For nine issues in this newsletter, we’ve been highlighting a number of chronic health issues with underlying inflammation the main culprit for the progression of the specific disease state in question. To date, there is no longer any doubt that these chronic disease states can also be referred to as inflammatory disease states. This has been confirmed by a number of major health associations ranging from the American Heart Association, to the American Diabetes Association as well as groups concerned about a range of issues from auto-immune diseases to chronic fatigue syndrome to fibromyalgia – and in each case we’ve discussed, there is clear association with the inability to resolve the inflammatory status of the condition and resulting poor outcomes.
The clinical ‘so what’ means: 1) underlying inflammation must be managed and controlled before the condition specific issue can be managed, 2) managing inflammation requires RESOLVING it and NOT Blocking it and 3) by incorporating this two pronged approach into patient management will support improved patient outcomes can more effectively and consistently. But the real ‘take home message’ to the question of ‘so what?’ is: knowing that resolution is a specific independent pathway that results in greater control and true ‘resolution’ of inflammation – and as an independent pathway, requires the use of specific nutritional therapy in the use of specific pro-resolving mediators (SPMs).
How do we manage all this?
First, as we’ve discussed before, blocking inflammation to the point of reducing inflammatory markers and responses (reflective of changes in PGE2, IL1b, IL6 and others) only serves to render the resolution pathway inactive. This means we have masked the symptom, perhaps suppressed pain responses but have not solved the underlying or root cause and response to the problem of inflammation. Thus, moderate suppression of a normal inflammatory response with natural products like curcumin, or xanthohumol can be used in conjunction with SPMs to help optimally activate a resolution response.
This first step is particularly important in individuals who are obese, metabolic syndrome, have peripheral insulin resistance, and may be pre-diabetic. These particular patient segments have been shown to be deficient in their availability of SPMs to help activate the resolution pathways while at the same time are also not able to convert other metabolites to the active forms of resolvin mediators. Overcoming these two limitations is a big clinical challenge and we now know that use of SPMs as a nutrition therapy can help overcome this challenge. This is particularly exigent in this group of patients as their peripheral insulin resistance has led to changes in metabolic control and coupled with higher oxidation rates, their ability to activate and convert macrophages to a resolution mode is compromised.
The second step is making sure that a clinically effective therapeutic approach is taken. Recent clinical observations have shown that for the hyper-inflamed patient with these chronic disease states, a 4 week regimen using higher doses of SPMs can help begin to resolve the inflammation. Subsequent monitoring of the patient over the next 4 to 8 weeks can then help assess progress and result in lowering use of SPMs down to what would be considered a maintenance and/or preventive dose.
Lastly, with resolution actively being managed, more focus can then be taken toward the condition itself and addressing specific, and classic, biomarkers of the selected chronic disease state can then be achieved.
So, blocking inflammation should be minimized and only mildly suppressed while preferentially managing the resolution of inflammation. This will be most helpful in patients who have compromised resolution capacity and especially by those that are obese, over weight and with insulin resistance.