Chronic Inflammation and Yoga: An Update

by Ram

Yamamoto Takeru no Mikoto between Burning Grass 

by Utagawa Kuniyoshi

In my earlier posts on inflammation (see Chronic Inflammation and Yoga: Combating the Fiery Killer). I discussed inflammation and yoga’s role in dampening the inflammatory response. Briefly, inflammation is part of the body's defense response and involves clearance of toxic pathogens, damaged cells, or harmful irritants from the body. Inflammation has a high beneficial value. For example, if you develop a viral infection or if your back sustains a severe blow, inflammation sets in to care and protect the injured tissue and initiate a healing response. The classical signs of inflammation are pain, heat, redness, and fluid accumulation (swelling), and reflect the body’s defensive strategies that get activated to ward off the damage and heal the injured area. The defensive strategies are carried out by leukocytes, macrophages, dendritic cells, mast cells, bradykinin, histamine, interleukins, and TNF, among others. In a perfect setting, the inflammatory process occurs just as it should, releasing defense/pro-inflammatory molecules when needed and then turning them off when the threat has been sufficiently addressed.

Chronic inflammation, on the other hand, is characterized by an aberrant out-of-control defense response and is akin to a constant slow-burning fire. In chronic inflammation the defense/pro-inflammatory molecules continue to be present in the body even when they are not needed and the body operates as if it is constantly under attack. Thus, chronic inflammation continuously draws on your body’s energy and resources, which can result in bodily damage with time. Furthermore, as the system goes out of control, it self-perpetuates and triggers severe disease conditions, including, atherosclerosis (inflammation in blood vessels), diabetes (inflammation in pancreatic tissue), arthritis (inflammation in bones and joints), celiac disease (inflammation in digestive system), fibromyalgia, and neuralgia (inflammation in limbs, muscles and nerves) Ankylosing Spondylitis (inflammation in the spinal region), among others. 

In addition to the factors that influence inflammation that I outlined in my previous posts, today I’m updating that list to include:

Obesity. This is now considered a heightened state of chronic inflammation because of the elevated plasma levels of several pro-inflammatory markers. It is believed that fat cells (adipocytes) themselves trigger the release of a number of these markers in the blood stream.

Physical Activity. People who are physically very active have lower levels of inflammatory biomarkers than their sedentary counterparts, so physical fitness is inversely associated with inflammation.

Emotions. Emotional disorders, including anxiety and depression, can trigger inflammation and elevate the levels of pro-inflammatory molecules.

Stress. Chronic stress can directly provoke increases in proinflammatory cytokines.

Furthermore, inflammation is now regarded as a risk factor for most cancers as well because of the recent evidence that inflammation influences cancer cells to grow, survive, and proliferate. Scientists believe that cancer treatment procedures trigger the inflammatory process that fails to turn off. In addition to the weakness and pain from the cancer therapy procedures, cancer patients now suffer from inflammation that draws on their body’s resources resulting in chronic fatigue. It’s as though the body’s defense system fails to distinguish its own self thus making the body vulnerable to attacks from its own cellular system. 

Yoga can help with all these factors. On our blog we have highlighted yoga’s effects in controlling obesity by making correct choices of our eating habits (Yoga for Healthy Eating), and we discussed the benefits of yoga in controlling stress (Stress, Your Health and Yoga) and emotions (Yoga and Your Emotions). And in a landmark study that I highlighted earlier in Yoga's Healing Powers, researchers showed that cancer survivors who had a regular yoga practice: (a) reported less fatigue and higher levels of vitality, (b) showed reduced levels of several pro-inflammatory molecules in the body, (c) reported less pain and less inflamed joints, and (d) demonstrated significantly improved sleep (see 6 Ways to Foster Brain Health with Yoga). This study not only offered biological evidence of the benefits of yoga, in addition it substantiated people's own reports of their improvement. 

Yoga and yoga-related practices, including meditation, affect cellular processes at many levels that result in immense health benefits. While most of the health benefits may not appear immediately, all the benefits of yoga may become evident with a sustained and regular practice. So the next time you visit your doctor and are told that you have an inflammatory condition, think of yogic management practices.

