The problem with blaming everything on inflammation

When White House officials announced their new dietary guidelines on Wednesday, they said their approach would help people reduce the “general body inflammation” that they blame for driving America’s chronic disease crisis.

You’d be excused for wondering if inflammation is the cause of all our ailments and reducing it is the skeleton key to a healthy life.

But the story is more complicated.

“Inflammation has become a catch-all culprit,” Shruti Naik, an immunologist at the Icahn School of Medicine at Mount Sinai, told me. “It’s a convenient shorthand, but it flattens a very complex biology.”

Chronic inflammation is indeed on the rise, a phenomenon that researchers have linked to industrialization and modern life. But inflammation isn’t all bad — it’s actually one of the most important things your body can do to fight infections and repair tissue. It is a flashing signal from your immune system. We just aren’t very good at reading it yet.

That uncertainty has created a vacuum, filled by oversimplified advice and dubious cures. In reality, managing inflammation requires far more nuance than a single supplement or a “clean” diet hack.

And today, scientists are starting to figure out that nuance. At major academic medical centers like Stanford and Mount Sinai, new clinics are measuring inflammation in patients over time, trying to define what “normal” actually looks like — and when it becomes dangerous.

Right now, when we go in for a health check-up, we might ask our doctor, How is my blood sugar? What’s my blood pressure? But none of us asks, How is my immune system doing? “Even if we did, they would look at us perplexingly,” said Bali Pulendran, an immunologist at Stanford University.

But, Puledran continued, “I think the time will come, not so far in the future…when inflammation will become sort of a vital sign like a blood pressure or glucose.”

That future isn’t here yet. And until it is, anyone promising a quick fix for inflammation — especially on TikTok — deserves your skepticism.

Here’s what the real experts want you to know about the state of inflammation science right now — and where it’s going.

Even though inflammation is a process our bodies have always performed, our current fixation on “chronic” inflammation is new.

For most of our history, physicians focused on what they could see, like the red, puffy skin around an infected wound, the visible side effects of a medical problem.

But the world has changed. Now we can see the invisible processes of our bodies at the molecular level. Thanks to advances in genomics, cell sequencing and imaging, we’ve learned that inflammation is present within every tissue and every cell.

“Every cell in your body can experience inflammation. That means every cell can remember it,” Naik said.

For most of human history, inflammation has provided vital protection. In the time before modern medicine offered treatments like antibiotics, prescription drugs, medical devices and life-saving surgeries, the only defense your body really had against outside invaders was its own innate ability to counteract them. Inflammation was the engine for your immune system to fight back.

But now that we do have these things, our bodies exist in a state of evolutionary confusion.

A baseline level of high inflammation may have made sense when life was short and pathogens were everywhere. But today, people live longer than ever and have access to modern medicine. (There is growing evidence, too, that inflammation increases with age; scientists call this “inflammaging.)

“Inflammation is always induced when there is a problem. Sometimes there is nothing to protect from — but it’s induced anyway, and then it makes matters worse,” Ruslan Medzhitov, an immunobiologist at the Yale School of Medicine, told me. “For thousands of years, the immune system evolved to deal with infections. Suddenly, the world changed, but the immune system did not.”

At the same time that our inflammatory drive is working overtime, the environment around us has changed dramatically. Studies have found that more industrialized countries tend to have higher rates of chronic inflammation than less developed countries — cultures that are more steeped in environmental pollution and artificial substances that didn’t even exist a hundred years ago.

And nothing has changed more in these societies, scientists say, than what we eat.

Foods that interfere with your metabolism can increase inflammation — especially foods high in unhealthy fats and sugar. These are the same types of foods that have contributed to modern health problems like obesity, heart disease, and high blood pressure, all of which are linked to higher levels of inflammation.

Ultra-processed foods are also associated with higher rates of chronic inflammation: At its most basic level, inflammation starts when the body detects unusual presences. Processed foods are chock full of ingredients that our bodies would have considered strange just a few decades ago.

So that inflammation is happening more isn’t that surprising. This is our body reacting to new stimuli. But when should we reduce it?

There are at least three different kinds of inflammation — and most of them are actually good. The first, acute inflammation, occurs when you have an illness or an infection and is an important protective layer that your body provides itself. That is not the kind of inflammation that we want to reduce.

And then there is homeostatic inflammation, which keeps your immune system at the ready and allows your tissues and organs to repair themselves — the same process that allows your muscles to rebuild stronger after lifting weights. It’s necessary for your body, and it definitely isn’t the kind of inflammation we want to get rid of.

