What is Inflammation?

Inflammation is one of those words that people use without really thinking about its actual meaning. So today we’re going to take a bit of a break from the blood lipid series to cover inflammation. In later posts, I’ll dig deeper into how the inflammatory response works with stuff like exercise and heart disease, but for now, I’ll just get the basics out there.

Existence is suffering, according to certain schools of thought. I don’t know that I’d go quite that far, but I would emphatically state that anyone who spends a modicum of sentient time in the space time continuum we call existence is gonna experience some unpleasantness. A bump on the knee, a bacterial infection, an acute injury, a persistent illness, a death of a loved one, a broken heart. It’s a big and often angry world that doesn’t necessarily care about you, and something’s gotta give. When that happens and the sanctity of our bodies is interrupted by pain, injury, or illness, our bodies respond with inflammation.

There’s that word again: inflammation. It pops up quite often in our circles, usually playing either the starring role, absolutely killing it as a supporting actor, or stealing the show with a cameo appearance in some malady or another. Heart disease, obesity, depression, arthritis (and any  -itis, really), autoimmune diseases, insulin resistance – all classics worthy of accolades (although tonsillitis totally got robbed in last years Oscars), and all linked to inflammation, sometimes even causally. So inflammation must be terrible, right? It must be completely and unequivocally a negative trait, kinda like how our body evolved to manufacture cholesterol to kill us. What, didn’t you know that coronary heart disease confers a survival advantage?

Jokes aside, the fact that inflammation is a common, natural, innate response to injury/pain/illness/stress is a hint that there’s probably something necessary about it. It’s not some accident, nor is it our body hell-bent on making life miserable for itself. On the contrary: inflammation is our body’s way of saying it isn’t gonna take the affront of injury or illness lying down. It’s not a passive spectator totally reliant on the kindness of Pfizer and Walgreens and an ice pack to get it out of a jam. Although you wouldn’t think it, what with the barrage of altruistic allknowing medical experts and commercials both touting some essential pharmaceutical, our bodies can actually heal themselves. And the first responder, so to speak, is the inflammatory process. That’s right. Pain, swelling, redness, and that radiating sense of warmth that we feel at the site of an injury or illness don’t manifest by accident or for kicks. That’s inflammation, and it’s essential to our very existence in a world of hurt.

First up, acute inflammation.

The initial response to a pathogen or an injury is acutely inflammatory. In other words, it is brief, lasting several days or less. All sorts of things can cause an acute inflammatory response. Here are a few:

  • Trauma (punch, kick, golfball to the head)
  • Infection by pathogens (bacterial, viral)
  • Burn (sun, fire, seatbelt buckle on a summer day)
  • Chemical irritants
  • Frostbite
  • Stabbing/Cut/Laceration
  • Allergic reaction

Things happen pretty fast in an acute inflammatory response and involve several different players, including the vascular system (veins, arteries, capillaries and such), the immune system, and the cells local to the injury. First, something painful and unpleasant happens; choose one of the above injury options. Then, pattern recognition receptors (PRR) located at the injury site initiate the release of various inflammatory mediators, which in turn initiate vasodilation (or widening of the blood vessels). This allows increased blood flow to the injury site, which warms the site, turns it the familiar red, and carries plasma and leukocytes to the site of the injured tissue. The blood vessels become more permeable, thus allowing the plasma and leukocytes to flow through the vessel walls and into the injured tissue to do their work. Emigration of plasma into tissue also means fluid buildup, which means swelling. At the same time, the body releases an inflammatory mediator called bradykinin which increases pain sensitivity at the site and discourages usage of the injured area. These sensations – heat, redness, swelling, pain, and a loss of function – are annoying and familiar, but they are absolutely necessary for proper healing.

Allow me to explain why the four primary symptoms of acute inflammation are important:

  • Increased blood flow warms the injury and turns it red, which can be irritating and unsightly, but it also carries the guys – leukocytes – that will be cleaning up the injury site, mopping up pathogens, and overseeing the inflammatory process.
  • Swollen body parts don’t fit into gloves, are really sensitive, and don’t work as well as their slim counterparts, but a swollen finger is a finger that’s full of a plasma and leukocyte slurry and therefore on the road to recovery.
  • Pain hurts, but if an injury doesn’t hurt and it’s serious, you’ll keep damaging it because you won’t know not to use it.
  • Loss of function prevents you from using what could be one of your favorite body parts, but you don’t want to make it worse be re-injuring it. Besides, it’s only temporary.

These symptoms both indicate and enable inflammation (and, thus, healing), but what’s the deal with inflammation being linked with all those chronic illnesses – like obesity, heart disease, and depression? How does something normal and helpful go haywire and become implicated in some of the most crushing, tragic diseases of our time?

When inflammation becomes chronic and systemic, when it ceases to be an acute response, when it becomes a constant low-level feature of your physiology that’s always on and always engaged, the big problems arise. The inflammatory response is supposed to be short and to the point. I mean, just look at its responsiveness. Go twist an ankle (don’t, not really) and watch how fast it swells up and gets warm to the touch. It isn’t meant to be on all the time.

And because a big part of inflammation is breaking the tissue down, targeting damaged tissue and invading pathogens, before building it back up, the inflammatory response has the potential to damage the body. That’s why it’s normally a tightly regulated system, because we don’t want it getting out of hand and targeting healthy tissue. But if it’s on all the time, regulation becomes a lot harder.

All these inflammatory mediators and their effects are short-lived and require constant propagation to keep going. The only thing that keeps it flowing is sustained or subsequent injury to the site, so a little cut that heals in a couple days will need to get infected or reopened if the inflammatory cascade is going to continue. This usually doesn’t happen in developed countries. Wounds don’t fester, limbs aren’t hacked off because they got infected, and we don’t live with as many parasites as we used to. There’s no exogenous bacterial epidemic laying waste to the population by invading our bodies and stimulating an inflammatory response that never quite ends (although the Jaminets would suggest that persistent infections are more common than we might think). No, there must be another explanation. There’s got to be another stressor, or stressors, that are doing two things: inducing the inflammatory response and hanging around in the environment as a constant feature.

