First Aid For Injuries Part III – Inflammation: Embrace It and Control It

So you’re (still) injured but now you hopefully understand why you’re injured. As discussed in Part I of the Sock Doc First Aid For Injuries, if you didn’t have some sort of traumatic accident then your injury was slowly developing over time due to muscle imbalances which resulted from too much stress in your life. Now, perhaps the injury is not healing at all or healing very slowly and you’re into the chronic stages where compression and body work, (discussed in Part II) don’t seem to be helping anymore, and resting (even actively), is only making you less fit. So you turn to the dark side – drugs. I’m not talking about any of the pain-management medications (or illegal drugs) available, but anti-inflammatories.

Should you take a non-steroidal anti-inflammatory drug (NSAID)? Before you try any type of therapy, especially a drug therapy, you should have a basic understanding of the mechanism behind the action – why they (may) work. You should also be aware of the risks involved too. The one sort of nice thing about NSAIDs is that if you feel better when you take them then you know your chemistry is off – your fatty-acid metabolism is not functioning optimally. To understand this, you first must understand a bit of biochemistry. As always, I’ll make it fun and applicable towards real-life situations, (I hope).

Eicosanoids and Inflammation:

To understand how a NSAID works, you must understand a bit about something called an eicosanoid, (pronounced: eye-kah-sah-noid). An eicosanoid is a hormone-like substance made from two long chain essential fatty acids, alpha-linolenic acid (ALA, an omega-3 fatty acid) and linoleic acid (LA, an omega-6 fatty acid). The primary role of the eicosanoids is to regulate immunity and inflammation within the body.

There are three groups of eicosanoids that are important when it comes to understanding inflammation causes and treatments. Two of these groups are more anti-inflammatory and for simplicity I’ll call them Group 1 and Group 3. The other group, Group 2, is more pro-inflammatory. All three groups are important – some inflammation is normal and necessary in the body especially during an injury, (discussed in Part I and II of the Sock Doc First Aid).

Group 1 eicosanoids are derived from the omega-6 fat Gamma-linolenic acid (GLA) which is formed from linoleic acid (LA). These fats are commonly found in vegetable oils and nuts/seeds (the oils of such), whether raw or refined. They are typically a more anti-inflammatory eicosanoid.

Group 3 eicosanoids are derived from the omega-3 fats of Eicosapentaenoic acid (EPA), which alpha-linolenic acid (ALA) can create. ALA is abundant in flax seed oil and walnuts while EPA is commonly found in the oil of fish and other sea creatures (algae). They are also a more anti-inflammatory eicosanoid.

Group 2 eicosanoids are derived from what is known as arachidonic acid (AA), a pro-inflammatory eicosanoid. AA is obtained in the diet from red meat, dairy, shellfish, and eggs. The amount of AA is greatly dependent on the diet of the animal which produced that food, or is that food. AA can also be synthesized from the omega-6 LA, (vege oils), converting it a pro-inflammatory eicosanoid, (whereas LA is an anti-inflammatory fatty acid if it converts to GLA), and this as you’ll soon see is a major problem especially when dealing with injuries.

Balanced Eicosanoids Means Controlled Inflammation

So why is the biochem lesson important? It’s actually very important because if your eicosanoids are balanced then you’ll be very successful at creating enough inflammation to heal and calm down inflammation when your body has had enough. A healthy immune and nervous system need balanced eicosanoid levels too.

You can see that if you have too many of Group 2 eicosanoids (AA) and not enough of Group 1 (GLA) and Group 3 (EPA) then your body will be in an inflamed state. This alone can create an injury, (a biochemical-type of injury), and if/when you sustain an actual physical-type of injury, that pain and inflammation will be much greater than if your three eicosanoid groups were in a normal and healthy balance with one another.

So how do you balance your eicosanoids? You primarily do so through diet. Though many say that this is easily done by eating more of Group 1 and 3 foods and less of Group 2 foods it is not that simple, (though not that complex either). You can’t simply just eat a lot of veges, nuts, and seeds and pop some fish oil capsules to have stellar anti-inflammatory Groups 1 & 3 and consume little to no Group 2 fats which are more pro-inflammatory. Sorry, but there’s a bit more to it than that.

