A lot of patients come to my office with concerns about their memory, cognitive decline, and fear of dementia. In the medical literature, chronic inflammation in the body has been linked to dementia.

Now, inflammation is normally not a bad thing. It is the body’s natural response against any number of incursions on your health. When bacteria invade your body—let’s say in the case of a sore throat—the immune system is triggered to create antibodies and other immune compounds to defeat the invaders. You experience the outward manifestations of inflammation as swollen glands, pus-filled tonsils, and high fever. When the inflammatory or “shock and awe” response has done its job, it should turn off. If inflammation is not controlled by innate physiologic checks and balances, chronic inflammation goes undetected wreaking stealth havoc until the damage is widespread enough to surface as memory loss and cognitive decline.

A recent study published in the Journal of Neurology set out to assess just that problem. Studies have previously looked at the problem of inflammation and brains of older patients. The goal of this study was to determine the impact of inflammation in middle-aged people on cognition as they grew older. As part of the Atherosclerosis Risk in Communities (ARIC) study, researchers followed 12,336 people with an average age of 57 years for approximately 20 years. The researchers stratified the group using an inflammation composite score consisting of 5 common markers of systemic inflammation. The subjects were also tested to assess baseline memory, processing speed, and verbal fluency. These tests were repeated again 6 and 9 years later, as well as at the end of the study. The results, after controlling for common variables like age, education, high blood pressure, and heart disease, indicated that the subjects with the inflammatory markers in middle age had the greatest decline in cognitive function over twenty years. Deeper analysis indicated the area of cognitive function most affected by inflammation was memory.

Here is the issue:  You may have chronic inflammation and not know it until scary things like memory loss and cognitive decline are impacting your life.

Why would a person have chronic inflammation?

So what would cause your body not to turn off its response to inflammation? It comes down to genes and the environment, the usual suspects. If the blueprints (genes) for building key proteins and enzymes have just a single variation, the protein or enzyme built using the blueprint will either not work at all or respond inappropriately. This is called a single nucleotide polymorphism or SNP (“SNiP”), for short. Each of us have about 5 million of these. While most SNPs will do no harm, some possibly could. Why possibly? It depends on environmental inputs. Genes including SNPs can be switched on and off by environmental inputs like stress, toxins, viruses, bacteria, and food (like processed carbohydrates and refined vegetable oils). Once turned on, as in the case of genes responsible for the inflammatory response, inflammation mounts resulting in damage to cells, tissues, and other genes. This turning on and off of genes is called epigenetics. The basic definition of this is that genes are not your destiny, they are influenced by lifestyle choices and environment! So, even if you have the gene for “XYZ problem” you may never manifest that problem if you give your body great inputs (like good sleep and a good diet) and avoid environmental triggers (like heavy metals and electromagnetic fields).

Could I be chronically inflamed? How would I know it?

The term inflammation is a broad term for very specific responses that the body makes on a cellular level to protect itself. So, in that sense, you can rest assured it is happening, although you will not be aware of it. Let’s take a look at what happens if an epigenetic insult like stress persists.

In a study published in the Journal of Neuroscience, researchers from Ohio State University stressed out several mice by periodically putting a much more aggressive mouse into their cage. After six days of exposure, the stressed mice could no longer recall the location of a hole to escape a maze, which they remembered easily before the stressful period began. Four weeks later, the stressed mice were still cowering in the corner. The researchers suspected that the stress was affecting the mice’s hippocampus, a part of the brain key to memory and spatial navigation. They found cells from the mouse immune system, called macrophages, in the hippocampus, and the macrophages were preventing the growth of more brain cells. The stress, it seemed, was causing the mice’s immune systems to attack their own brains, causing inflammation. This study clearly illustrates how an external stressor triggers, then prolongs, a cellular response until it becomes noticeable. We may not be mice but we can certainly imagine this happening or may have even experienced memory loss after our own run-in with prolonged stress. So, if you are experiencing fuzzy thinking, distractibility, foggy focus, a hard time learning, low mental energy or drive, loss of creativity, and depression it is time to get rid of the bad mouse.

What should I do next?

Do an inventory of your health. Early symptoms of chronic inflammation may be vague, with subtle signs and symptoms that may go undetected for a long period. You may have been tolerating symptoms as “ That is just me…” or “It’s just aging.” As inflammation progresses, however, conditions and symptoms that should raise your suspicion include: brain fog, fatigue, migrating joint and muscle pain, abdominal bloating, weight gain, night sweats, hives, eczema, irritability, and palpitations.

Then find a doctor who will listen to your story and understands how to look for and treat the root sources of inflammation. There are general markers of inflammation that should be tested. I measure hs-CRP, ESR, fibrinogen, ferritin, and insulin. When these are elevated, I start digging deeper based on patient symptoms. LPLA2 and myeloperoxidase are markers for cardiovascular inflammation; I will also look at various antibodies to look for autoimmunity impacting the brain, thyroid, joints, and gut.

