies, bio-identical hormone replacement therapy and functional medicine to get you get back on track to optimal health. Call our clinic at 918 935 36 36 or visit our website at www.revolutionhealth.org to schedule your appointment today.
Voice Over: Welcome to the Against The Grain podcast with Doctor Chad Edwards where he challenges the status quo when it comes to medicine we get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready because we are about to go against the grain.
Marshall: Hello, hello this is the super tall Marshall Maurice and today I am joined by Doctor Chad Edwards, who believes that 80% of medical recommendations are crap-
Doctor Chad: Technically speaking they are crap
Marshall: -pure crap and he is the author of Revolutionize your health with customized supplements, he served in the US Army, he is an Oklahoma state university medical school graduate, but most importantly he is the founder of revolutionhealth.org and against the grain podcast. Doctor Edwards welcome I am so excited to be joined by you here today.
Doctor Chad: I am excited to be here, it’s always good you know I record this on Fridays, so it’s Friday it’s good.
Marshall: It’s good. Well, let’s get into it. What is our hot topic here today?
Doctor Chad: Well, before my disclaimer, I’ve got this kind of sniff thing going on if I sniffle in this thing I don’t mean to offend anybody am try to get away from the microphone but that’s my disclaimer.
Marshall: Okay, what are we talking about? What is like the main core concepts that we are getting in today?
Doctor Chad: Yes, we are going to talk about inflammation and why is inflammation an Against The Grain kind of topic. We are going to cover a couple of things actually a few things but inflammation and specifically what is called the arachidonic acid pathway and the arachidonic acid pathway is the biochemical pathway through which we make these chemicals that lead to inflammation. Why is that against the grain? Well, because the prevailing thought is that inflammation is bad and we have podcasts where we talked about prolotherapy and how prolotherapy actually induces inflammation. Inflammation in the cute setting in the right place is a very very good thing and it is essential and we need it, when it becomes chronic that’s another topic.
Marshall: Okay, the whole against the grain idea is that inflammation is bad, but really what we are going to talk about today is why it actually is helpful for the body Tulsa prolotherapy.
Doctor Chad: You got it.
Marshall: Okay, let’s get into it. Why don’t you walk us through the way that inflammation manifests itself?
Doctor Chad: Yes, first I think it’s important I mean it’s a good idea to understand the definition of what is inflammation. People come in and say, “I’m inflamed. I have this — my knee is really inflamed.” The dictionary definition is that inflammation is a physical condition which part of the body becomes reddened, swollen, hot and often painful especially as a reaction to injury or infection. That is the definition. Injury infection, chemical exposure those kinds of things can lead to this process of inflammation, several things can trigger it.
It’s also important to understand that inflammation is non-specific, in other words if you get — I can’t think of a good analogy. But it doesn’t matter if you get exposed to a certain chemical that will be toxic that will cause inflammation or if you get hit or if you tweak your ankle or something like that, inflammation– the inflammatory response is non-specific. It doesn’t matter what causes it. There are five signs that we often will refer to as the cardinal signs of inflammation they’re: heat, there is redness, swelling, pain and loss of function. Those you know again — think about that, you tweak your ankle, tweak your knee something like that and the area can get — it gets inflamed and that’s that redness, the pain, swelling, loss of function, it’s warm to the touch those kinds of things.
Some of this things we see more in response to infections, had a guy in the clinic today had a big abscess on his neck and I feel awful for the guy because that thing looked horrible, it looks horrible and uncomfortable we are going to take care of it not a big deal but it is very very firm to the touch, push on it and it is hard, hard as a rock it’s like an alien brain in there and it’s very red swollen, painful, tender, all those things. That is inflammation and it’s inflammation in response to an infection. Same kind of process happens when you tweak your ankle, it may not get red on the surface of the skin but that same process happens when you tweak your ankle or if you get this infection in your neck. This guy, total side note but when we have this — when you have an abscess it’s kind of a skin infection that kind of coalesces into this — basically it’s like a big pimple, huge gigantic pimple. The fix for those is not antibiotics, it’s not doing all this crazy weird things, the fix for that is open it and get the junk out, you’ve got to the crap out of it and let it drain. When you do that this things will get better, we did that a couple of days ago — today looked quite a bit better, still has a lot of work to do but we are going to get that thing fixed and — but it’s just going to drain.
Once you remove the source of the infection, the source of the inflammation the inflammation begins to reside and recede sorry. Those five signs again heat, redness, swelling, pain, loss of function. There is — when we talk about information there is three components of inflammation and this is kind of — this is a little bit of med school inflammation 101 getting a little nutty on it but just helping understand what is going on underneath the hood, the three components of inflammation is one you have an increase in blood vessel diameter and an increase rate of blood flow and that’s what accounts for the heat and the redness, you’ve got more blood flow going to this area, the blood vessels dilate and allow for that increased blood flow and you need that because there is a whole host of other things that are going to follow behind that are bringing in the chemicals the white blood cells all those things that are needed to repair this damaged areas, blood vessel diameter, red blood flow Tulsa prolotherapy.
Second thing is capillary permeability, big word. The capillaries are the smallest blood vessels you’ve got to start with arteries goes down to this arterials eventually — it’s getting smaller and smaller and when you get down to the capillary it’s — capillaries are so small only one red blood cell can fit through them, little bitty little bitty things and that is where your oxygen exchanges, where a lot of your gasses and a lot of your nutrients exchange in these capillary beds Tulsa prolotherapy.
The capillaries become more permeable meaning that it will allow fluids, it will allow different things creep across the membrane out of the blood vessel out of the capillary itself and into the surrounding tissues, these things get leaky and that is where we start seeing some of that swelling some of the oedema that goes along with that is because will trigger this capillary permeability. And the last component is leukocytic oxidation, leukocytic leukocytes white blood cells they’re a big component in repairing you know what is going on they cause the additional inflammation. And so these things are actually migrating across the blood cell — the capillary and into these tissues and they are almost like little scavengers and they are going across based on specific targeting, they are engulfing things that are damaged and getting rid of the bacteria and bad tissue and all those kinds of things.
This whole process of inflammation is occurring so that we can heal that’s why we have this, that’s why you have this three components. All of them are working together to heal this damaged tissues; the blood vessels get bigger so that more blood flow can get in there so that you can get more leukocytes into that area so we can get more chemicals in there to make those capillaries more leaky so that this chemicals can get across there that help drive this whole inflammatory process. So all three of those pieces are important so when we tweak something, you tweak an ankle, you tweak a knee and you look at that swelling you say, “Oh my gosh it’s inflamed. I got to stop this.” You really don’t that — those are indicators that your new system is kicking in and fighting what is going on. That swelling is letting you know what’s going on underneath the hood. I would argue that that’s not bad. Now that can be painful and that’s why a lot of people want to treat that and talk about anti-inflammatory after we come back from the break in a minute, about anti-inflammatory medications and certainly things like ice.
