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Chronic Inflammation

Introduction

There are two important things to understand about inflammation following a traumatic brain injury. One is that we initially need these inflammatory responses to promote healing, and the second is understanding that this inflammation can become harmful if it continues long after the initial need was over.

Dr Amber Hayden said, ‘While it’s a relatively complicated process, inflammation becomes “chronic” if your internal “emergency alarm” fails to shut off when it should. This ends up allowing chronic inflammation to destroy healthy tissue and create related symptoms.’

When neurological inflammation persists over time, it can lead to neurodegeneration and inflammatory diseases.

The symptoms of neuroinflammation include brain fog, depressed mood, fatigue, cognitive disruption, lack of motivation, problems with balance, vision issues and pain.

The following points are made by Matthew V. Russo and Dorian B. McGavern in their paper ‘Inflammatory neuroprotection following traumatic brain injury’ and along with other commentators note that a lot more research still needs to be done.

  • Traumatic brain injury (TBI) elicits an inflammatory response in the central nervous system
  • Neuroinflammation can persist for years following a single TBI and may contribute to neurodegeneration
  • Administration of anti-inflammatory drugs shortly after injury was not effective in the treatment of TBI patients
  • Some components of the neuroinflammatory response seem to play a beneficial role in the acute phase of TBI
  • Early inflammation can set the stage for proper tissue regeneration and recovery
  • This can, perhaps, explain why general immunosuppression in TBI patients is disadvantageous

If you haven’t read it, ‘What happens to the injured brain,’ will tell you more about how inflammation starts after trauma and brain injury.

The devil is in the detail

There is no doubt that a lot of research still needs to be done but what we have so far could be helping more people if brought to clinical trial.

We know the symptoms associated with brain injury and neuroinflammation. The big question has to be, ‘is there an effective way to address the biochemical cascade that occurs as the secondary injury, and when is it best to administer this?’

Logic follows that if we can manage the inflammatory response, then we can theoretically also manage many of the symptoms that often interfere with conventional therapies.

Current science tells us that we should be focused on:

  • the significant effects a brain injury has on the gut microbiome
  • the rapid depletion of micronutrient reserves

If we address these two early on, then effectively, we are supporting the immune system and the gut-brain axis allowing the body to support recovery naturally. When we fail to address these two criteria, people become deficient in vital vitamins and minerals such as vitamins D and B12, leading to further symptoms such as headaches/migraine and insomnia. Without restorative sleep outcomes become chronic.

When the biological systems are already overwhelmed by the shock and trauma of a brain insult, it is less able to manage further toxins being introduced. Ranging from pharmaceutical drugs to dietary intake of inflammatory foods and substances such as alcohol, recreational drugs and tobacco it is essential to understand where and how these can start a vicious circle that becomes difficult for people to break free of and prolongs recovery.

By joining the dots between existing research, the picture of what is happening and how to treat brain injury becomes clearer. 

Gluten and neuroinflammation

Scientists and an increasing number of general practitioners are recognising that while celiac disease (CD) is one manifestation of extreme gluten intolerance many other people have non-celiac gluten sensitivity (NCGS) or gluten sensitivity (GS).

A study published in BMC Magazine “shows that the two gluten-associated disorders, CD and GS, are different clinical entities…”

While there is no evidence that gluten causes neurological disease in people who aren’t gluten intolerant, we know that for those who are gluten sensitive, there can be significant effects on neurological health. In some individuals, gluten sensitivity was shown to manifest solely with neurological dysfunction. People living with a brain injury may be more likely to be gluten sensitive due to possible high levels of neuroinflammation.

A researcher at the University of Pittsburgh is seeking a grant (2018) to study the link between the microbiome and patient outcomes after traumatic brain injury. While the research is still very new, it is entirely possible that brain injury can have an impact on the microbiome and vice versa. The study is designed to discover how changes in a critically-ill patient’s microbiome can impact their quality of life and recovery.

Gluten sensitivity has been linked to both depression and anxiety and may lead to depressive symptoms by causing changes in the gut microbiota and inducing abnormalities in serotonin production. Neuroinflammation leads to brain dysfunction, cognitive impairment, and an increased vulnerability to neurodegenerative disease, so people with brain injury must do all they can to reduce overall inflammation.

The spleen and inflammation

Autonomic control of splenic macrophages can modulate systemic inflammation after injury Diana Casper ResearchGate

You may wonder what the spleen has to do with brain injury. Because several studies have led to advances in understanding inflammation and because trauma launches the immune response to brain injury and is initiated in the spleen, it can be helpful to know that brain injury can lead to spleen deficiency.

Spleen deficiency and inflammation are a precursor to neurodegeneration. If we know how to care for ourselves, we can decrease the risk of developing a number of inflammatory associated diseases.

Known as ‘brain-spleen inflammatory coupling,’ the processes and sequence of events that follow were thought to end after the acute phase of recovery.

However, as the spleen is responsible for removing toxins from the bloodstream, this process can be on-going and the spleen can become overburdened, particularly when a person has poor nutritional intake or is commonly exposed to pollutants and external toxins.

