Inflammation: The Fire Under Everything

When I teach this live, I start with inflammation, because so much of what happens downstream runs through it.

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Inflammation is your immune system's repair response, and in the short term you need it. You cut your finger, and the area turns red, warm, and swollen. That is your immune cells rushing in to fight infection and begin the repair. Then the response is supposed to switch off.

The trouble is inflammation that never switches off. Researchers call it chronic, low-grade, or systemic inflammation. It runs quietly through your whole body for years, without the throb of a banged-up knee, and it sits underneath many of the illnesses we fear most.

Acute and Chronic: The In-Breath and the Out-Breath

Your immune system runs 2 arms that are meant to take turns.

The first arm raises the alarm: it calls in immune cells, raises the heat, and fights the threat. The second arm resolves: it calls off the alarm, clears the debris, and returns your tissue to quiet readiness.

In a healthy body, these 2 arms cycle like an in-breath and an out-breath. Chronic inflammation is the in-breath that never gets its out-breath.

Resolution is an active process. Your body builds specialized calming molecules, some of them made directly from the omega-3 fats in fish, to switch the response off. When the threat keeps arriving, or when the resolving arm is too depleted to do its work, the alarm keeps ringing.

Running an inflammatory response is also metabolically expensive. Your immune system has to pull that energy from the reserves you would otherwise use to think clearly, repair tissue, balance your hormones, and digest your food. This is part of why chronic inflammation can leave you so depleted, and why energy often returns as the fire calms.

If you have wondered why you cannot keep up, you may be doing plenty. A large share of your energy may be going, quietly and constantly, to a fire that has not yet gone out.

How Inflammation Hides in Plain Sight

Women often hear the word inflammation and think, my digestion is fine, so this must not be me. That is how inflammation hides in plain sight. It can look like:

• Colds that linger for weeks
• Sinus headaches and migraines
• Constipation and bloating
• Hair loss
• Fatigue and brain fog
• Allergies that came out of nowhere
• Joint pain, the aches and creaks you figured came with age
• Puffiness, skin flares, and weight that settles around your middle

Most of the symptoms on the first pages of this guide can be traced back, at least in part, to inflammation, alongside the other roots this guide walks through.

It can also look like:

• Eczema, rashes, acne, or hives
• Anxiety, low mood, or a shorter fuse
• Sleep that does not leave you rested
• A puffy face in the morning
• Food and environmental sensitivities that are new or getting worse
• Aches that seem to move from joint to joint
• Cuts and small infections that are slow to heal

Seen together, these lists show 1 fire showing up in many rooms of the house.

A puffy face is 1 of the signs Women in the Hashimoto 411 group ask about most. 1 of the educators who host the group reads it as inflammation, and her answer to 'which supplement will fix it?' is a question: what are you doing to manage your Hashimoto's and lower your inflammation? You cannot supplement your way out of inflammation.

My own inflammation showed up in 3 rooms at once: my digestion, my fatigue, and my joints. Until I started AIP, healed my gut, and began LDN, all my joints ached. Walking felt achy, hard, and tiring.

Today I have no pain at all, and I am not limited physically in any way. I am still a little sensitive to cold, nothing like before.

How Inflammation Is Created in Your Body

1. Something registers as a threat. An infection, an injury, a food your immune system has flagged, bacterial fragments leaking through your gut lining, a blood sugar spike, a surge of stress hormones, or fat tissue sending out distress signals.
2. Your immune cells sound the alarm. They release chemical messengers called cytokines, with names like IL-6 and TNF-alpha, which call more immune cells to the scene.
3. Your liver answers. It makes C-reactive protein, the CRP that an hs-CRP blood test measures. It also raises ferritin, which is why inflammation can make your iron look better than it is.
4. In a healthy response, it resolves. Your body makes its own calming signals and switches the response off once the threat is gone.
5. In chronic inflammation, the threat never leaves. The triggers keep arriving, day after day, so the alarm keeps ringing at a low volume in every tissue it reaches.

Inside your cells, many of these alarm signals meet at a master switch called NF-kB, which turns on the genes for inflammatory messengers.

Refined carbohydrates, foods your body reacts to, short sleep, chronic stress, and toxins all tend to flip it on. Whole foods, enough sleep, movement, and a calmer Nervous System help quiet it. The choices you make each day decide, in a direct biochemical sense, how often that switch gets thrown.

What a Day of Inflammation Can Look Like

Picture an ordinary Tuesday. A Woman wakes after 5 and a half hours of broken sleep and reads work email before she is out of bed.