They’re wanting to control those symptoms but I think it’s just so permeated our society, especially in Sports Medicine. I had a t-shirt that said “Just Ice It” and as a medic in the army, we had — we carried Ranger Candy and it’s like you just throw out Motrin as if it were candy and we don’t want to inhibit that inflammation because that stuff’s healing.
What drives this whole process? You have something that activates inflammation and there are some major classes of chemicals, I’m not going to get too geeked out on this stuff but I want you to understand there’s a lot going on in this whole process. You have vasoactive amines and chemicals like histamine; I would think pretty much everybody knows what a histamine is.
It‘s one of the things that gets released with this inflammatory process and what causes histamine to be released, there’s a number of things. Certainly allergy type things can lead to that but trauma can lead to it as well. So we have a release of histamine and with histamine we see things, when you get hives, that’s a histamine reaction and so you’ll see swelling in the area where those hives are going on and that’s because those capillaries are becoming more leaky and histamine’s doing its thing. That’s part of this inflammatory cascade.
You have another classic chemical, it’s called endopeptidases, that’s a big, gigantic word and within that you’ve got the kinin system where you have bradykinin, it’s a chemical that brings several things into the area. You have complement system which works with antibodies and antigens and identifying and all stuff like that and the clotting system so that you can cause coagulation so that you don’t leak out too much and things like that.
The last category and I think it’s one of the biggest ones for where we’re going to go with this discussion are the prostaglandins. Prostaglandin, the term actually came from prostrate, the prostate gland. They actually first identified prostaglandins coming from the prostate gland and which is why it got its name and they reproduce several of the aspects of the whole inflammatory process.
Earlier, I talked about this arachidonic acid pathway and arachidonic acid is an omega-6 fatty acid that is the back bone for a lot of the chemicals specifically these prostaglandins, and eicosanoids and, leukotrienes that are part of this inflammatory cascade and a lot of medicines that people take will inhibit one of these parts in this arachidonic acid pathway.
For example, asthmatics or allergy sufferers might take Singulair, it’s a medication and that’s actually a leukotriene inhibitor and that’s one of the chemicals that’s produced in this arachidonic acid pathway. There are two of the biggest ones that probably most people are aware of is what’s called cyclooxygenase or COX-1 and COX-2.
Two different isoforms meaning two different enzymes that work in a little bit different manner that produce a lot of these chemicals, specifically the prostaglandins that are part of this inflammation. When we get back from the break, let’s go to the COX-1 and 2 and the anti-inflammatories and how it plays a role in this whole thing.
Marshall: Okay, let’s take a quick break and we’ll be right back Tulsa prolotherapy.
Voice Over: Vertical Limit Fitness constantly strives for better. Better mind, function, fitness, capacity and, community. They accomplish this through body weight boot camp style classes and high intensity functional fitness classes. From group classes to private training, Vertical Limit Fitness elevates your health and wellness while helping you become able to do and prepare you for everything that life may bring along.
Call 918-409-1633 or visit their website on www.verticallimitfitness.com for more information and to sign up for a week of classes.
Marshall: We are back. Joined today with Doctor Chad Edwards and we’re talking about inflammation and why this is an against the grain topic. Doctor Edwards, let’s get back into it what is or what are these COX-1 and COX-2? Break these down for me.
Chad: When you look at this arachidonic acid pathway, basically, you’ve got, I think have it almost like a pyramid or even a yes/no flowchart thing; flowchart’s probably the best way to describe it. You start with the arachidonic acid, this chemical gets acted on by an enzyme called phosholipase a2 and then it converts into another series of chemicals and you’ve got enzymes that work on each of these things.
Basically, what you’re doing is you’re taking a chemical that looks one way; arachidonic acid is this long chain fatty acid like the omega-3s. If you want to listen back to the official podcast we just did where we talked about this long hydrocarbon that’s this fish oil. Arachidonic acid is the same thing but it’s an Omega-6 fatty acid but it’s this long chain and the prostaglandins, eicosanoids, those kinds of things are a very different shape.
They’re rounded and they have two tails but it’s like a ring and two tails and so you have this biochemical process that’s producing these things from long chain to ring with tails. There are enzymes that help this conversion take place at each step so cyclooxygenase 1 and 2 are some of these enzymes that work in this arachidonic acid pathway.
Now, the reason that most people would care about this is because the medicines that you take like Motrin, Naprosyn, Ibuprofen, all of these NSAIDs or nonsteroidal anti-inflammatory drugs act on COX-1 and/or COX-2. The terms, I think, probably came into mainstream when they came up with these COX 2 inhibitors, something like Celebrex.
The part of the problem when you look at this arachidonic acid pathway, and I’m a visual person so I don’t know that saying it over a podcast helps a ton, but there is a lot of chemicals that get produced in this pathway and some of these prostaglandins have different effects. Some of them will cause vasoconstriction, some cause vasodilation, some cause smooth muscle relaxation, some cause smooth muscle contraction, some protect the lining of the stomach through secretions, those kinds of things Tulsa prolotherapy.
When you take a medication that blocks all of those, then for example, you’re blocking the prostaglandin that protects the lining of the stomach, you take an anti-inflammatory medication and you’re blocking the prostaglandins that actually protect the lining of the stomach.
That’s where we start getting ulcers and in fact there’s evidence that within one week, 50% of people on anti-inflammatories are having endoscopic evidence, meaning that when we look with a scope, we can see damage to the stomach when we see changes in the stomach because of these medications. It happens early, it happens frequently, we can disrupt the stomach because of these medications so we have to be very, very careful.
Like I said, some of these prostaglandins will help control blood flow through vasoconstriction and vasodilation and they work in the kidney and we see this. It’s so common, it’s so far more common than anybody probably recognizes that someone’s on anti-inflammatories for a long period of time and then go in a kidney failure because of it. This stuff can kill your kidneys.
If you have a headache and you take one, in fact I’m taking them right now for my nose stuff and it’s beneficial for that, but you don’t want to just willy-nilly take it and think, “Oh, I’m going to be fine.” It can do real damage and we have got to be careful with that. The COX-1 enzyme tends to produce these prostaglandins that are produced and ready. In other words, it’s almost like the stockpile that you already had built up is ready to go to work so we make some of these prostaglandins, we just have them on stand-by.
COX-2 tends to produce the chemicals that get made or get produced in response to some kind of stimuli. You tweak you ankle, you got some that are already there and they’re ready to go and then you have some that are being produced because of that injury and the COX-2 would inhibit more of the ones being produced because of the injury.
The COX-2 inhibitors are the ones that protect — they don’t inhibit the COX enzymes, the cyclooxygenase enzyme that makes the chemicals that protect the stomach so you’re getting a more selective result and you’re taking it NSAID or an anti-inflammatory that’s going to have less impact on your stomach.
When I was in the military, we had people that would prescribe Celebrex as a first-line deal. These drugs are much, much more expensive than Ibuprofen and some of these providers would just be like, “Oh, here’s your Celebrex. We don’t want to mess up your stomach.” Well, it’s cool but it costs 10 times as much so we’re spending a lot of money for somebody that doesn’t really need that protection.
If money were no object, I’d say, “Yes. Go that route.” But you put a hundred people, you start doing that a bunch and it’s just going to make a difference cost-wise because the cost of medicine goes up the more expensive stuff we use. I think the Celebrex, Vioxx was one that was out several years ago and it was banned I think in 2006 and it was a COX-2 selective medication.