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Depression May Be Caused by Inflammation

by Nina

Burning House by Marc Chagall*

“Inflammation is our immune system’s natural response to injuries, infections, or foreign compounds. When triggered, the body pumps various cells and proteins to the site through the blood stream, including cytokines, a class of proteins that facilitate intercellular communication. It also happens that people suffering from depression are loaded with cytokines.” —Tim De Chant

The first thing I did after I read a short article Depression May Be Caused by Inflammation was write to Ram. After all, Ram has written more than once about the dangers of chronic inflammation (see Chronic Inflammation and Yoga: Combating the Fiery Killer and Yoga’s Healing Powers), but he never mentioned depression as a problem that could be caused by inflammation. Here is his reply:

"Yes, I saw this item this morning and it does not surprise me. Inflammation is now thought to be the underlying event for a number of health issues including Alzheimer's, diabetes, obesity, hypertension, thyroid issues, arthritis, etc. What was once thought of as a novel and protective mechanism for the hunter-gatherers has now gone haywire thanks to modern interventions/lifestyle that has extended the median life span.”

So with that nod of approval, I decided to look more into the matter. After all, if yoga can help with chronic inflammation and depression is caused by chronic inflammation, then practicing yoga for chronic inflammation could be helpful to people suffering from depression. So, what are scientists saying about how is depression connected to chronic inflammation? An article in the Guardian Is depression a kind of allergic reaction? put it this way:  

“Both cytokines and inflammation have been shown to rocket during depressive episodes, and – in people with bipolar – to drop off in periods of remission. Healthy people can also be temporarily put into a depressed, anxious state when given a vaccine that causes a spike in inflammation. Brain imaging studies of people injected with a typhoid vaccine found that this might be down to changes in the parts of the brain that process reward and punishment. Depression may be triggered by an immune response.” 

And because these scientists are now thinking that depression may be a side effect of inflammation, they are exploring new treatments that address the inflammatory symptoms of depression with positive results. For example, a study The cyclooxygenase-2 inhibitor celecoxib has therapeutic effects in major depression: results of a double-blind, randomized, placebo controlled, add-on pilot study to reboxetine in Molecular Psychiatry concluded that an anti-inflammatory medication had therapeutic effects for depression.

But as Ram wrote in Yoga’s Healing Powers, a regular yoga practice is also effective for reducing chronic inflammation. He said that yoga:

1. Brings down the levels of stress hormones that promote inflammation
2. Lowers the levels of a number of pro-inflammatory molecules in the body
3. Reduces a subset of pro-inflammatory molecules called cytokines

Yes! Yoga helps reduce those pesky cytokines, which are exactly what the scientists are thinking may be responsible for triggering depression, as well as reducing inflammation in general. And, stress, which promotes inflammation, has also been long thought to be a factor in depression, as Timothy McCall wrote in Stress, Your Health, and Yoga.

So I’m going to make the leap and say if you want to reduce chronic inflammation and lower your levels of cytokines to help depression: focus at least some of your practice on stress management (see The Relaxation Response and Yoga). In general, supported inversions (see All About Supported Inversions) are particularly good for people with depression because you can keep your eyes open while practicing and don’t need to focus internally, which can lead to brooding. 

But, as always, you should experiment to find out what works for you, and if you enjoy restorative yoga or guided relaxation or breath work, go for it. In general, the way you practice yoga should probably depend on the type of depression you have, rajasic or tamasic. See Tamasic and Rajasic Depression for further information.

I came to the conclusion that yoga for depression should include stress management practices a long time ago because I had two bouts of agitated depression that both followed periods of sustained stress. And since I’ve learned to manage my stress levels with yoga, I’ve managed to avoid any more episodes (going on 20 years now!). Of course, until recently, I only had what scientists call “anecdotal evidence” and the wisdom of my yoga teachers to back me up. Now it’s great to have a possible scientific explanation as well!