I’m going to fire off a few things that both induce inflammation and tend toward prevalence in developed countries. You let me know if anything sounds familiar to you.

  • Toxic diets: High-sugar, high-processed carb, high-industrial fat, high-gluten, high-CAFO meat, low-food is a pretty accurate descriptor of the modern Western diet.
  • Insufficient omega-3 intake: Omega-3 fats form the precursors for anti-inflammatory eicosanoids, which are an integral part of the inflammatory response. Poor omega-3 status means insufficient production of anti-inflammatory eicosanoids and a lopsided inflammatory response to normal stimuli.
  • Excessive omega-6 intake: Omega-6 fats form the precursors for inflammatory eicosanoids, which are an integral part of the inflammatory response. High omega-6 status (especially when combined with poor omega-3 status) means excessive production of inflammatory eicosanoids and a lopsided inflammatory response to normal stimuli.
  • Lack of sleep: Poor sleep is linked to elevated inflammatory markers. Poor sleep is a chronic problem in developed nations. Either we go to bed too late, wake up too early, or we use too many electronics late at night and disrupt the quality of what little sleep we get. Or all three at once.
  • Lack of movement: People lead sedentary lives, by and large, and a lack of activity is strongly linked to systemic, low-grade inflammation. People don’t have to walk to get places, they take escalators and elevators, they sit for hours on end, and they don’t have time for regular exercise.
  • Poor recovery: Other people move too much, with too little rest and recovery. When I ran 100+ miles a week, I certainly wasn’t sedentary, but I was chronically inflamed. Overtraining is a form of chronic inflammation.
  • Chronic stress: Modern life is stressful. Bills, work, commuting, politics, exercise that you hate – it all adds up and it doesn’t seem to let up or go away. And if it becomes too much for you to handle (I know it’s too much for me at times), your body will have a physiological, inflammatory response to emotional stress.
  • Lack of down time: When you’re always on the computer, always checking your email/Facebook/smartphone, you are always “on.” You may think you’re relaxing because your body is stationary, but you’re not relaxing.
  • Lack of nature time: We spend too much time contained in cubicles, cars, trains, and cities, away from trees, leaves, and soft earth. In a way, nature is home for us. Going home certainly has its measured benefits.
  • Poor gut health: The gut houses the bulk of the human immune system. When it’s unhealthy, so is your inflammatory regulation.
  • Poor acute stressor/chronic stress ratio: We respond far better to acute stressors than repeated, sustained stress – even if the latter is of a lower intensity.

See what I mean? Since we’re set up for acute stressors requiring an acute inflammatory response, all this other low-level, evolutionarily-discordant, superficially mild stuff throws us off and sets us up for a lifetime of chronic inflammation.

Anyway, that’s all for today. I hope it was a learning experience. If you have any questions about inflammation, leave them in the comments and I’ll try to work them into future installments. Take care and Grok on!

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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145 thoughts on “What is Inflammation?”

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  1. Chronic inflammation is the big killer, and we don’t really even know it’s happening. Most likely the culprit and precursor behind obesity and diseases.

  2. I used to have 9 of those 11 causes on your list of things that induce systemic inflammation before going Paleo. Now, I’d have to say I’m clear of all of them.

    My body feels so much different now that it is not so inflamed and looks different too!

    1. The difference in an inflamed body and one that is functioning properly (paleo-ized) is very evident. When I look at someone’s face (or old pictures of myself), it’s one of the first things I notice!

        1. They say the same thing to my wife and I. I tell them it’s all the bacon and butter. They think I’m joking.

      1. Bizarre (or not) but true…. I have had many people tell me I look much better today than I did 10 years ago; healthier, balanced physique, “radiant glow”… pretty apparent I am doing something right here.

      2. OK, while I agree that a non inflamed body is healthy, I don’t think you should put (paleo-ized) in brackets, right next to ‘functioning properly.’ By doing this you are automatically declaring only paleo-ized bodies are functioning properly. This is a grandiose statement, which even I, as a Paleo dieter am against. I am against all such grandiose statements in any field. Not just that of nutrition.

  3. “In a way, nature is home for us.”

    THIS is what a lot of people don’t understand. I grew up near a national forest and spent hours in it daily, climbing trees, catching frogs, digging mud holes and looking for small fish in creeks.
    Now that I am married and live in the suburbs I so MISS the forest, espeically during fall. It used to put me at ease, all my worries gone. Whenever we head to the mountains to go ‘hike’, we end up going for 1.5 hours max and drive back home because my S.O. can’t or doesn’t want to keep up, it’s frustrating. I so wish I had a fit, healthy and motivated partner to do this with…ah well…

    (i put ‘hike’ in quotes because at the pace we usually go it’s more like dilly-dally-ing or strolling)

    1. This is what most of us miss so much. We were born outside. All animals are. No animal, including us, is supposed to spend most of their life inside. It’s ridiculous.

      We need the nature. It is absolutely essential. I guess I should start busting my ass so I don’t have to be living in Michigan during the winter next year!

    2. I miss those things too, and the long family camping trips we would take when I was a kid. I didn’t marry a camper or very outdoorsy person. But I have decided that this year I will tag along when friends go camping and take my kids. They and I need to experience more of this!

    3. I first grew up by the city, but them my parents divorced and moved to a more rural area. I miss it now that I’m married and living in the burbs. People are always cutting down trees and bushes, and shooing away animals. I lived right by a forest preserve on a hill, and in summer time, the sun would set above it and thousands of lightening bugs would twinkle. It was amazing and breathtaking. Now, it’s a concrete jungle:(

  4. Does this include bloating? My understanding is that bloating is another part of the inflammatory response to diet. It is amazing how many people complain of that after the holidays! I like the list, almost could become a checklist of what to work on one bit at a time 🙂

    1. bloating in my belly went away after going low-carb…it looked like i lost weight even before i actually did!
      as far as inflammation goes, i am convinced my shoe size is smaller now that my joints are not swollen! (toes are joints, too..)