So again, it protected the stomach and it works for — they work for relieving the pain that people would get. This anti-inflammatory medications could inhibit the cyclooxygenase enzymes. But it can also inhibit a whole host of other chemicals like thromboxanes for example. The thromboxanes are — they work with platelets and platelet aggregation and Omega-3s, fish oil, also goes through this arachidonic acid pathway. So you have something that’s an Omega-6, arachidonic acid, that goes through this pathway and a bunch of enzymes could work on it and make certain chemicals. But then you have something like your Omega-3s, EPA and DHA specifically that can go through the same arachidonic acid pathway that get worked on by enzymes but they produce a different prostaglandin thromboxane. For example, thromboxane a2 is the one that works on platelet aggregation and the omega-3s when they go through that arachidonic acid pathway, they make thromboxane a3.

Some would argue that that is a non-functional thromboxane so it prevents platelets from sticking together. So it’s yet another way that fish oil can be anti-inflammatory and inhibit platelet aggregation. It’s an important concept. Some doctors would say stop taking your fish oil before surgery and it’s because of this action. Because of how it works on the arachidonic acid pathway and the chemical that it produces. Because it’s making thromboxane a3 that either doesn’t work or it’s much less effective. So when we’re talking about taking fish oil, we’re trying to balance the amount of Omega-3s with the amount of Omega-6s that we get.