The kind of inflammation that scientists are concerned about is chronic low-grade inflammation above those levels that are necessary for a healthy functioning body. This is the kind of inflammation that can be brought on by a poor diet or by environmental pollution or by an infection that lingers for a long time. (Researchers think that long Covid, for example, may be associated with persistent inflammation even after the acute infection has subsided.) Over just the past decade, investigators have detailed how this low-grade chronic inflammation can cause damage to people’s tissue and organs at the cellular level over the long term.

Scientists are still figuring out when this kind of inflammation is the cause of a disease and when it is simply a symptom.

Obviously, when inflammation is a response to an injury, virus or bacteria, it is a symptom. But chronic metabolic diseases and even cognitive problems associated with aging may be the result of persistent and unresolved inflammation: Atherosclerosis, the hardening of arteries that is associated with high blood pressure and heart disease, for example, is one common condition that seems to be caused by long-term inflammation. Researchers are also investigating whether dementia and Alzheimer’s disease may be the outcome of an overly inflamed brain.

From person to person, we still don’t have the full picture. It’s not possible to say that you or I at any given time have too much inflammation. Your individual baseline for a healthy amount of inflammation, and when that crosses over into something unhealthy, is the next frontier of inflammation science.

So what would it take to get there?

First, researchers would need to figure out how to establish personal baselines.

We have only recently identified biomarkers — such as cytokines, the immune-signaling proteins, and metabolites produced by the gut microbiome — that can tell us how much inflammation an individual person actually may have. But as with a lot of things in medicine these days, our ability to measure something does not mean that we necessarily know how to interpret it.

So you might be able to find a doctor willing to order a test that measures your own cytokines. But whether the results are really a cause for concern or simply what’s normal for you is not yet clear.

“Biomarkers are always a proxy. Sometimes they’re a good proxy, sometimes they’re very generic,” Medzhitov told me. “It’s a very gray area still. We know the answers at the extremes — but not in the middle.”

That’s why teams at Stanford, Mount Sinai, and other top academic medical research centers have begun what are called human immune monitoring programs, which will allow scientists to collect the longitudinal data that can start to tell them what is normal for different individuals with different backgrounds and health histories.

If you see a doctor at a major academic research hospital, you can inquire about whether they have such a program and if you could participate. From the patient’s perspective, you would be committing to a series of blood draws and possibly providing other types of samples (your saliva and stool) over an extended period of time. The samples would then be measured by new technology that can detect inflammation biomarkers. By collecting data over an extended period of time, scientists can see how your inflammation changes after an infection or after you receive a medical treatment or a vaccine.

That could allow you to play a small part in figuring out what normal inflammation actually looks like and what is actually a cause for concern.

We are inching toward a future in which we can measure and track inflammation in every patient in the same way we measure and track blood pressure and blood sugar at every primary care appointment. It could serve as an early warning system for certain kinds of health conditions that are not always obvious or measurable through other means; Medzhitov told me that we might be able to get to a point where it becomes a diagnostic tool: Once an inflammation metric has reached a certain threshold, it’s a clear sign that the patient has a specific health problem.

“I can envision a future where inflammation is a pre-symptomatic warning sign — something you notice before you feel sick,” Naik said.

That is what inflammation care could soon look like — but not yet.

Scientists are investigating the anti-inflammatory properties of GLP-1 drugs; their ability to reduce inflammation may explain why they are associated with a wide range of health benefits, such as reducing the risk of dementia and heart disease and more. But proving that effect and establishing the actual biological mechanism that makes it happen is the subject of ongoing research. Is it the result of lifestyle changes and better diet? Or is it the result of how GLP-1 medications affect the brain, which does help to manage inflammation throughout the body? A combination of lifestyle and biological effects?

“A lot of the remedies that are touted, whether they’re natural or not, have not been tested. Just because someone makes an awesome video…does not mean there is evidence behind it,” said Naik. “There is no magic bullet. If something sounds too good to be true, especially when it comes to inflammation, it probably is.”

In the meantime, the best advice from the real experts on how to maintain good health is pretty simple: Don’t fixate on the inflammation you can’t see, and instead focus on maintaining a healthy diet, low in fats and sugars, with a lot of whole foods and unprocessed ingredients. They also recommend getting regular exercise, which has been shown to reduce chronic inflammation.

The obsession with inflammation is symptomatic of so much of our health and wellness discourse these days: It is a reasonable area of concern, but the messages about what’s good and what’s bad have become too simplistic — fertile ground for grifters trying to sell you on a cure.