    2. Bloating is often caused by grain products and sweets; i.e., breads, cake, cookies, pie, etc. People tend to eat more of this kind of thing during the holidays. Such foods promote acidity, which in turn promotes chronic inflammation. A quick online search (probably including this website) provides many effective ways to alkalize the body.

  5. Mark,

    Great article, and nice work on using “modicum”, “sentient”, and “continuum” in the same sentence!


  6. Thanks for this and I look forward to more on this topic. An interesting area to cover is the relation between excess, chronic inflammation and cancer. Inflammation, according to books I’ve read such as Anti-Cancer: A New Way of Life, allows cancers to spread more readily and become more aggressive.

    1. Interestingly, a common idea about cancer is that it is encouraged by a lax immune system. The writer Barbara Ehrenreich (may be familiar to some politicos here) studied cellular biology in college and she says that actually, macrophages (a type of white blood cell) have been implicated in the spread of some cancers. Might be a partial explanation of why chemotherapy works, since it tends to be immune-suppressing.

      Anyway, I thought of that because as Mark said above, inflammation involves increased immune-system activity. So that dovetails nicely with what Ehrenreich said about immune cells and cancers.

  7. Mark

    Great article. A question. What are the markers of chronic inflammation? What should I look for in a blood test to detect chronic low level inflamation?

    1. Dr. SEARS has addressed this for a couple of decades. Silent Inflammation. There is a blood test, though pricey, that he has found to identify Silent Inflammation. The AA/EPA blood test – which (simply stated, if not over-simplifying) is the Omega-6 / Omega-3 ratio.
      However, he also states that the Trigyceride/HDL ratio is/can be used as a simpler though not as accurate indicator.
      A TriG/HDL ratio of under 2.0 is preferred and a value near 1.0 is ideal.
      When I started my journey my TriG/HDL ratio was a very high 4.0! Now it is at about .9 ….

      1. Thanks!!

        I will go back and look at past tests, and I will check out what Dr. Sears has written about this topic.

        DR. KRUSE also talks a lot about CRP in his recent interview on Livin’ La Vida Low Carb, but I havent been able to find the blog article about blood tests he refers to in the interview.

  8. Most people are aware of acute inflammation, as is something everyone deals with from time to time. However, I would say most people are unaware of chronic inflammation, why it occurs, and the dangers it presents. So it is nice to see a post describing chronic inflammation and how to do prevent it.

  9. Chron’s Disease is the chronic inflammation of the GI tract, correct? Sorry just wondering…

    1. It’s a type of chronic inflammation, yes, though it’s not the only one.

  10. If only it was that easy….I have 2 herniated discs in my low back. I went full primal for 4 months. I lost 10-15 lbs , but my back pain got worse. I did everything on that list to a T…….

    1. Maureen, that list is great but something that was not listed is that certain foods, mainly proteins can be very inflammitory. Foods high in Methionine, cysteine and tryptophan are inflammitory and concentrated heavily in muscle meat. My suggestion is you lower or eliminate the foods high in these amino acids. Replace them with foods higher in amino acids like glycine to balance them. Also fruits are high in salicylic acid which is a natural anti inflammitory so a diet high in fruit would be a good idea.

      For more info on these ideas, please research Ray Peat. I do not use all his ideas in practice but found that lowering my meat consumption, upping my gelatin and fruit consumption VASTLY improved chronic inflammation of the lower back and hips.


      You should also look into the inflammitory response of high muscle meats. I know you recommend one balance meats with joints/ligiments/skin, etc but i bet a lot of primal eaters are failing to do so and getting some inflammation from eating a diet heavy in unbalanced amino acids.

        1. What do you mean by using joints and ligaments, Zach?

          I’m only a couple of months into primal eating after 25+ years as a vegetarian. I’m trying to deal with the chronic inflammation of Chronic Lyme Disease. Being new to meat-eating, it’s been tough just getting down (and keeping down) meat. Hunks of fat or big pieces of skin seem to be the best part of eating animals according to my husband and sons. I made a bone broth for the first time a week ago and that helped with gelatin (which I’ve refused to eat since I was around 5 years old and found out what it was made from). But I haven’t read anything yet about joints and ligaments. They just seem too tough to be edible. Am I missing something? Also, Mark mentions offal a lot and I’m definitely not ready to eat that. But would organs help with the amino acid balance you’re describing?

        2. One for DecafDebi

          The primal thing is not all steak and “flesh” meats, but uses the whole animal, so it is essential to find a way to cook up ligaments and joints..an easy start might be lamb shanks, which transtions away from flesh and into the less well frequented areas. Slow cook joints and ligaments as they will be unedible otherwise. Once you get used to this perhaps move onto Oxtail soup and get more adventurous with pigs trotters..and move into visceral meats like liver ( great with bacon and onions)..there are many more wonderful posts here on this site around usingthe whole animal but at your stage I suggest taking it slow.

    2. Something else: watch your carbohydrate intake. I’m a little vague on this but it seems that if you have chronically high insulin it can affect what pathway is taken by the arachidonic acid you eat (also present in muscle meat, especially red meat) to become inflammatory rather than anti-inflammatory. AA can go either way and it depends on what else is going on in your body.

  11. In addition to everything you mentioned, throw on top of it the treat-the-symptom-not-the-cause approach of most doctors and it compounds. If you twist your ankle and it swells up [like you mention], most conventional advice is to put some ice on it to get the swelling down. Maybe stimulating the injured area with cold helps in other ways, but the treatment seems focused on the symptom [swollen ankle] and not the cause [poor ankle mobility, for example]. Running a small temperature? Pop some Motrin to bring it down – don’t bother thinking about why it is elevated or what you could do to prevent that from happening.

    Great post Mark!
    Grok On!!

    1. So does putting ice on an inflamed joint (or other part of the body) only slow down the body’s natural healing process, or does it enhance the process as Conventional Wisdom has always told us? I could not determine a clear-cut answer to this in the article.

    2. This is homeopathic medicine vs allopathic (or “standard”) medicine in a nutshell. Allopathic medicine focuses on symptom abatement, often at the expense of understanding or dealing with the core reasons for the symptom (e.g., antidepressant medication for depression). My understanding of homeopathic medicine is that it taps into the body’s own healing response.

