Until recently, no one truly understood inflammation – what it is, its role in healing, its newly discovered role in muscle growth, and how and when and if to treat it.
The standard protocol was as follows:
Any time you injured yourself – from a cut finger, a bruised leg, or pair of overtrained hamstrings, – you experienced inflammation. Out of habit and folklore and momma's sage advice, you immediately iced up and Pezzed down handfuls of anti-inflammatories.
You, along with nearly everybody else, thought that inflammation was bad. Sure, how could you think otherwise? Even the word, from the Latin inflammo, suggests heat or fire.
I'm here to tell you that in many cases, fire, or inflammation, is good, and that you should sometimes consider ditching the prescription anti-inflammatories and the OTC pain-pills and even the ice.
Get this straight.
Without inflammation, wounds wouldn't heal... ever. The common cold would persist for years. That chancre sore would fester and thrive for years. Even the muscle you strive to strengthen and build might never get bigger or stronger if inflammation didn't exist or, as is the current trend, was completely wiped out by inadvisable pharmaceutical interventions.
Let's assume that, like Freddie Krueger, my hand came through this computer screen and scratched your cheek with my razored glove.
Opportunistic microbes would attack the exposed tissue within seconds, and cells under direct attack would respond by "calling 911," which, in this case, equates to flinging out an ammonia-like substance called histamine.
A lot of this fluid splashes uselessly onto other cells that are under similar attack, but some of it manages to slosh onto some of the ultra-miniaturized blood vessels that permeate the area.
The tiniest amount of histamine acts like a cattle prod to these vessels. Almost immediately, they swell and double in size and in doing so create holes or gaps in the cellular tissue.
These gaps allow a special protein-loaded fluid, always on hand in the bloodstream, to come flooding in. This fluid attacks the invading microbes and smothers them dead.
Through these same gaps, sometimes doubling over on themselves to squeeze through, come ravenous white blood cells called macrophages. Amoeba-like, they extend one "foot" through a gap, fold over, and then suck the rest of the body into the battle area, sort of like a fat man trying to step into a pup tent. There, the macrophages can simultaneously engage and destroy up to 100 bacteria each before they fall victim to their own gluttony and die from their own digestive enzymes.
Later come the antibodies, specifically programmed to attack the particular invaders in the area.
That whole battle that takes place after a cut or a scrape – the initial responses and the histamine release and the subsequent swelling – is part of inflammation. It's a tightly choreographed offensive designed to heal the body. The swelling allows the super-hero like proteins, white blood cells, and antibodies, to come charging into the area.
Likewise, this same swelling that affords access by antimicrobial defenses also makes it easier for post-battle chemical factors like growth hormones to come into play. These growth factors stimulate fibroblasts, epithelial cells and endothelial cells (which make new blood vessels) to come to the area and begin the reconstruction process.
Why then, do we – doctors and peons alike – work so hard to thwart inflammation when it's obviously so crucial to healing – even the type of healing muscles undergo after an intense workout?
Before we answer the question above, we need to distinguish between the two types of inflammation, acute and chronic.
- Acute inflammation is the kind that happens after an injury like the aforementioned slash to the face, a bruise, or even after you work out hard. It's also what you'd experience with appendicitis, cancer, or even stress. It's not long lasting, it's localized, and it often results in rapid healing.
- Chronic inflammation, on the other hand, starts as a gross overreaction to some stimuli that's usually pretty benign. It's like bringing a cannon to a pillow fight. It's what you see in common allergies or gluten sensitivity.
You also see chronic inflammation as a response to the body attacking its own tissues. Examples of this include Crohn's disease, Type I diabetes, and rheumatoid arthritis, and these conditions – along with dozens of others – are collectively known as autoimmune diseases.
The big difference, of course, is that chronic inflammation doesn't stop; it continues against all practicality and logic. It's a toilet that won't stop running; an air conditioner with a broken thermostat that keeps the room at bone-chilling temperatures.