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Yoga's Healing Powers

by Ram

Morning Glory by Melina Meza

Undoubtedly, all of us who do yoga as part of our daily routine have experienced its benefits, either at the physical, mental, or emotional level or at all levels. We all agree that it is relaxing, it is calming, and above all it has helped us in our flexibility and strength. Additionally, for some of us, yoga has helped in the healing of the heart, brain, gut, colon, kidney, hips, spine, and so forth. And all the anecdotal reports of the benefits that people have raved about are now being proved by empirical findings. In one of the largest studies of health benefits of yoga, it appears that yoga can reduce inflammation, the body's attempt at self-protection. Before I describe the study, let me briefly discuss inflammation and its positive versus negative health effects.

Inflammation is part of your body's defense response; the objective is to remove damaged cells, harmful irritants, or toxic pathogens from the body and initiate a healing response. While inflammation is not infection, an infection itself caused by bacteria, virus, or fungus can trigger an inflammatory process. Inflammation has a high beneficial value. For example, if you develop a viral infection or if your back sustains a severe blow, inflammation sets in to care and protect the injured tissue. The classical signs of inflammation are pain, heat, redness, and fluid accumulation (swelling). Other signs include: fever, chills, fatigue/loss of energy, muscle aches, headaches, and loss of appetite. All these signs are the body’s defensive strategies were activated to ward off the damage and heal the injured area. These defensive strategies are carried out by an arsenal of molecules that fight the invaders. The molecules include but are not limited to: leukocytes, macrophages, dendritic cells, mast cells, bradykinin, histamine, interleukins, and TNF, among others. Thus, the inflammatory process is akin to a country’s defense system involving several units of entities of increasing specificity that culminate in the removal of invaders and promote healing of any damaged tissue. In a perfect setting, the inflammatory process occurs just as it should: releasing defense/pro-inflammatory molecules when needed and then turning them off when the threat has been sufficiently addressed.

Now imagine if this body’s strong defense system turns awry and the defending molecules take on their own body’s system (akin to a coup). That would be the negative aspects seen in chronic inflammation, which are characterized by a defense response that is aberrant, out of control, and not completely turned off. Just like a constant, slow-burning fire, in chronic inflammation the defense/pro-inflammatory molecules continue to be present in the body even when they are not needed and the body operates as if it is constantly under attack. Thus, chronic inflammation draws on your body’s energy and resources, which can with time result in bodily damage. Additionally, when this system goes out of control, it self-perpetuates and triggers disease conditions, such as, atherosclerosis (inflammation in blood vessels), diabetes (inflammation in pancreatic tissue), arthritis (inflammation in bones and joints), celiac disease (inflammation in digestive system), fibromyalgia, and neuralgia (inflammation in limbs, muscles and nerves), among others. It is as though the body’s defense system fails to distinguish its own self, making the body vulnerable to attacks from its own defense team. The causes of chronic inflammation are numerous and include age, genetic predisposition, smoking, environmental stressors, allergens, chronic stress (both physical and mental), poor foods (sugary, processed, or fast food), and hormonal imbalance, among others.

But there’s good news for those of us who have a regular yoga practice. Several studies now report that a regular yoga practice:

1. suppresses inflammation
2. lowers the level of several pro-inflammatory molecules in the body
3. reduces a subset of pro-inflammatory molecules called cytokines, thereby relieving severe pain associated with the inflamed tissue

More specifically, studies report that yoga reduces inflammation in patients with cardiovascular problems and also improves levels of glucose and insulin in diabetic patients. There are also reports demonstrating yoga’s role in curbing inflammation that may serve as a panacea for people recovering from cancer. It turns out that following several rounds of radiation and/or chemotherapy cancer survivors suffer from persistent and debilitating fatigue for months or even years. Scientists believe that the cancer treatment procedures trigger an inflammatory process that fails to turn off. In addition to the weakness and pain from the cancer therapy procedures, these patients now suffer from inflammation that draws on the body’s resources, resulting in chronic fatigue. It is estimated that about a third of breast cancer survivors suffer from inflammation and chronic fatigue for several years after they complete treatment.