There are two reasons why this thought process doesn’t work. One reason is that the more pro-inflammatory Group 2 (AA) can be made from the anti-inflammatory Group 1 (GLA), as previously mentioned so you’ll create inflammation if you eat too many Group 1 fats. (WHAT?! – You’ll see why in a bit). Another reason is that Group 2 (AA) is not as bad as it’s made out to be; you need a certain amount of AA fats to be healthy and heal from injury. After all, as you hopefully know from reading other Sock Doc articles, I’m a big proponent of Group 2 fats – pasture raised red meat, free range eggs, and organic dairy (heavy cream and butter – yum!). Confused? I hope not – read on!

Arachidonic Acid Has Its Nice Side

Arachidonic acid (AA), that “more” pro-inflammatory fatty acid, is vital for good health especially when it comes to the nervous system. AA is perhaps the most important fatty acid in respect to a developing human being. Along with DHA from fish oil and other marine lipids, (as well as breast milk), AA is the most abundant fat in the brain. AA protects the brain from oxidative stress – that’s free radical damage. Hey do you remember in Part I of First Aid For Injuries that oxidative stress was a predisposing factor when it came to inflammation? Now hopefully you see the link and the importance of some AA fats in your diet. AA is also necessary for the repair and growth of skeletal muscle tissue. That’s right – it helps with repair and growth of tissue – that’s an anabolic process and a necessary one when it comes to an injury.

The key to healthy AA though is to make sure you don’t have too much and that you’re getting it from the right sources. Actually consuming foods high in AA is very unlikely to increase inflammation. Put another way, eating red meat, dairy, shellfish, eggs, and other foods touted as “unhealthy” because of their AA levels will not make you more inflamed. But more AA that is derived from Group 1 omega-6 fats will make you inflamed, and this is the most important part of this entire story/lesson.

Carbohydrates and Stress Increase Inflammation

As you just learned, it’s how AA is derived (and also metabolized) in the body that dictates whether it is pro-inflammatory or an anabolic eicosanoid that will benefit your health, fitness, and potential injury. The way to increase inflammation in your body is by increasing the amount of AA your body makes from linoleic acid (LA), the omega-6 fat. Unfortunately, this process occurs very easily.

High insulin, as a result of a high carbohydrate diet, and high cortisol, from excess stress, are the two main ways a person will convert their LA to AA. When LA is converted to AA due to such reasons, (and there are others too, such as smoking and alcohol), the process if very fast and inflammatory. As you may have now realized, high carbohydrate foods are those same foods that often contain high levels of the omega-6 oils, (corn, safflower, soy, sunflower, peanut, and other cooking oils). So a person consuming breads, cookies, pastries, and other baked goods will increase their insulin level and their LA level, which will then convert to the inflammatory AA fats. That ain’t good, it’s an inflammatory storm.

Stress, as you know, increases cortisol levels. Although a normal amount of stress is good as are normal levels of cortisol throughout the day, increased and unleashed stress can spike cortisol levels and leave them high for hours, days, and even months or years. The increased cortisol will also take the anti-inflammatory LA fats (Group 1) and convert them to pro-inflammatory AA (Group 2) fats. Reducing stress will reduce cortisol levels and reduce inflammation and that also has a positive impact on antioxidant levels which are so important when it comes to injury prevention and treatment; (remember that in Part I?) That means resting and recovering well, (not overtraining), building a solid aerobic base, modifying your lifestyle (emotional stress), and of course eating a proper diet, will help you naturally fight inflammation and repair tissue. You’ll heal up faster than anyone could have ever expected!

So do you take that NSAID? That’s next in Part IV along with several ways you can naturally tame inflammation in your body. But until then, whether you’re injured or concerned about getting injured, consider removing all refined polyunsaturated vegetable oils from your diet as well as most if not all refined carbohydrates to lower inflammatory levels. Next, evaluate the stress in your life to help normalize stress hormone levels and naturally decrease free radical damage, both of which can predispose you to injuries.

Dr. Stephen Gangemi "Sock Doc"

I'm a board-certified chiropractic physician and clinical nutritionist with a passion for true natural health care. I implement dietary & nutritional therapies, exercise & movement practices, and lifestyle changes along with manual therapy techniques to help the body heal and prevent illness and injuries.