If you take a look at almost any disease, you see chronic inflammation's butt-ugly head. It's pretty much at the root of all things bad, health wise. Ask a 100 cardiologists about the cause of heart disease and the only thing 95 of them will agree on is that it's a disease of inflammation. Even hair loss is partly due to inflammation.
And, as you might guess, chronic inflammation is death to muscle growth.
While long suspected, it's recently become accepted that acute inflammation is essential for muscle growth.
You know those macrophages that march in after an injury occurs? They also march in after a muscle is damaged, only in two waves. The first wave comes soon after muscle fibers are injured and they begin to lyse or dissolve injured muscle fibers. They reach their highest concentration about 24 hours after a workout or muscle injury and their concentration dwindles after about 48 hours.
Then comes a second, Iraq-like "surge" of non-phagocytic macrophages that bathe the injured muscle fibers in the growth hormone IGF-1, which significantly increases the rate of muscle regeneration.
Likewise, exercise-damaged muscle cells release protein molecules called cytokines, which initiate healthy inflammation that results in decreased levels of myostatin, the protein that tells the body to stop growing muscle, in addition to initiating muscle catabolism.
Acute inflammation also brings about a rise in cyclooxygenase (COX) enzymes, which play a big part in initiating satellite cell proliferation, differentiation and fusion (with muscle fibers).
(Satellite cells are "dormant" cells that lie adjacent to muscle fibers. When muscle cells incur injury, these dormant cells spring to life and grow into full-fledged muscle cells, in addition to giving rise to more satellite cells. They're just one reason muscles grow in size after resistance exercise.)
However, if you impede or stop inflammation by taking post-workout non-steroidal anti-inflammatories (NSAIDS) like aspirin, ibuprofen, or Naproxen, or even if you ice your muscles, you could very well negate your workout's muscle-building effects!
So it's pretty safe to say that acute muscle inflammation is a good thing, and heroic efforts to thwart it are ill advised and counterproductive to growth.
- Chronic inflammation, however, increases levels of myostatin, thus impeding muscle growth just as effectively as if you stopped acute inflammation.
So, clearly, too little inflammation and your muscles won't grow. Too much and muscle growth is retarded (along with imposing all kinds of other negative effects on the body). To put it succinctly, acute inflammation heals, while chronic inflammation destroys.
The key, obviously, is a Goldilocks not-too-hot, not-too-cold inflammation sweet spot.
Unfortunately, we've taken to treating acute inflammation much the same way we do chronic inflammation. Doctors often instruct patients to start taking anti-inflammatories immediately after surgery.
Athletes take NSAIDs right after a brutally intense workout. That, or they apply ice right after the last sprint is run or the last dumbbell is lifted.
All of these measures impede healing and impede muscle growth.
The impetus of all this misguided treatment is avoidance of pain. Swelling often causes what we call nociceptive pain, which is caused when pain receptors react to a change in temperature, vibration, stretch, or swelling. Obviously, swollen and stretched tissues can press against nerve endings and cause pain.
If we reduce the swelling, pain diminishes. But it's a rotten trade-off. It's a wuss trade-off. You quench some or all of the pain, but you impede healing. You make it harder for the body's defenses to clean up and reconstruction crews to do their job.
- If you're experiencing acute inflammation – the type that occurs after an injury, after surgery, or after a muscle-fiber damaging workout – avoid taking any NSAIDS. While they'll help quell the pain, they impede the healing process and in the case of muscles, they may well impede further growth. Granted, the occasional use of NSAIDS won't likely pose much of a problem, but if you take them regularly, the odds are high that you're impeding muscle growth.
- Reconsider icing sore muscles. The initial thinking was that it was safe to ice a muscle because there was no need for immune cells to get all angried up when the injury was internal and there was no possibility of infection. The trouble is, that's short sighted. Granted, icing will help with pain, but since we now know that inflammation is necessary for muscles to grow bigger and stronger, icing is likely counterproductive.
- If you're hurting from acute inflammation caused by an injury or you're debilitated from a brutal workout and you simply can't handle it, consider using acetaminophen. While it does exhibit some anti-inflammatory effects, it's more of an analgesic.