In a recent paper published in the Journal of Clinical Oncology Yoga’s Impact on Inflammation, Mood, and Fatigue in Breast Cancer Survivors: A Randomized Controlled Trial, researchers looked at 200 breast cancer survivors who had completed all the breast cancer treatments. The randomized, controlled trial involved only yoga novices. The yoga group practiced yoga twice a week for 12 weeks with take-home DVDs to practice at home. The control group was wait-listed to receive the same yoga sessions after the completion of the trial. The group that had practiced yoga for three months reported less fatigue and higher levels of vitality three months after the treatment had ended. The yoga group also reported significantly improved sleep. Additionally, three cytokine proteins in the blood that are markers for inflammation were all lowered by 10 to 15 percent. The novelty of the study was that it offered biological evidence of the benefits of yoga in addition to people's own reports of how they felt.

Cancer treatment leaves patients with high levels of stress, fatigue, and insomnia, which may trigger inflammation that in turn triggers tissue damage, leaving the patients completely debilitated and in a downward spiral. As we are now well aware, yoga reduces stress and fatigue (see Stress, Your Health, and Yoga ) and helps people to sleep better (see Sleep: A Pillar of Life), all of which may ultimately block the inflammatory process thus providing immense benefits to the cancer survivors. I guess you would agree with me that you cannot find a better, cheaper, and effective therapy for combating inflammation!

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Chronic Inflammation and Yoga: Combating the Fiery Killer

by Ram

Red Leaves by Melina Meza

Ever experienced an unexplained excruciating pain in the joints, ankles, knees that lasted for some time and then subsided? Or, maybe when you bent your fingers to hold some object, you experienced a burning pain in your fingers so painful that you were unable to straighten them for some time. Or, for some of us who do yoga regularly, we may have experienced pain, burning, numbness, or tingling in the buttock, hip, low back, knees, etc. Notice how this pain subsides when you are advised by your physician to take non-steroidal anti-inflammatory drugs like ibuprofen, or for some of us who have been living with this chronic agonizing pain, relief comes from those powerful anti-inflammatory steroid medications.

So, what is inflammation, why does it occur, and what are the best safe and natural options to curb this disorder? Let’s start by defining the term: From the Latin term "inflammo" (meaning setting alight or igniting), inflammation is part of the body's immune/defense response, the body's attempt at self-protection. The objective of inflammation is to remove damaged cells, harmful irritants, or toxic pathogens and begin the healing process.

When something harmful or irritating affects a part of our body, there is a biological response to try to remove it. This response takes the form of inflammation for the body to heal itself. While inflammation is not infection, an infection itself caused by bacteria, virus or fungus can trigger an inflammation process. Thus, you may appreciate the fact that inflammation in a true sense is beneficial when, for example, you develop a viral infection or if your back sustains a blow and the injured tissues need care and protection. The classical signs of acute inflammation are pain, heat, redness and fluid accumulation (swelling). Inflammation may also be associated with symptoms including: fever, chills, fatigue/loss of energy, muscle aches, headaches and loss of appetite.

Chain of Events that Occur during the Inflammation Process. Just as every country maintains an army, air force and naval units to defend itself from enemy forces, our body too has an excellent defense system (aka immune system) characterized by an arsenal of molecules. Acute inflammation is the initial response of the body to harmful stimuli and is characterized by the release of (a) specialized chemicals that create a conducive atmosphere for the defense molecules (pro-inflammatory molecules) to act and (b) specialized defense molecules/cells that fight the invaders. You may have heard from your physician or other sources terms including but not limited to: leukocytes, macrophages, dendritic cells, mast cells, bradykinin, histamine, and TNF. All these constitute our defense/immune system that is akin to a country’s defense system, with several layers of defenses of increasing specificity that culminate in the removal of pathogens and promote healing of any damaged tissue. Thus, in a perfect world or perfect body, the inflammatory process occurs just as it should, releasing defense/pro-inflammatory molecules when needed and then turning them off when the threat has been sufficiently addressed.

Negative Aspect of the Inflammation Process. Imagine if the defense forces take on their own country and its citizens! Similarly, chronic inflammation is characterized by a defense response that is aberrant, out of control and is not completely turned off or extinguished. Just like a slow-burning fire that does not ebb, in chronic inflammation the defense/pro-inflammatory molecules continue to be present in the body even when they are not needed. With the inflammation switch refusing to turn off, the body operates as if it is always under attack. Inflammation draws on our body’s energy and resources and having a constant, low-grade flow of powerful pro-inflammatory molecules can result in bodily damage with time. Furthermore, once this system goes out of control, it self-perpetuates and quickly spirals into disease in areas such as blood vessels (atherosclerosis), pancreatic tissue (diabetes), bones and joints (arthritis), digestive system (lactose and gluten intolerance), limbs, muscles and nerves (fibromyalgia), fat tissue (obesity), throat (thyroid issues)—just for starters. Sounds like the body going haywire in its own defense, with the immune system failing to distinguish between what is foreign and what is our own self, and making the body vulnerable to attacks from its own defense team.