    3. Add to that one important thing… when you have a fever and it’s not life threatening, let it run its course. Fevers are good for something. I’m saying that as I’m sitting here with a fever, fighting an infection. 🙂

    4. So I guess this brings ups a question of my own. I have a stress fracture in my right foot, and my doctor prescribed me large doses of ibuprofen to deal with the pain and inflammation. Now, I’m not a moron, so I’m going to stay off my foot — even with the ibuprofen, I actually can’t walk with even a remotely normal gait. I’m not the person who is popping a pill so I can get on life and ignore the problem. The question is, am I better off sucking up the pain and inflammation?

  12. I have a copper IUD, and while apparently no one is entirely sure exactly how it works, it is thought that it causes constant low-level inflammation in the uterus, preventing pregnancy…is this sort of localized but long-term inflammation something to worry about?

    1. I thought most metallic IUDs were thought to subtly alter the pH in the uterus, making it inhospitable.

    2. This is in response to the comment about the copper IUD. YES! I was a fitness instructo. I taught classes until I was 7 months pregnant. After the pregnancy I was recovering and then over the course of a few weeks I started to gain weight without explanation. I’ll spare you the details but after gaining 4 sizes in 3 months I began to go to doctor after doctor for over two years. I got lectured on diet and exercise continuously. I knew something was really wrong but was treated like I was crazy, or worse- lazy. 13 doctors, 2 minor strokes, 5 sizes, asthma, chronic bowel issues, hair loss, malabsorbtion, 2 yrs of chronic pain and $10,000. later…
      A naturopathic doctor (ND) told me to take the IUD out immediately. I did. Within 3 weeks most of my systems returned mostly to normal. I would have thought this was isolated to my body, but the ND said I was the 5th person she had seen this IUD inflmation in. It is a direct result from copper overload. My blood tests went from everything failing to “the blood tests of a 22 yr old athlete” in six weeks. The only thing I changed was the IUD. I also lost 3 sizes.

  13. C-Reactive Protein is one measure of inflammation. Before I went Paleo my CRp was really high (I also have MS)when I cut out grains and sugar it plummeted to normal-low. Needless to say, my primary care doctor was intrigued and asked alot of questions about my diet (she is very open-minded compared to my other doctors). In the approx. 3 yrs. that I’ve been diagnosed (I gave up sugar/gluten immediately)I have had no significant flares. I also keep my dairy intake very low.

    1. I’ve had a response similar to yours, Sara, with my PA (psoriatic arthritis), an autoimmune disease. Even with a strong drug my CRP and Sedimentation Rates were well above normal. After being low carb for 6 months (paleo the 4 most recent months), they’re just a hair above normal. Now my doctor is weaning me off the drug and I’m keeping fingers crossed (and sticking to paleo) so I can be drug free one day soon.

  14. As a person with chronic tendonitis in both forearms this was a really great article. I’ve noticed that after cleaning up my diet and going primal, I’ve been able to reduce my inflammation fairly significantly and ween myself off of NSAIDS I had been prescribed for over a year.
    Thanks Mark. This is a topic I’ve been hoping you would cover 🙂

  15. My husband has always suffered from a stuffy nose. Once we cut out all grains, he could breathe freely for the first time in his adult life. We couldn’t believe it. A low level inflammation in his nasal passages caused by grain consumption. That was enough for us to be convinced that primal was the way to go.

    1. I noticed the same thing. I literally had a chronically stuffed-up nose for years and it was like a miracle when it cleared up. I also had problems with my ear canals and they are almost entirely back to normal.

    2. That was one of the good results of going primal for me as well. I grew up believing it was that catch-all — hay fever. I sniffled daily.

  16. Love today’s topic.
    I’ve been mostly primal for over 2 years, and about 4-5 months ago noticed an arthritis-like pain in my hip and lower back. I was still very active and figured I’d just push myself through it. Well, it gotten much worse, to the point of barely being able to walk.

    I thought about it long and hard. After eliminating ALL grains and my pain not going away, I started doing research and stumbled upon GAPS (Gut and Psychology Syndrome) diet. The idea behind it is that many people develop tiny tears in their gut lining and the food basically escapes straight into blood. It affects different people in different ways. Anything from chronic inflammation, to multiple food allergies, to Autism in younger kids. Through this diet you’re basically trying to seal the lining of one’s gut through healing foods such as bone broths and tons of good animal fats (so very Primal friendly).

    Anywho, my 2012 resolution is to claim my health back, so I’ve decided to try GAPS. I’m on day 3 and loving my bone broth. It seems like the aches and pains are less now than what they were 3 days ago.

    1. Happy,

      Check out my responce to Maureen a few posts up. It seems you may be on the right track with balancing your amino acids with things like bone broth, very high in gelatin.

      1. Sorry i meant that for Choclatechip69, and for you to check out my response to Marcs post, not Maureen.

        Not used to posting. hah!

    2. Check out the personal paleo code on Chris Kresser’s site. Yes, it costs money but the meal generator allows custom menus for a wide variety of diets and/or treating specific symptoms. A menu for the GAPS diet exists.

    3. GAPS is stalking me. I doubt I’ll escape.
      Have you found Health, Home Happiness’ GAPS-friendly meal plans? Sarah at Nourished and Nurtured, the cookbook Internal Bloss, or even Cheeseslave will have GAPS-friendly recipes once you’ve moved past stage 3.

  17. I’m still working on getting down chronic inflammation. Each month I’m trying a different approach to clear the last little bit. This month is going back to eating as close to 100% primal as I can after the holidays. Next I think, looking at your list, should be upping the Omega 3 intake. Thank you!

    1. Try an alkaline supplement or alkaline water. Inflammation and acid are one of those circular arguments. here’s a link to a guy who had serious gout – basically inflammation.

  18. “It’s not a passive spectator totally reliant on the kindness of Pfizer and Walgreens and an ice pack to get it out of a jam.”


