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From the Townsend Letter
June 2013

Rethink Health: Inflammation Is Actually Repair Deficit: Using Physiology First to Achieve Better Outcomes
Part 1: Value and Importance of Understanding Inflammation As Repair Deficit Opportunity
by Russell Jaffe, MD, PhD, CCN, and Jayashree Mani, MS, CCN
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Part 2 is also online.

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Inflammation is increasingly recognized as a cause or amplifier of all chronic, degenerative, and autoimmune conditions; the health challenges that rob many of their vitality and life quality (Figure 1). The many expressions of inflammation bring over 100,000 excess deaths adding an annual incremental health-care cost exceeding $200 billion. Lives and resources saved by correcting repair deficits can be repurposed to deliver higher-quality life for these people, their families, and communities, and at substantially lower net cost of health care because they have shifted from very high risk and cost to equally low risk and cost by choice and due to incentives for more healthful habits of daily living.

Figure 1: Inflammation

Part 1 of this article rethinks inflammation based on physiology rather than pathology and systems biology rather than mechanical engineering, finding insights and opportunities to improve outcomes at lower risks and costs.

Inflammation is revealed to be repair deficit and chronic inflammation is cumulative repair deficit. Inflammation has long been taught as a "fire" to be "fought" or a symptom to be suppressed. In contrast, repair deficits are opportunities to rebuild, renew, and rehabilitate as well as to remove obstacles to recovery by providing adequate amounts of essential health factors according to each individual's requirements.

This article explores inflammation's causes and consequences as cumulative repair deficits. Essential nutrient deficits, toxin excess, physical deconditioning and mental anguish potentiate and/or cause the blocks to recovery experienced and observed clinically as inflammation.

The immune defense and repair system's critical roles in inflammation are discussed here. A brief review of immune system functions is followed by a proven comprehensive integrative approach known as the Alkaline Way that engages the choices which people make about what they eat, drink, think, and do to evoke or inhibit healing responses. A goal is to meet individual needs so that repair can be completed and inflammation resolved naturally yet promptly and fully.

The Alkaline Way is an evidence-based personalized approach to redress the causes of inflammation and thus restore healthful resilience through enhanced enabled repair. The Alkaline Way concept has been successfully tested in controlled, community-based outcome studies of people with fibromyalgia, chronic fatigue syndrome, and both types of diabetes.1-3 Clinical reports from over 60,000 cases over 30 years indicate that all autoimmune conditions have mechanisms in common and clinically respond to this fundamental yet elegantly frugal approach. Small changes in what we eat, drink, think, and do can reward us with years or decades of quality life documented by independent predictive biomarkers. Choices of what we eat, drink, think and do determine 92% of our quality of life years (QoLY) that is epigenetic (RNAs) with 8%  determined by genetics (DNA).

The Alkaline Way approach to personalized care includes identifying and substituting each of the individual's sources of foreign invaders known generally as antigens that can wear down the immune defense and repair system. Maldigestion and dietary intolerances as well as detoxification and neurohormonal balance are other aspects included in this approach to removing obstacles to recovery.4

The Alkaline Way includes a health-promoting, nutrient-dense, whole food, and fiber-rich diet; an active lifestyle;  and targeted supplementation based on meeting individual needs, meaningful work, and nurturing relationships.5 The program is often more effective and brings more prompt and substantial relief than current best standard of allopathic care for that condition.

Inflammation Unmasked
In Western allopathic medicine, inflammation is seen as being either acute or chronic. In other healing arts, more nuanced approaches are taken to understanding the continuum of effective and ineffective repair systems, elective protective systems, and proactive health-promotion systems.

Acute Inflammation
Acute inflammation is the short-term immune response that the body mounts in cases of trauma, infection, and allergy. Symptoms occur only when the immune defense and repair system uses up and runs out of essential protective, energizing nutrients and calls for help by recruiting additional aspects of the immune system.

Western medicine first recognized the four signs of inflammation 2000 years ago as tumor, rubor, calor and dolor, Latin for "swelling," "redness," "heat," and "pain." Galen, the Alexandrian physician redactor, a few hundred years later added functio laesa, Latin for "loss of function," as the fifth aspect or consequence of inflammation. Little has been done since until recent evidence revealed the upstream causes of downstream inflammation.

Besides physical changes, important psychological correlates may include lethargy, apathy, loss of appetite and increasing sensitivity to pain – a suite of symptoms that are collectively known as "sickness behavior."6 This article recommends using predictive biomarker tests to appreciate areas of strength and resilience while identifying areas in need of improving. The Alkaline Way of sustainable living includes measured, and effective means based on the aggregate evidence and experience.4

Chronic Inflammation
Chronic inflammation occurs when repair deficits persist. The body calls for repair, and the first-responder cell team is unable to complete the repair or defense mission. Recruits are called by pro-inflammatory signals. Pathology and conventional medicine sees inflammation as a persisting slow-burning fire, continuing to call for pro-inflammatory responses even as the immune systems are unable to meet the needed repair requirements because some essential factors are missing or from toxin exposures.

