In the last blog we discussed how DAMPs activate inflammation.  DAMPs is an acronym for damage associated molecular patterns. (When tissue is injured, white blood cells infiltrate the area and trigger inflammation when the DAMPs which are pieces from the damaged tissue activate the receptors.)  The purpose of the inflammation is to clean up the damaged tissue and prevent infection. 

The key point with injury is that this is a temporary, self-limiting process.  With joint degeneration as in osteoarthritis, the temporary and self-limiting become chronic driving ongoing inflammation.  We also mentioned that the receptors on white blood cells that activate inflammation can be stimulated by PAMPs or pathogen associated molecular patterns.  Pathogens refer to infectious agents.  Inflammation is the first response in ramping up the reaction against infectious organisms.

Infections generally are temporary, and the immune system eliminates the organism.  There are however, chronic infections whose PAMPs drive chronic, non-resolving inflammation.  Most notable of these chronic infections are dysbiosis, chronic sinusitis and chronic urinary tract infections.  Dysbiosis refers to an unhealthy balance in the gut microbiome. 

Our microbiome consists of 100 trillion microbes that live mostly in our gut.  This mass contains about 1000 different species, some which help prevent inflammation and others which can trigger it.  Our level of inflammatory activation is dependent on the balance in these two types of microbes.  Either low levels of the commensal bacteria who help to suppress inflammation, or high levels of dysbiotic/inflammatory bacteria can produce chronic inflammatory activation. 

The image shows a gut microbiome sequencing test in a subject with high levels of several dysbiotic/inflammatory bacteria.  They create a chronic flood of PAMPs which trigger chronic inflammation. 

The most common cause of dysbiosis is antibiotic use.  These dysbiotic/inflammatory bacteria are always present in the gut but their levels are suppressed by the adequate levels of the commensal bacteria.  When antibiotics reduce their levels, the inflammatory bacteria often overgrow.

The commensal bacteria help also control inflammation by another mechanism.  These good bacteria ferment soluble fiber from our food creating short chain fatty acids which are anti-inflammatory.  The other path to dysbiosis is a poor diet low in soluble fiber so the commensal bacteria do not populate. 

One other factor is involved in the ability of dysbiosis of the gut to drive systemic inflammation.  The largest collection of immune tissue in the body, approximately 75%, is in the gut. Inflammation there quickly becomes systemic inflammation.

Most people with dysbiosis have symptoms like reflux, abdominal bloating/pain, constipation and/or diarrhea.  However, up to 30% have no gut related symptoms and yet have systemic inflammation.  Common symptoms in that group are skin problems such as eczema, joint pain/tightness such as in the hands, and brainfog. If dysbiosis is suspected, a microbiome sequencing test is indicated.  In some cases the solution will be to use high dose probiotic with soluble fiber/prebiotics.  In other cases a kill off of the dysbiotic/inflammatory bacteria with herbal antimicrobials is done.  It is important to take probiotics during this as the antimicrobials will lower their levels as well.

All openings to the outside world such as the nose or the lower urinary tract have a microbiome.  A similar remove and replace protocol can be used from chronic infections in those systems.

One additional factor in the recurrence of infections in the GI tract, urinary tract and sinuses is that most of the organisms that cause them produce biofilm. The organisms hide under the biofilm they produce making them difficult to get to with antimicrobial therapy. The bacteria will often become dormant in biofilm so the infectious symptoms temporarily resolve. These infections periodically reactivate appearing to be a “new infection” when they are actually just activation of the dormant state. Antimicrobial therapy often should be combined with enzymes that dissolve biofilm for best results.

In the next blog we will discuss one of the most common triggers of chronic inflammation, HAMPs or homeostasis-associated molecular pattern molecules.  These are a group of signaling factors associated with abnormal diet and body fat such as high insulin.  High HAMP inflammatory signaling is the link between poor diet, weight and disease.  Stay tuned.