  19. My wife has what I think is Lupus, she has kidney problems, migranes, IBS and other issues that come and go with hormones, stress, and other random mysterious triggers. How do I get her to stop eating junk when she isn’t really over weight. Any advice would be tremendous.

    1. Rich, have her check out Dr. Natalia Cambell-McBride’s work. She does a great job of explaining what causes most auto-immune diseases and how food we eat affects it.

    2. Richy,

      My husband has a “lupus like” undiagnosable autoimmune disease & over the years we have tried a bit of everything to the point that he’s not willing to try new things as he’s tired of getting his hopes up only to be disappointed. I’ve just recently started to introduce the paleo eating into our diet, but on the sly! I’m hoping that even if it isn’t 100%, we might see some improvement. If your wife is the one doing the majority of the cooking, perhaps you could take over a few nights a week? I don’t know a woman who’d turn that down!

      1. I have tumid lupus… Does anyone know about affect of paleo-diet on an over active immune-system?

    3. The short answer is you can’t, and the more you push, the more she’ll push back. State your case once. Then set an example. Cook healthy food. Buy the books and keep them on your bookshelf. Put the websites on your computer’s browser bar. Make it easy for her to follow up on her own, in private. And realize when you have a chronic disease it takes a lot of guts to go against what your dr. tells you to do. She’ll come to it on her own, or not. It is out of your hands.

  20. Very interesting read. Outside of being just slightly overweight (mainly from holiday bloat right now), I deal with impingement/tendonitis/bursitis in both shoulders. One person suggested that a gluten sensitivity may cause some of this, and a Paleo friend of mine suggested that getting my Omega 6:3 ratio may help with these issues.

    So that is my goal for the next little bit: Increase Omega 3 intake through supplements and eventual grass fed meats. Hoping doing this with my PT routine will bring the shoulders back to feeling normal.

    I’m trying to correct the other parts (sleep, stress, etc) and getting better, but getting my Omega 3’s in order hopefully will help.

  21. Really interesting post today! By the way, what do you guys think of today’s CNN article on “orthorexia”? While some people do take different diets to extremes, it makes it sound like anyone interested in seriously improving their health might just have an eating disorder…. Ah, I guess we should just stick to Conventional Wisdom and SAD…

    1. HAHAH! I just read the Wikipedia entry on Orthorexia.

      What a joke. “Bratman claims Orthorexic sufferers have specific preferences about the foods they are eating and avoiding.”

      OMG We’re all sick! Sick sufferers!

      1. Not a joke. At. All. I have a relative who suffers from this very real disease. She is also anorexic, and resisted treatment because she thought her diet was fine because she ate such healthy food and she didn’t binge. Her binges were exercise. She nearly died, and will forever be at risk for heart issues. Again, not a joke.
        There is a difference between healthy and disordered eating, and much of it has to do with what it does to your body. Paleo in general is not a disease, but I can see where someone with a history of restricting and anorexia could do a lot of damage if not carefully supervised.

        1. I don’t understand the connection. Where does ‘orthorexia’ play into that?

        2. The connection is that paleo/primal practiced by a healthy person is not a disease. But, someone who takes either to the extreme where they are malnourished could have orthorexia. My bigger point, though, is I think it’s awful that people within the paleo/primal community seem to turn what is a real disease into a joke. When you see it up close, it’s not funny. And I think trainers, nutrition consultants, and even well-intentioned friends who suggest the primal lifestyle to folks should be very careful recommending it to someone with an eating disorder and be aware of what the signs may be when people take compliance too far.

        3. Great response! Orthorexia is NOT a joke and the suffering is great. Many people with ED go to the ortherexia side to “hide” as they simple declare they are eating “healthy”. There is nothing healthy about obsession with food. This is a mental disorder that is played out with diet. It is not about the food! PS this can also be seen in over-exercising again it’s not about health its a mental disorder being played out with exercise. These people are suffering just as much as those with physical diseases.

        4. If someone is malnourished, then it is because they’re not eating “healthy” food, or because they’re anorexic or exercise too much as you stated above.

          Simply because you believe in a ‘disorder,’ please don’t expect everyone to.

          If someone is eating too much good food, maybe you could call it glutony. If someone throws up “healthy” food every day after eating it, you can call it anorexia. If someone’s “binge” is exercise, then they exercise too much. I still haven’t seen in which way this “orthorexia” has affected your friend so terribly.

        5. I see your point Bruno. The difference is in the intent, the real intent of the dietary changes. Most people who begin eating for health do it just for that reason and do in fact improve their all around wellness.
          You may not believe it but people USE food yes even healthy food as a drug so to speak….this does not mean Paleo is not healthy or that those of us who eat primal are ED.
          People with the intent of using food to alter their psychological state -over eating, under eating or pathologically controlling- or to manage their psychological distress vs dealing with the anxiety, depression or fear in the same way an alcoholic or drug addict would us their substance to be free momentarily from their inner distress. My comment was to the idea that anyone who is prone to such mental disorders should be supervised carefully. Eating Disorders have the highest mortality rate of all mental illness if we care about health this is important to be mindful of.

  22. Zach, I have just managed to procure my first marrow bones after searching high and low. I find that all the recipes I have come across say to remove the fat, or to strain through cheese cloth. I know it’s advisable to remove the scum that appears at the top to get rid of impurities but I was hoping for a fat filled soup to fill up on. Do you have any recipes which you could post that are fat friendly?



    1. Marrow is really for eating – the creamy white kind, that is. The dark, gritty kind is for soup. For eating marrow, roast the bones standing up and scoop the marrow out to eat, spread on toast (well, maybe not) or use in some other dish (I’m working on a paleo version of the trad German marrow dumplings for soup).

      For soup, roast a mix of marrow, joint and meat bones. Pour the rendered tallow off into a jar for later, then throw the bones in a stock or crock pot, just cover with purified water, add a bit of wine or vinegar, and let it steep for about half an hour. Bring it to a low boil, skim (more scum = lower quality bones) and turn it down to juuuust bubbling for 24 hours. Yes, one day, not 2 to 4 hours. You can do this with chicken backs, wings and feet, just don’t roast them first.