She skips breakfast and drinks a sweetened latte in the car. At 10, a granola bar at her desk.

At 3 PM, the crash, and a handful of chocolate to get through it.

Dinner is pasta and a glass of wine, and on a hard day, a second glass. Her phone is the last thing she sees before sleep.

Nothing in that day feels dramatic. To her immune system, it is a day full of small alarms: blood sugar spikes, stress surges, gluten reaching a gut that may already be open, alcohol loosening the seams of her gut lining, and too little sleep to reset any of it. Tomorrow brings the same ones.

If any part of that Tuesday looks like yours, you have also found your first places to begin.

Where Inflammation Comes From

These are the sources I see most often in Midlife Women. Many Women have several at once, which is why removing just 1 rarely clears it.

• Sugar, refined starch, and insulin resistance. Sugar, processed food, and chronic stress push your body toward insulin resistance. Your body compensates by making more and more insulin, and that excess insulin feeds inflammation.
• Belly fat. Fat stored deep around your organs is active tissue. It releases inflammatory messengers of its own, so inflammation and belly weight feed each other.
• A leaky gut. When your gut lining is damaged, bacterial fragments called endotoxins, or LPS, slip into your bloodstream, and your immune system reacts to them everywhere they travel.
• Foods your immune system has flagged. Gluten, dairy, soy, and others, different for different bodies. Every exposure can restart the reaction. Many of these sensitivities grow out of a permeable gut, and many ease as the gut heals, while gluten and dairy stay out for an Autoimmune body.
• Chronic stress. In the short term, cortisol calms inflammation. After years of stress, your cells stop listening to cortisol's calming signal, and inflammation rises.
• Too little sleep. In research on healthy adults, even 1 night of partial sleep loss raised inflammatory signaling the next morning.
• Falling estrogen. Estrogen is 1 of your body's brakes on inflammation. In Perimenopause that brake comes off, so the same diet you ate at 28 produces a different result at 47.
• Alcohol. It loosens the tight junctions in your gut lining and adds to what your liver has to clear.
• Too little movement, and lost muscle. Working muscles release their own anti-inflammatory messengers. A sedentary body misses that daily dose.
• Infections that linger. Epstein-Barr reactivation, long COVID, gum disease, and gut infections such as SIBO or H. pylori.
• Toxins and mold. Smoke, chemicals your body has to process, and mold in a home or workplace, which some Women react to strongly.
• Autoimmune activity itself. Once your immune system is targeting your own tissue, that response becomes 1 more steady source of inflammation.
• Relationships that do not feel safe. A conflict that never resolves keeps the same alarm circuitry switched on that drives inflammation, as 'Key 4: Love & Healthy Relationships' in the Remission chapter describes.

Finding Your Loudest Source

Dr. Datis Kharrazian, 1 of my teachers, offers a sequencing principle that changed how I work. Anti-inflammatory food, habits, and supplements bring limited benefit while a major source of inflammation is still active.

Think of pouring cool water on a fire while someone keeps pouring gasoline on the other side. The water helps, and it cannot win until the gasoline stops. So the work is to find the loudest source first.

This sequencing holds a great deal of hope. If you have cleaned up your plate and your symptoms have barely moved, the food is still doing its part. You may simply not have found your loudest source yet.

A clean diet is the foundation, and on its own it cannot put out a fire that an infection, a moldy bedroom, or years of chronic stress keeps feeding. Your healing has a logical order, and you can work it 1 source at a time.

A food and symptom journal is 1 of the best tools for this. When you track what you eat and how you feel alongside what is happening in your life, patterns appear that are invisible day to day: the flare that follows a weekend in a damp cabin, the fatigue after certain foods, the ache that rises in the high-stress weeks.

These are the clues I look for with each source:

• Blood sugar: the 3 PM crash, shakiness or irritability when a meal runs late, and a waist that keeps growing. Check fasting insulin and HbA1c.
• Your gut: bloating, irregular stools, and reactions to foods you used to tolerate. A comprehensive stool test tells you the most.
• Stress: 'I'm fine, just busy', wired at night and tired in the morning, and getting sick on the first day of vacation.
• Sleep: fewer than 7 hours most nights, or waking at the same hour every night.
• Hormones: symptoms that changed in the same years your cycles did.
• Infections: an illness you can point to with a clear before and after, or gums that bleed when you brush.
• Mold and toxins: feeling better away from home and worse in 1 particular building, a musty smell, or water damage in the past.

