Host: Deanna Minich, PhD
Guest: Kara Fitzgerald, ND
In this discussion, Kara Fitzgerald, ND and Deanna Minich, PhD explore the active process of inflammation resolution and how to provide clinical support to quench inflammation chronicity in your patients. Dr. Fitzgerald thinks of inflammation broadly, as a complex immune response to a variety of inputs. The offensive input could be a pathogenic insult like a bacterial or viral infection, and the inflammatory response is acute and protective to the patient. But when inflammation continues unchecked (due to continual proinflammatory inputs or inadequate inflammation resolution processes), that can open the door to many chronic diseases.
Even in the absence of the cardinal physical signs of inflammation (i.e., redness, pain, swelling, heat, loss of function), patients may be experiencing systemic inflammation that’s not obvious to the naked eye. Dr. Fitzgerald describes useful biomarkers healthcare practitioners can leverage to investigate inflammation in their patients. The basic lab workup includes a CBC to assess white blood cells, high-sensitivity C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR, or sed rate).
Functional Medicine and personalized lifestyle medicine practitioners often cast a wider net for biomarker assessments, including inflammatory markers associated with cardiovascular disease like: omega-3 fatty acid panel (specifically to ascertain the omega-6 to omega-3 fatty acid ratio and omega-3 index), lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO), fibrinogen, and F2-isoprostanes (F2-IsoPs). In fact, Kara considers these labs “low-hanging fruit” and explains that they are often covered by insurance and can be performed at standard reference labs. She also shares that serial measurements of basal body temperature can have clinical value, but normal or low readings do not rule out inflammation.
Dr. Fitzgerald goes on to explain that, “we can think about chronic inflammation as a failure of inflammation resolution.” Thus, efficacious clinical approaches that balance and resolve inflammation in the body become essential. Kara and Deanna delve into clinical strategies that treat major, underlying players in inflammation: intestinal permeability (tend to the gut first; address dysbiosis), metabolic endotoxemia (lipopolysaccharide [LPS] antibody lab is useful), a proinflammatory diet, excess omega-6 fatty acid intake, and inadequate omega-3 intake.
The goal is to improve the patient’s omega-3 index, but differential responses can occur with omega-3 supplementation, underscoring the benefit of a personalized patient care approach. Dr Fitzgerald mentions some potentially competing factors in improving omega-3 status: high blood glucose and insulin, high intake of omega-6 fatty acids in the diet, and consuming a proinflammatory diet. This trifecta scenario is common for individuals consuming the standard American diet (SAD). Kara compares and contrasts clinical response and other practical aspects (e.g., price, sustainability) for fish, algal, krill, and flaxseed oils. Options for vegans are covered, as well as dosing strategies for omega-3 supplementation in the chronically inflamed patient. Kara summarizes that, ultimately: “we want to make sure that omega-3s are robustly represented in the lipid membranes in all of our cells.”
Dr. Fitzgerald also explains that, “eicosanoids get the party started…SPMs come in and quench it (inflammation).” Thus, the remainder of the discussion examines a class of novel lipid mediators known as specialized pro-resolving mediators (SPMs). If healthcare practitioners approach chronic inflammation as a failure of inflammation resolution, then it becomes abundantly clear that a symphony of SPMs is critical for a harmonious result in the patient.
To that end, Dr. Fitzgerald is leveraging SPMs acutely in her chronically inflamed patients. She concludes the discussion by summarizing her clinical approach to mitigate and resolve inflammation in her patients with the following lifestyle changes: anti-inflammatory diet, lowering blood glucose and insulin levels, addition of omega-3 fish oils, and targeted supplementation with SPMs.
This Metagenics Institute LIVE broadcast took place live April 30, 2019 on the Metagenics Institute Facebook page.