      You strain these bone broths through cheesecloth to get the dissolved bone bits out, preventing a gritty broth. If you don’t care about grit, don’t strain! When broths cool (strained or not) they will have a thick layer of fat on top. If you are worried about your sources, esp for poultry, use the fat as a lid but don’t eat it. Otherwise, enjoy!

      (If you’re stuck for soup recipes, try Nourished Kitchen, or GAPS forums, or I have a few on my blog.)

    2. Note that GAPS soups involve cooking fatty cuts of meat IN bone broth – one can’t expect *gobs* of greasiness out of bare bones. Broth has many benefits other than fat content, and I’d still recommend it in the strongest terms as a kitchen staple.

  23. I liked the list of things that cause chronic inflammation. But I was curious to hear WHY some of those items actually cause the inflammation. For instance, WHY does lack of movement, low omega-3 intake, lack of nature time cause the body to think that it has been injured in some way? As much as I enjoy movement, and being in nature, etc, I don’t get how that might actually cause the inflammation response.


    1. How do you determine your percentage of inflammation with such precision? Are you just pulling our legs?

  24. An article on how to get tested on the various inflammation markers and how to understand the test results would be greatly appreciated 🙂

  25. Thanks for the great read, I do have a question about a year ago I suddenly broke in hives,rashes but that has all cleared up thanks goodness, however what remains are bumps on scalp and it itches like crazy and it seems nothing I do gets rid of them, I am sure this is some sort of inflammation. I eat pretty clean no wheat no eggs no milk – pretty much gluten free and eat all organic fruits and veggies. I am at a loss of where to look for answers or suggestions. Help would be so appreciated. I do have Hep C but this is not related.

    1. That could be seborrheic dermatitis or a mechanical hair follicle plugging issue (sebum plugging the follicles causing the bumps and itching). You might try going shampoo free and using an apple cider vinegar rinse (diluted 1/4 c in 16 oz). Liberally apply it to your hair and scalp, rub in, wait 5 minutes or more, then rinse out completely. Dilute further if it stings. Give it 4 weeks or more for your scalp and sebum production to adjust, and re-evaluate.

    2. Um… awkward. I was referring to interabdominal inflamation. The uterus, not the skin.

    3. Um… awkward. I was referring to interabdominal inflamation. The uterus, not the skin. Thanks for your input, though. I wouldn’t consider an external reaction to be normal.

      1. Sorry, I thought this was in response to my comment – not the other. Just ignore me.

    4. definitely check out source of contact dermititis, e.g. shampoo, colourants, maybe even hat, cap, scarf or other fabrics? Hope it clears up soon!

    5. I had a rash on my chest for 2 years…dermatologist did biopsy, turned out to be autoimmune disease- lupus.

      I’d see a dermatologist…

  26. What a great post! I suffered from chronic inflamation for most of my adult life and had no idea (for years at least) what was wrong. After all, I was following all the “right” health advice. Reading your list of causes of chronic inflamation is like reading a check off list of the things I CHANGEd to get healthier. Most recently, when I switched from traditional soaked grains to totally giving up grains AND starchy vegetables, I really saw the difference. It’s hard to be depressed of inflamed leading a paleo lifestyle!

  27. I enjoyed the post but thought maybe you could add something to your list: body fat. Apparently adipose tissue secretes inflammatory cytokines, too! https://www.ncbi.nlm.nih.gov/pubmed/17027526 Vitam Horm. 2006;74:443-77.
    Release of interleukins and other inflammatory cytokines by human adipose tissue is enhanced in obesity and primarily due to the nonfat cells.

  28. Mark (and friends),

    This particular segment from the article made me wonder:
    “And because a big part of inflammation is breaking the tissue down, targeting damaged tissue and invading pathogens, before building it back up, the inflammatory response has the potential to damage the body.”

    My dad has just had his 3rd back surgery for a ruptured disk(s) in his lower back. He is “on the road to recovery” (says the conventional doctor), but has extensive nerve damage to the point that he can no longer feel one of his feet.

    From what I have read in the past, “degenerative disk disorder,” a)doesn’t really exist and b)is the name for a bunch of symptoms that are very closely related to inflammation and the korg lifestyle.

    In short: This inflammatory response is certainly ACUTE and has been going on for 5 LONG YEARS. Inflammation—>ruptures disk—>more surgery—>seems to heal—>BAM gets hurt again…
    and the cycle continues.

    Just bought dad the Primal Blueprint…any words of wisdom on how primal eating can contribute to healing mobility issues/nerves and how/if decreasing inflammation plays a role SPECIFICALLY to CHRONIC acute inflammation? I know the article and lifestyle suggest movement, getting out in nature, etc…but he’s nearly immobile AND gets stressed out because of the desire to get out and enjoy life and the lack of ability to satisfy that desire. Once again…a cycle.

    Thoughts? Thanks in advance?

    1. Hi
      I had a similar injury 4 years ago- ruptured L4-L5 disc with emergency surgery- resulting in sciatic nerve damage. I still can’t feel my foot and right glutes, hamstrings, calves and foot muscles are still weaker than the left, however I have improved immensely since coming out of hospital on crutches and being told things would not improve after 3-6 mths. Still improving now, went back to personal training and teaching BodyPump 1 year ago- couldn’t do lunges until then, still can’t do them with any weight. I don’t know how eating primally would affect nerve damage- I just started this year- but I found that walking barefoot/ with minimal support has helped immensely!Shoes without support allow you to use all the muscles in your feet and I’m sure it improves feeling as well. Kettlebell training has also helped a lot- just make sure you use good technique:)
      By the way, I’m 47 and live in Australia, so walking barefoot is often possible, particularly indoors.

      1. Hey Sue!

        I am struggling with a similar thing. I had surgery in 2008 for herniated disks at l4-5 and l5-s1 and then again in 2010 for L4-5. The second surgery resulted in a drop foot on the left. I am housebound still (since 12/2010) because I can’t walk safely. I’ve been paleo for 3 months and down 20 lbs and just started with vff. I’m seeing progress! I desperately miss being active though I will never go back to my chronic cardio/Ironman days!