Once markers of inflammation are identified then the work of finding and addressing the root cause begins.

Putting out the fire: Lifestyle, food, and supplements

Stress and Sleep. In my mind, the two cannot be separated. Sleeping well protects your brain and body from inflammation by avoiding the pro-inflammatory activity that occurs in the presence of poor, dysregulated sleep. And sleep offers us significant protection against stress, another source of inflammation. A 2017 study identified the critical connections between chronic stress, increased inflammation, and the development of a range of diseases including cancer, heart disease, diabetes, and depression. Meditation is one solution to manage stress and improve sleep. It will enhance your mindfulness and calm down your nervous system thereby reducing your stress and setting you up for a good night’s sleep.

Exercise. It only takes 20 minutes to reap the anti-inflammatory benefits of exercise. In 2017, researchers from the University of California San Diego reported that pro-inflammatory cytokine levels dropped by 5% in adult subjects after just 20 minutes of moderate intensity activity. What can you do in 20 minutes? A lot! Jump rope, jump on a trampoline, jog two miles, ride a stationary bike, or do a light weight work out.

Clean up the plate and the cup. Avoid these flame throwers that are certain to dial up the inflammation: sugary drinks, refined carbs, trans fats, highly processed foods, aspartame, alcohol, and fish high in mercury. Here are a few of my favorite fire-fighting foods and beverages that should be added to your diet:

• Berries: These delicious fruits provide antioxidants known as anthocyanins. These compounds may reduce inflammation, boost immunity, and reduce your risk of heart disease.
• Broccoli: This cruciferous veggie is one of the best sources of sulforaphane, an antioxidant with powerful anti-inflammatory effects.
• Grapes: Several plant compounds in grapes, including resveratrol, can reduce inflammation. They may also reduce your risk of several diseases.
• Green Tea: A great beverage choice, green tea is high in epigallocatechin-3-gallate (EGCG) that reduces inflammation and safeguards cells from damage that can lead to disease.
• Fatty Fish: Options like wild-caught salmon, sardines, and anchovies hold high amounts of the omega-3 fatty acids EPA and DHA, which have anti-inflammatory effects.
• Dark Chocolate: No list of anti-inflammatory foods is ever complete without this favorite. Flavanols in dark chocolate and cocoa can reduce inflammation. Enjoy a square once a day.
• Water: This basic staple is crucial for flushing inflammatory toxins through the liver, kidneys, and bowels and helps to eliminate them through sweat. Pure filtered water is best. Add Himalayan salt for an extra hydration boost. Drink at least 64 ounces daily.

Supplements

Sometimes food is not enough when it comes to inflammation. Severity of symptoms, nutrient deficiencies, and individual genetic variances require targeted supplements. Here are the supplements I recommend most often as a foundation to prevent and treat inflammation.

• Vitamin A: This valuable nutrient can keep the immune system from overreacting and causing inflammation. Vitamin A is available in two forms: Beta-carotene is a provitamin that converts to vitamin A in the body and preformed vitamin A is a bioavailable antioxidant that protects the body against free radicals. Diets rich in beta-carotene and vitamin A can help to reduce inflammation.
• Vitamin D: Studies have long established a connection between low vitamin D and a variety of inflammatory diseases. Vitamin D is naturally available from the sun, but most of us don’t get enough sun and when we do we block the UVB light with sunscreens and clothing. So, get your vitamin D level checked and supplement with an appropriate amount per your practitioner’s instructions.
• Fish Oil: Contains the essential fatty acids EPA and DHA. These are critical to maintaining the integrity of cell walls thus protecting cells from damaging inflammation. EPA and DHA can be obtained in fish like salmon, mackerel, anchovies, sardines, and herring. If you are not consuming 3 to 4 servings per week, then I recommend taking about 2,000 mg or more of a high-quality fish oil daily.
• Curcumin: This is the main active ingredient in turmeric, a spice that has been used for thousands of years for medicinal purposes. Curcumin has anti-inflammatory properties that rival most anti-inflammatory drugs without the side effects. It also has potent antioxidant properties and has been shown to improve memory.
• CBD: Also known as cannabidiol, CBD is the non-psychoactive component (meaning it doesn’t get you high) from the marijuana plant, Cannabis, which has been used for thousands of years to treat pain. Recent studies have supported its potent anti-inflammatory and neuroprotective benefits. The human body contains a specialized system called the endocannabinoid system (ECS), which is involved in regulating a variety of functions including sleep, appetite, pain, and immune system response. Studies have shown that CBD may help reduce chronic pain by impacting endocannabinoid receptor activity. I have used it successfully as a sublingual tincture and topical ointment. I work with advanced providers who can also blend botanicals and increase levels of THC to augment the anti-inflammatory benefits.

Inflammation is the common denominator of many chronic diseases. As I have pointed out, its effects on the brain can be devastating. However, by making some simple lifestyle changes, including anti-inflammatory foods, and adding in targeted supplements, you can not only limit inflammation but optimize your health and performance.