Physiology recognizes that persisting inflammation means accumulating repair deficits throughout the body, leading to many common chronic conditions. For example, persisting repair deficit in blood vessel linings can lead to atherosclerosis, coronary artery, and peripheral artery vascular diseases. In the endocrine organs such as the pancreas, thyroid or adrenal glands,  (pathologies such as Cushing's hyperadrenalism or Addison's hypoadrenalism can occur.

Most chronic pain such as arthritis, bursitis, back pain, and costochondritis is a result of persisting repair deficit in joint tissue. If repair deficits persist in the gut lining, then loss of elective protective mechanism occurs. Lactose and gluten intolerance, as well as low mucosal antibody (IgA) and inflammatory bowel diseases, occur secondary to maldigestion, dysbiosis, and impaired repair of the gut resulting in compromised digestion, assimilation, and elimination.

Figure 1 shows how common and pervasive chronic inflammatory conditions are. Symptoms that people commonly associate with persisting chronic inflammation include body aches and pains, congestion, recurrent infections, diarrhea, dry eyes, indigestion, maldigestion, shortness of breath, skin outbreaks, swelling, stiffness, and weight gain/obesity.

Most pain medications work by blocking the repair process so that swelling reduces and pain abates. Blocking repair sets up a cycle of increasing inflammation that requires increasingly intensive immune suppression. Recent evidence understood in biological rather than mechanistic terms suggested there is a better way to improve outcomes more safely and with substantially less risk, collateral damage, and cost.
Conditions of cumulative repair deficit reduce life quality and increase costs of care that currently is mostly palliative and symptom suppressive rather than identifying and correcting the deficits or toxins that prevent full and enduring repair.7

Inflammation and the Immune System
The immune defense and repair system responses, including neurohormonal modulators, are keys to a deeper understanding of inflammation. Together they are the neuroimmunohormonal governing system of the animal body.

Animal immune systems have two parts known as innate/intrinsic and adaptive/acquired that will now be described functionally.

Innate Immune System
The innate immune system develops during the neonatal period concurrently with the digestive system. First responder or phagocytic cells are part of the innate immune system. First responder cells include the surveillance cells that traffic throughout the body as well as specialized cells inside each differentiated organ system. Examples include blood polymorphonuclear leukocytes, monocytes, basophils, and eosinophils as well as tissue mast cells, macrophages, fibroblasts, Kupffer cells in the liver, sinusoidal cells in the spleen, astrocytes in the brain, and so on.

Acquired Immune System
The acquired immune system is adaptive. This aspect of the immune system is called upon and learns what additional defense or repair is needed beyond what the innate immune system can accomplish. The adaptive immune system develops based on interaction with its environment when innate responses lack the capacity to complete the tasks of recycling that which is not self and is thus foreign to the body.

In other words, the more toxins, disease causing bugs, or allergens that we are exposed to and successfully fend off beyond what the innate immune system can neutralize and recycle, the more our acquired immune system grows in complexity. However, when we exceed immune defense and repair competences, chronic, degenerative, and autoimmune diseases then emerge. These conditions have become so common that it is hard to find an asymptomatic healthy population upon which to standardize lab tests.

Impact of a Burdened Immune System
Chronic infections, a telltale sign of a burdened immune system, also include inflammation repair deficits while also increasing the probability of concurrent metabolic imbalance, weight management issues, and insulin resistance leading to the continuum of prediabetes, diabetes, and the myriad heart and blood vessel consequences that ensue.

Additionally, inflammation usually so imbalances immune responses that delayed allergies develop because underlying maldigestion increases digestive remnants recognized as foreign by the body and not trapped by elective protective mechanisms such as mucins, sIgA, insoluble dietary fiber, and digestive enzymes. We find that delayed or late-phase food and other chemical sensitivities contribute in most people to chronic low-grade systemic inflammation and play a role in causing or amplifying autoimmune, chronic, and degenerative illnesses.

Perhaps one of the most baffling conditions of our times is cancer. In addition to chronic repair deferral, the repair system also eliminates the cancer cells that people form every day. One of the reasons for increased cancer risk is an immune system preoccupied with defense and unable to identify and eliminate the abnormal cells that form daily in all people.

Items taken up into the body are either nonthreatening and helpful or threatening and unhelpful. Infectious agents and digestive remnants (incompletely digested material) are treated equally by the immune system – both are considered foreign; that is, not "self tolerant."

Since defense takes precedence over repair in the immune system, digestive remnants occur due to maldigestion, prolonged transit time, and consequent toxicant reabsorption. Intestinal permeability increases due to cumulative repair deficits. Increased permeability allows digestive remnants to invade the body, increasing the defense work in the immune system. In chronic illness, underlying maldigestion and repair deficit set the stage for host hospitality to chronic infection and/or autoimmune, self-attacking chronic degenerative illnesses.

In healthy people pro-inflammatory compounds are released when needed and then turned off with anti-inflammatory antioxidants when the threat has been neutralized or the repair completed. Homeostasis or self reequilibration can thus be restored.

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