    2. Dr.Sarno’s books about healing back pain might prove helpful…

  29. Since going primal, 4 months ago, the chronic asthma that I have been experiencing for 5 years has all but disappeared. The inflammation in my lungs seems to be gradually going away. I feel better, am exercising more and lower back pain diagnosed as degenerative disc disorder is fading. My health has taken a u-turn, thank you very much Marc.

  30. Dr. Barry Sears addresses this (internal inflammation “silent inflammation”) amd has addressed this for well-over a decade ago. His latest book “Toxic Fat” tones down some of the science, chemical and biological human processes involved, and makes it simpler for most folks to understand. He has addressed all of the factors as listed by Mark, since his first book on the Zone diet and more specifically in his book “The Omega-RX Factor”, now about a dozen years ago. Except for good sat fat like coconut oil, and some allowances for some grains, any Paleo/MDA folks would benefit by combining MDA/Paleo with Zone. I wnr the other way. tarted with ZONE in April 2004, went down 65 lbs to nearly ideal. Then started exercising in Fall 2010. And finally came across MDA in Fall 2011. I had already switched over to Coconut Oil, one of my disagreements with Dr. Sears. Then through MDA blogs and articles, and further research, decided to move to grain-free or mostly grain-free, and have been that way for a few months – was mostly that way intuitively before finding MDA.

  31. Great article. I have found that since I went primal last august, my sinus has drastically improved, with fewer seasonal allergy symptoms, my ears have improved with no blocked ears. I am trying to shift my husband to grain free, and have found that his snoring has improved dramatically and sleep apnea he had developed lately disappeared. Also I got gerd acutely last year, resorted to the tablets just before ditching grains, and threw then out as it simply vanished! I still have a way to go, but I think people need to remember that for some of us, the inflammatory paradigm has been in place longer than the primal one and it will take time to resolve. Enjoy change and get out in the garden,

  32. Dealing with bursitis in my right ankle for years, I’ve tried nearly everything—from RICE to cutting out wheat to acupuncture. You mentioned that with chronic stress, “your body will have a physiological, inflammatory response to emotional stress.” I was recently turned on to Dr. Sarno’s theory (e.g. in “Healing Back Pain”) that unexpressed emotions like fear and anger can actually sustain long-term inflammation. I’d like to hear more about how one’s psychological state can play a causal role with regard to physical ailments.

  33. This was a cool one! I was indeed very curious about this subject of inflammation. It preponderant in our Western culture today, but it was also preponderant in the past, which makes it a part of our lives. In some way, moderate inflammation helps the body improve its resistance and immune system.

  34. I deal with an autoimmune disease (Addison’s). Started primal before the diagnosis but after symptoms began in a hope of curing whatever I had. I think things have been slowed, but definitely not halted. Can a perfect primal diet stop the inflammation that is destroying my adrenals (they were working at about 50% last month), and put a disease like this into remission?

    1. I wonder this too. I’m so afraid to fool with my diet too much. Though I eat very little bread rice or potatoes…

  35. Not to step outside anyone’s comfort bubble, but I have a girly question that’s been bothering me for 18 years. I am a recent convert to the Primal living lifestyle. I’ve been on and off it, and finally now firmly on it, for a couple of years. I feel better and stronger and happier and more alert and awake when I’m on it, and I’m so happy to have found it. But the issue of inflamation creates a question about a normal and healthy natural cycle most of us women deal with each month. I have suffered from more painful and difficult cycles than most women throughout my life, and was even Rx’d anti-inflamatory meds when I was 15. If I work out, which you would think increases physical stress and mild damage to the body, I get an acute reduction in inflamation. It happens right away that the pain lessens and the swelling and bloating will go down. When I’m living Primal, I have MUCH easier cycles, largely because of less inflamation. But with the mechanics of what’s happening in my body (the whole uterine wall tearing away and all that), shouldn’t the swelling be the good inflamation helping my body to heal from the trauma? Shouldn’t it remain when I’m healthier? I’m certainly not arguing with being in less pain, but it doesn’t seem to track. Any thoughts?

    1. Hop over to the primal parent – good girl-issue posts there.
      (And you’re not alone: lots of women reporting easier, shorter, redder, more regular cycles on strict paleo.)

  36. Excellent post, Mark! I often find myself saying “you should avoid inflammation” to my friends but then have some difficulty explaining what inflammation is in an easy to understand way. This post was very helpful in that regard (^^)

  37. Thank you very much for this write-up. I frankly wondered what inflammation “meant” as far as inside the body, or exactly how it would be bad, and so on. Great work making it so I can tell other people what it is and why it’s bad when it persists.

  38. I’ve always immediately iced my bumps and bruises to keep swelling down. Should I let the area swell so that the healing slurry can do its work? I was always under the impression that we evolved to swim in cold waters so ice was good for injuries.

  39. Without any changes in eating or lifestyle I have gained 70 poubds over the last year is this caused by inflamation or is there something else wrong with me(50 year old man) thanks

  40. This is all great to me, but how come NONE of my friends are willing to disconnect from society for a week???

    They INSIST on having their smart phones on a CAMPING trip!!!

  41. I wonder if you have any remedies for achilles tendonitis? I have struggled with this problem on my right heel right where the tendon connects to the heel bone. been to a doctor, given some anti inflammatorys and told to rest and stretch. It has improved some but it is clearly still not normal and I really do not want a surgery which I am told is very risky. I am 53 and had this problem almost three years. Thanks

  42. this just may be me thinking this….but doesn’t it seem odd that many of the things on the list that cause inflammation come directly of the modern era? when you compare this with what kind of dangers we faced before we became so advanced, you can see that we have simply traded oranges for apples. with that said, i feel like somehow the Primal Blueprint and other such lifeways could not work without the modern era and all it’s particular drama (unhealthy stuff). we may have lived the primal lifestyle when that was all we had but we were light years away from understanding simple infections. now we know all about infections and such, but we live like crap. so maybe this was all meant to happen. i dont typically think in fatalistic terms but while trying to catch up on some older posts today i read this one and it just struck me. we have finally figured out (to a certain degree of which i am clueless) what makes our species healthy. we have known all along in many cases, but on the whole, have screwed this up for centuries. especially with this last one. i guess it was inevitable that our knowledge of health and the human body would catch up to our technology. and this comment has just made me think of even more questions….