When the spleen slows down, so too does your energy and vitality exacerbating associated experiences with neuro fatigue. The spleen plays a leading role in the uptake of nutrients which we know are vital if we are to combat the effects of inflammation, including depletions in vitamin and mineral reserves and the fight against free radicals.

Spleen deficiency is effectively improved with acupuncture, changes to the diet and the addition of some herbs and supplements can also help. An acupuncturist will be able to diagnose spleen deficiency and with treatment, people see an improvement in energy, detoxification, skin health and healing.

Diet and inflammation

Research undertaken at the Brigham and Women’s Hospital (BWH) suggests that diet may influence neurodegeneration in the brain. The connection between what we eat, the health of the gut microbiome and inflammation has been inferred by a number of studies, however, because these interactions were not fully understood researchers at BWH decided to seek out more concrete evidence. The team were able to pinpoint the molecular pathway involved in inflammation.

Study author, Francisco Quintana, Ph.D., said, “Deficits in the gut flora, deficits in the diet or deficits in the ability to uptake these products from the gut flora or transport them from the gut – any of these may lead to deficits that contribute to disease progression.”

Other studies also show links between stress/negative emotions and unhealthy meals.  Janice K. Kiecolt-Glaser, Ph.D., notes that stress influences food choices, can enhance maladaptive metabolic responses to unhealthy meals, and diet can impact mood as well as proinflammatory responses to stressors. There are ‘notable bidirectional relationships among psychological, dietary, and biological pathways to inflammation.’

Other clinical studies have confirmed that chronic inflammation can worsen or cause food intolerance and many people are already aware that food toxins such as gluten from wheat and other grains and caseins from milk products are triggers for most chronic diseases.

Reducing inflammation

In order to try and relieve many of the commonly felt symptoms of brain injury, which can prolong for many years post brain injury, it is important to try and rebalance the immune system and reduce inflammation.

By reducing many of the symptoms that plague them, people living with brain injury outcomes can regain mental clarity helping them to focus on rewiring the brain and introducing strategies that help with daily living.

Rebalancing the immune system and reducing inflammation also decreases the risks associated with auto-immune diseases. People must get their general health back as soon as possible.

It is only recently that scientists and doctors have started to realise how important it is to treat a brain injury in the early stages and while it will inevitably take time for protocols to be changed, the information is beginning to flow through. Research has shown that pharmacological interventions are not effective following a TBI and also that the injured brain is much more sensitive to drugs.

A rational treatment plan should include the various remedial measures that target all of these processes of secondary injury:

  • Excitotoxicity
  • Oxidative stress
  • Dysfunction of mitochondria
  • Disruption to the blood-brain barrier
  • Calm neuroinflammation

How to reduce inflammation

It is always essential to consult with your doctor before making any changes, and this is particularly important if you are using prescription medications or are pregnant. We recommend starting with the One, Two, Three Plan, and that you think nutrition, think detoxification of your body and brain and use supplements. Please check the links from this page which take you to further information and detail.

It can also be helpful to understand more about the effects of stress and cortisol on the brain and body.

One neuroprotector that is also packed with vital micronutrients is scientifically proven to support the gut microbiome, balances the immune system and is effective in targetting the processes of the secondary injury as above is black seed oil.

When used with other supportive interventions, black seed oil can quickly reduce the symptoms of neuroinflammation and support biological healing. With symptoms adequately addressed and managed, it is easier for clinicians and patients to focus on therapeutic treatments and rewiring the brain.

Clearing neuroinflammation allows people living with a brain injury to have a clearer picture and understanding of the effects of the primary physical injury. The logical expectation would be that these interventions may help with apathy and lack of motivation following a brain injury. Further research is needed to clarify this theory but if it is effective, this could impact the speed of recovery.

References:

NCBI – Non-celiac gluten sensitivity triggers gut dysbiosis, neuroinflammation, gut-brain axis dysfunction, and vulnerability for dementia.
Science Direct – Neuroinflammation
BMC Medicine – Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity
NCBI – Microbiota and Neurological Disorders: A Gut Feeling
NCBI – Gluten sensitivity: from gut to brain
Nature Magazine – From gut dysbiosis to altered brain function and mental illness: mechanisms and pathways
Nature Magazine – Type I interferons and microbial metabolites of tryptophan modulate astrocyte activity and central nervous system inflammation via the aryl hydrocarbon receptor
NCBI – Stress, Food, and Inflammation: Psychoneuroimmunology and Nutrition at the Cutting Edge
NCBIThe inflammation theory of disease
Science Inflammatory neuroprotection following traumatic brain injury
ResearchGateNeurology – Midlife systemic inflammatory markers are associated with late-life brain volume The ARIC study
NCBI – Brain-Spleen Inflammatory Coupling: A Literature Review
NCBI – Clinical evidence of inflammation driving secondary brain injury: A systematic review
NCBI – The Spleen Contributes to Stroke-Induced Neurodegeneration
NCBI – Latest Study on the Relationship between Pathological Process of Inflammatory Injury and the Syndrome of Spleen Deficiency and Fluid Retention in Alzheimer’s Disease
Women’s Health Network – What is chronic inflammation?
Researchgate – The Role of Neuroinflammation in Traumatic Brain Injury
NCBI – Neuroinflammation after traumatic brain injury: opportunities for therapeutic intervention
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