Standard American diet, very heavy in Omega-6s and if that’s all you have then you have this very pro-inflammatory state because going through this arachidonic acid pathway. Whereas with fish oil, it’s balancing that the Omega-6s going through this pathway so that at the end, you have a balanced inflammation. You have it when you need it. Not too much, not too little. We don’t want to take anti-inflammatory medications all the time especially for a musculoskeletal sports injury because we need to heal. But things like fish oil can be very good at balancing the immune system so that you — so you have a normal natural response.

Standard American diet, very pro-inflammatory. It’s one of the reasons that where we say, “Avoid this kind of diet. Eat a good healthy, almost a Mediterranean or a Paleo type diet.” Make sure your Omega-3 levels are up because it helps you understand the balance between these two things and it can really help shut off the inflammation. Again, going back to that arachidonic acid pathway, I think that’s a lot of the reason why. Some people may think this topic’s pretty dry and it is kind of but when you tie all that together and bring in the Omega-3s and Omega-6s and the anti-inflammatories and all that, it all has to do with this inflammatory arachidonic acid pathway. That’s why I wanted to do this topic.

Marshall: If I understand this, correct me and jump in here if I’m straying too far.

Chad: Yes..

Marshall: The way that I understand it is a lot of families and athletes and people will take anti-inflammatories thinking that, “Hey, I just want to reduce the swelling in my foot because my foot hurts.” Okay. They’ll take that for injuries. Or they have some type of chronic inflammation in the event of maybe not a proper diet. It takes a very little amount of external externality to cause your body to become inflamed. So they’ll frequently take that but what we found is that by taking all these anti-inflammatories, it can do a couple things. It can hurt you kidneys. It can hurt your stomach. And there’s things that we can do to mitigate that. We can take Omega-3s that will counterbalance it.

Chad: Correct.

Marshall: We can also not be so quick to prescribe anti-inflammatories.

Chad: Absolutely.

Marshall: Do you absolutely need this anti-inflammatory or is the body just doing its job?

Chad: Exactly. That’s exactly right. And the other piece on that, you mentioned the kidneys, you mentioned the stomach but also, do not neglect the fact that this is how you heal. You heal through inflammation. We see so many athletes with so many back pain, knee pain, shoulder pain, and all of these things. And these old broke — I say old, I’d say their in 40s, like that’s old, retired SF and army guys that are just broken and they’re broken because all these little things that may not necessarily be one big thing but all these little things. And what did they do? They took my anti-inflammatories every time they had a pain.

Marshall: So this is inflammation, how inflammation works, the purpose of your body’s inflammation. It’s actually healing the body. Any other closing thoughts on this particular topic?

Chad: I think we summed it up.

Marshall: All right.

Chad: It may seem a little dry but I think it’s worthwhile.

Marshall: Doctor Edwards, thanks so much for giving me this fire hose of knowledge on inflammation today.

Chad: It’s always my pleasure.

Marshall: All right. Boom.

Voice Over: Thanks for listening to this week’s podcast with Doctor Chad Edwards. Tune in next week where we’ll be going against the grain.

[00:25:40] [END OF AUDIO]