  43. Hi Heather
    I wanted to respond to your question on autoimmunity. I also have an autoimmune condition, hence my interest in paleo. To date I have not had success with it however I would say I am more “paleoish” than full paleo and plan on doing it 100% for the next 6 months to see if it can help.

    To get more info on autoimmunity see below:

    1.Google “success for those with autoimmunity” & marksdailyapple. There is a good discussion on the forum.

    2.Search for Dr. Terry Wahls on Youtube or Tedx talks and watch her video regarding her recovery from MS.

    For my diet over the next 6 months I plan to up my plant intake as Dr Wahls did. Change my protein sources, reducing chicken and pork and upping ruminant sourced protein. Also eating more “nose to tail” as opposed to just standard muscle meat. Upping intake of other sources of animal protein / fat eg bone marrow broth. I also plan to increase my sleep as I read somewhere that it’s all worth nothing if you’re not getting adequate sleep.

    I think us autoimmune people need to be our own guinea pigs. Lots of people have success on the primal / paleo diet. I have not as yet but I want to give it a good shot so at least then I will know definitvely whether it can help my case or not. I think it’s very important to continue to research and to ask people about their experiences and what they did.

    Hope you see this post and hope it helps!

  44. Mark:

    A much-needed post. Thank you.

    Question about the kind of inflammation caused by the stressors listed in the post:

    I’ve never understood exactly how that kind of inflammation presents. WHERE in the body is the inflammation, and WHAT exactly is it that gets inflamed?

    Example: Suppose someone has inflammation from the omega 3/omega 6 factors on your list, or from poor gut health. WHERE is the inflammation and WHAT is inflamed?


  45. Turmeric ( Generoudsly Spice Food)…Coconut Oil ( Soothes Inflamed Gut)…Vitamin D(4000 IU)…:) !!

  46. I am glad you posted this.

    I have sort of a question, sort of a statement in regards to my own experieces with acute inflammation.

    I broke my hand about a year ago. Given my age, the doctors told me it would take 12+ weeks to heal.

    They told me take as much pain killers & aspiring as I needed, even willing to prescribe some. Then they told me to ice it down to prevent the swelling.

    Guess what I did? I did the opposite!

    I used HEAT and ONLY HEAT on my hand. I took NO pain releivers at all (it really didn’t hurt that much). Oh, and I cut back my intake of coffee and increased my intake of beer (in the evening).

    My hand blew up like a balloon!

    (getting all the good stuff to the damaged site… cool!)

    My hand healed in less than 6 weeks, the time they told me it would heal had I been a teenager!

    I have had similar experiences as an Ultimate Frisbee player. I sprained my ankles about ~25 times (I have to play with ankle braces now).

    In a tourney, the ONLY way I made it through Sunday was with HEAT. Had I put ice on them, I would have LOCKED the joints!

    I have to wonder if it is HEAT treatment that is the holy grail?

    Why are the medicos so intent on bringing the swelling down?

    Seems to me, from the broken hand story, you actually WANT the reverse?

  47. Awesome post. Good information for everyone to read. Only if everyone can get on board and stop with the fast food and poor diets.

  48. inflammation is response to a stimulus. Its a protective response, – to remove the organism/ intial cause of cell injury (e.g., microbes & toxins)

  49. This is a great article, I am young at 23 but I have never learned this anywhere. Great information and bravo!…Thank you!

  50. Paleo has a lot to teach us about proper foods/nutrition. When not eating tho, there were other other things that went with the caveman lifestyle.

    One was walking most of the day looking for something to eat, and with no shoes to wear, the walking was barefoot.
    Fast forward a few million years…..
    a new science is now emerging, named “Earthing”. Researchers tell us the ground caveman, and we, walk(ed) on is a boundless storehouse of free electrons, which barefootedly pass into our bodies,equalizing the body’s own electrical level with that of the earth, thereby countering the buildup of chronic inflammation so prevalent today.
    The ungrounded (and inflammatory) condition we find ourselves in today began in earnest after WWII when the shoe industry progressed from leather (conductive) to rubber and plastic non-conductive shoe materials.

    Google “Earthing”to tune into the details

    As a caveman P.S. > walking all day with plenty of bare-skin exposure gave him gobs of sunshine/Vitamin D
    ….another deficiency our modern ways lead us to

  51. This is an excellent article. My question however is “Is there a blood test that can detect Inflamation?” If so at what level is normal? Your answers would be much appreciated.

    1. You could get a CRP test (c-reactive protein) which detects inflammation anywhere in the body. It will tell you whether it is there, but not where it’s coming from. Another thing to look into are interleukin tests. Especially interleukin-1 and 6.

  52. This is all very confusing to me and way too complicated. What is best…eating mostly protein or veggies and fruit with low carb intake? Also, what is the best way to keep your body at ph alkaline?

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  54. Mark, this is an excellent break down of inflammation. In my bodywork practice, I am always looking for the easiest ways to communicate why it is the low grade stresses in our lives that often trip us up. Too often it takes a major illness and physical breakdown to wake us up. The Chinese have a saying: ‘Take care of the little problems before they become big problems”. This applies to our bodies as well as our cars. It is much more difficult to heal than it is to prevent a health problem. We need to change our attitude that pain is ‘bad’ or something to be gotten rid of as quickly as possible, and regard it as a ‘messenger’ to wake us up to our need to do something differently. This article on inflammation gives a clear explanation of how the body’s systems work together for our benefit. Thank you!

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  56. There are certainly a lot of details like that to take into consideration. That is a great point to bring up. I offer the thoughts above as general inspiration but clearly there are questions like the one you bring up where the most important thing will be working in honest good faith. I don’t know if best practices have emerged around things like that, but I am sure that your job is clearly identified as a fair game. Both boys and girls feel the impact of just a moment’s pleasure, for the rest of their lives.

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