How we lived in our 20's and our 30's reveals itself in our 40's and our 50's. The late nights. The dieting. The coffee to boost our energy. The rounds of antibiotics. The day-to-day stress we called normal living, because everyone around us was carrying it too. None of that showed up on our labs at 28, because we had a hormone buffer thick enough to absorb it. That buffer is what thins in Midlife.

We do not get to live our 20's over again. Whatever you change from here counts more now than it did at 25.

The arc keeps going. How you treat yourself in your 40's and 50's shapes 60 and beyond, because the inflammation you cool now is inflammation your heart, your brain, and your joints do not have to carry later.

The Damage It Does

Chronic inflammation sits underneath many of the leading causes of disability and death. A 2019 review in Nature Medicine linked inflammation-related diseases to more than half of all deaths worldwide. Here is where it lands:

• Your heart and blood vessels. Inflammation in the artery wall helps build plaque and makes it more likely to rupture. In the CANTOS trial, a drug that lowered inflammation, without lowering cholesterol, modestly reduced repeat heart attacks, strokes, and cardiovascular deaths in people who had already had a heart attack and still had a high hs-CRP.
• Your blood sugar. Inflammatory messengers interfere with insulin signaling, which deepens insulin resistance, which drives more inflammation. It becomes a loop.
• Your gut. Sustained inflammation pries apart the tight junctions in a lining 1 cell thick, which lets more through, which drives more inflammation. Another loop.
• Your immune system. An immune system under constant alarm is part of the ground Autoimmune conditions grow in.
• Your thyroid. Inflammation slows the conversion of T4 into T3, the active hormone your cells use.
• Your brain and mood. Inflammatory signals reach your brain. Researchers have linked inflammation to brain fog and depression and, over decades, to cognitive decline and Alzheimer's disease.
• Your bones and joints. Inflammatory messengers switch on the cells that break bone down, which is part of why bone loss speeds up as estrogen falls. They also drive joint pain and stiffness.
• Your liver. Inflammation and insulin resistance together drive fatty liver, now the most common liver condition worldwide, affecting about 1 in 3 adults.
• Cancer. Chronic inflammation creates conditions that help some cancers begin and grow.

Researchers even have a name for the slow rise of inflammation with age: inflammaging. Most of the sources above are things you can change.

How to Cool It

The rest of this guide is an inflammation plan. Here it is in 1 place:

• Steady your blood sugar. Total sugar under about 15 grams a day, and under 10 if you are moving an Autoimmune condition toward Remission. Protein at breakfast, vegetables first, and a walk after meals.
• Heal your gut. 90 days of AIP removes the foods that damage the lining and floods your body with what rebuilds it: bone broth, organ meats, wild-caught fish, and 6 to 15 different kinds of vegetables a day, mostly cooked.
• Remove your triggers. Gluten, dairy, and alcohol, and soy if your body has flagged it. For an Autoimmune body, that means grain-free, not just gluten-free, and dairy-free.
• Eat the calming fats. Wild-caught fish such as salmon and sardines bring omega-3 fats, which help your body resolve inflammation.
• Protect your sleep. 7 to 9 hours, on a regular schedule.
• Build in recovery from stress every single day.
• Move, and build muscle. Walk daily, and strength train 2 to 3 times a week.
• Address your hormones and your thyroid with a practitioner, since falling estrogen and a slow thyroid both add to the load.
• Retest hs-CRP after 12 weeks, and watch the trend.

If your inflammation runs high right now, build your movement gradually, since a sudden jump into intense training or heavy lifting can flare an inflamed body. 'When Inflammation Is High, Start Low and Build', in 'Aches, Stiffness, Frozen Shoulder, and Elbow Pain: Your Joints and Muscles, and Keeping Your Strength', shows how to keep building strength while the fire cools.

Low Dose Naltrexone (LDN): A Gentle Tool for Inflammation and Autoimmunity

Some of the most useful tools for an inflamed, Autoimmune body are the ones almost no one mentions in a 12-minute appointment. Low dose naltrexone, or LDN, is 1 of them, and it has been part of my own healing.

Naltrexone is approved by the FDA to treat opioid use disorder and alcohol use disorder, at a standard dose of 50 mg. LDN is the same medicine at a tiny fraction of that dose, usually 1.5 to 4.5 mg a day, and at that dose it is used for a different purpose entirely.

That use is off-label, which means a prescriber chooses it for a purpose the FDA has not formally approved. Because no commercial tablet comes in these small doses, LDN is made by a compounding pharmacy.

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LDN is promising, well tolerated, and still under study. It is 1 tool, and it works best on top of the foundation: gut healing, an anti-inflammatory plate, steady blood sugar, restored nutrients, and supported adrenals.