- If pain persists after a couple of days, take any NSAID you feel is necessary, or, preferably, take appropriate doses of Curcumin. Curcumin is a potent anti-inflammatory and it blocks a host of inflammatory compounds by a certain reasonable percentage, as opposed to blocking one particular inflammatory compound by 100 percent. As an example of the latter, the prescription painkiller Vioxx shuts down COX-2 production completely and got lots of bad press for causing all those pesky heart attacks.
All of us experience varying degrees of inflammation, some of it necessary and some of it unnecessary. Some types are caused by environmental factors, some are caused by lifestyle factors, and some are caused by an immune system run amok.
We're thankful for the acute inflammatory response that leads to healing, but it's the chronic or unnecessary inflammations that drain us of life.
There are plenty of common-sense lifestyle changes we can make to suppress chronic or unnecessary inflammation and any 8-year-old could probably figure them out: get enough sleep; avoid alcohol and drugs; eat fruits and vegetables; eat enough protein; and drink enough water.
Granted, all that stuff would help, but given the stresses of modern life, some self-imposed and others dictated by just living in the material world, additional help in the form of nutraceuticals seems necessary.
As explained above, curcumin is a hugely powerful and valuable anti-inflammatory. It targets a host of molecular inflammatory targets, not shutting them down, mind you, but quelling them (as shutting them down completely might have undesirable effects. See Vioxx-comma-death.)
For weightlifters, taking curcumin generally results in a less achy day-to-day existence, in addition to helping quell chronic inflammation, which is a death knell to making progress in the gym. It also has a host of other health benefits, some or all of which might be related to its anti-inflammatory effects.
Most experts (including me) recommend one daily 500-mg. capsule as a rational, proportional response to everyday inflammatory stressors. This small amount, while being healthful, would still allow the beneficial post-workout inflammation that's crucial to growing bigger and stronger muscles.
For severe pain or chronic inflammation, it seems that two 500-mg. capsules, taken twice a day, works well.
Likewise, fish oil has proven to be a potent anti-inflammatory. While fish oil combats inflammation in a bunch of ways, the main mechanism seems to be by binding to a particular protein receptor known as GPR120 that's found on immune cells involved in inflammation. The omega-3 fatty acids found in fish oil clamped onto the GPR120 receptor and shut down nearly all inflammatory pathways.
I'm also somewhat interested in tart cherry juice as an anti-inflammatory. While it's probably too early to give it an unabashed thumbs-up, at least a couple of studies have shown it to significantly reduce levels of C-reactive protein and interleukin-6, two markers of inflammation.
- Don't ice after a workout. Icing doesn't heal anything; it's purely analgesic.
- Don't use NSAIDS after a workout or injury, unless absolutely necessary. If pain is severe, use acetaminophen or low-dose curcumin (one 500-mg. capsule daily).
- To combat daily, non-exercise related inflammation and maximize chances of being healthy in general, avoid inflammatory practices (not getting enough sleep, boozing it up, using drugs, crappy diet), and take anti-inflammatory nutraceuticals like low-dose curcumin and/or fish oil (two to four 500-mg. capsules a day).
- To combat chronic inflammation or severe pain, use NSAIDS as recommended on the label or use up to 2 capsules curcumin twice a day, and/or 4-8 capsules of fish oil per day.
- If you bust it up in the gym and drive inflammation up to deleterious levels, doing some gentle exercise the day after, e.g. walking, can reduce inflammation to non-damaging, muscle building levels.
- If busting it up in the gym day after day is your status quo, use peri-workout nutrition products to keep inflammation in the sweet zone. Inflammatory processes won't run amok, you won't be as sore, and you'll be able to bust it up in the gym day after day and make significant progress.
Most of the folklore regarding inflammation is based on pain management. Reduce the swelling through ice and/or drugs and you generally reduce the pain, but that's kind of a Faustian bargain – you accept the gift of pain relief but in doing so give up proper healing and/or muscle growth.
It's not a good deal. Don't take it.