Causes of Chronic Inflammation. As an aging researcher, I have learned that aging is one of the biggest risk factors for chronic inflammation because as we age, our bodies are less able to disarm the inflammatory process. Couple the aging process with a genetic predisposition, hypertension, or even smoking and it fuels the flames. In addition, stress (both physical and mental), environment, poor foods (sugary, processed, or fast food), high blood-insulin levels (type-2 diabetes), hormonal imbalance (estrogen and menopause) and obesity (leptin, adiponectin and other dietary hormone imbalance) are just a few of the factors that promote chronic inflammation.

Treatment for Chronic Inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) that include drugs like aspirin, ibuprofen, and naproxen, reduce the level of certain chemicals called prostaglandins that are involved in inflammation. Treatment with NSAIDs can lead to less swelling and less pain. However, extended use of NSAIDS can cause intestinal bleeding and serious damage to the stomach, liver and kidneys. Commonly referred to as steroids, glucocorticoids work to calm an overactive immune system and to decrease the level of inflammation in the body. People with multiple sclerosis, rheumatoid arthritis, lupus and other chronic inflammatory diseases are frequently prescribed these steroids to calm the inflammatory response. The problem is that these come with their own baggage of side effects and extended use of steroids can trigger osteoporosis, glaucoma, weight gain, high blood pressure and a lowered resistance to infections. Finally, a nutritious diet is the basis for good health. Vitamins D, E and C and folic acid have powerful anti-inflammatory actions, and foods high in omega 3s&6s, fruits, vegetables, fermented foods and unrefined carbohydrates may help to reduce the body's inflammatory response.

Yoga as an Anti-Inflammatory Therapy. There’s also good news for those of us who have a regular yoga practice. Several studies now report that a regular yoga practice (a) brings down the levels of stress hormones that promote inflammation (b) lowers the levels of a number of pro-inflammatory molecules in the body and brings down inflammation that is beneficial in conditions like arthritis, (c) reduces a subset of pro-inflammatory molecules called cytokines thereby relieving severe pain seen in diseases like fibromyalgia, and (d) inhibits inflammation that in turn weakens and even kills cancerous cells in people with cancer. See Stress, Inflammation and Yoga Practice to read one of the original studies.

In a study that confirms nearly all of the above observations, researchers at Ohio State University in Columbus divided 50 women with an average age of 41 into two groups: new to yoga and experts. The researchers than subjected these women to a battery of stress-inducing tasks, including holding their feet in extremely cold water or solving difficult math problems without the aid of a paper and pencil. Blood samples were taken several times before, during and after the stressful activities and measured for the levels of several pro inflammatory molecules. The research team found that women who were new to yoga had higher levels of nearly all the pro-inflammatory molecules tested and a much greater inflammatory response to the stressful tasks than women who were experts - suggesting that yoga may help to tune down the stress responses. See Adiponectin, leptin, and yoga practice.

Yoga’s beneficial effects on inflammation are not confined just to people with inflammatory conditions. Remember, I wrote a previous post about caregivers and how yoga could help these Karma yogis. Turns out that caregivers who exhibit high levels of stress-associated inflammation and who often don't have the time or energy to bring on a little relief from the stress of taking care of a loved one will benefit from a yoga practice even if it is for a brief period daily as it lowers stress-associated inflammation. In a study published in the  journal Psychoneuroendocrinology, researchers found that caregivers who participated in a yoga practice experienced a change in the response of 68 anti-inflammatory genes, leading to a global decrease in inflammation.

After writing this article in one sitting I am experiencing an unexplained burning pain in my fingers. So, guess what? It’s time for me to roll out the mat and do a few yoga stretches. What a cheap and effective therapy for combating inflammation!

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