Inflammation is defined as the first response of the immune system to infection, injury or irritation. It is characterized by redness, heat, swelling, pain, and dysfunction. There are two main components involved in the inflammatory process, one is exudative and the other is cellular.
The exudative component involves the movement of fluid to the injured area. This fluid contains important proteins including fibrin, which wall off-the injured area to prevent the spread of potential infection. It also contains immunoglobulins (antibodies) to fight foreign proteins and any potential existing infection. Unfortunately, the increase in fluid and plasma within this localized area creates swelling and oedema, which can press down on surrounding nerves and increase pain.
The cellular component involves the movement of neutrophils (a type of white blood cell) into the inflamed area. Once there they engulf bacteria, foreign or cellular debris and reinforce the protective wall.
The release of chemical mediators of inflammation by injured tissues and neutrophils spreads the inflammatory process to adjacent tissues. Its release into the blood stream can give rise to symptoms such as fever, malaise and nausea. These chemicals include histamine, prostaglandins and lymphokines.
Under ideal circumstances acute inflammation leads to resolution and healing. The foreign or infective agent is rapidly removed and there is minimal cell damage. Tissues recover, regenerate and return to normal.
If the amount of tissue damage is substantial or the causative agent more persistent then the inflamed area may become organized into healing tissue called granulation. This often leads to a prolonged healing period with ongoing pain and scarring. Failure to progress towards resolution at this point can result in chronic inflammation with the appearance of lymphocytes, macrophages and giant cells and chemical messengers such as TNF (tumour-necrosis factor). Such chronicity results in prolonged pain and delayed healing such as is seen with tendonitis or bursitis.
This inflammatory process happens to a greater or lesser degree in every infection, injury, muscle tear or sprain. With an aging and active population the incidence of muscle injury, osteoarthritis or other musculoskeletal conditions such as tendonitis is increasing dramatically. And with the safety of traditional anti-inflammatory medicines being questioned, many individuals are turning to natural supplements for relief from pain, swelling and inflammation.
Of the many supplements available, two in particular have been found to possess powerful analgesic, and anti-inflammatory properties without significant side effects. They are Ginger and Turmeric.
Ginger, or Zingiber officinale, is probably one of the best-documented medicinal plants. Pharmacologically, ginger root contains several hundred active ingredients, but the most important constituent is a group of substances known as the 4-hydroxy-3-methoxyphenyl (HMP) compounds. This group of active ingredients includes ingredients such as gingerol and shogaol.
Ginger works in two different ways. Firstly, when a tissue is injured, a group of immune modulators called cytokines are formed by the white blood cells. These cytokines, in particular, interleukin-1 (IL-1), and tumor necrosis factor (TNF) can damage cartilage, muscle, or other soft tissue, creating pain and inflammation. In addition, these cytokines stimulate the production of enzymes that further degrade tissue. Ginger helps prevent the white blood cells from liberating cytokines at high rates, thereby decreasing pain and inflammation.
Secondly, Ginger balances the ratio of inflammatory to anti-inflammatory prostaglandins and leukotrienes in the body. Under normal circumstances, the body is able to maintain this balance, however, in inflammatory diseases or conditions, or following injury, the balance is disrupted, resulting in an increase in the pro-inflammatory chemicals and subsequently pain and inflammation. There are two main enzymes that regulate the production of the inflammatory substrates, cyclo-oxygenase-2 (COX-2) and 5-lipoxygenase (5-LOX). Ginger has an inhibitory effect on these enzymes, greatly diminishing pain and inflammation without any adverse side effects. In one randomized, double-blind study of 261 patients, ginger significantly reduced knee pain as compared to a placebo.
Ginger should be used with caution in individuals receiving pharmaceutical blood thinners.
Turmeric, otherwise known as Curcuma longa, is a perennial herb belonging to the ginger family. It has been used throughout Asia for centuries to reduce pain and inflammation. Turmeric, like Ginger, inhibits COX-2 and 5-LOX activity, thereby decreasing the production of those inflammatory prostaglandins and leukotrienes. In addition it is thought that Turmeric inhibits the breakdown and metabolism of cortisone by the liver. This would increase the amount of circulating cortisone in the body and prolong its anti-inflammatory, analgesic effects. It has also thought to increase the body’s production of other adrenal corticosteroids, which also possess anti-inflammatory properties, in those with weakened or deficient adrenals who are not making enough steroid of their own.
Further studies support a role for turmeric in the sensitization or priming of cortisone receptors, further increasing the activity of this anti-inflammatory hormone.
Studies comparing the efficacy of turmeric to that of phenylbutazone, a pharmaceutical anti-inflammatory drug, showed that patients improved equally, with either treatment, but the Turmeric group showed fewer side effects.
Turmeric can cause slight stomach upset with prolonged use, and has been shown to increase the production and flow of bile, so should be avoided in those with bile duct blockages or gallstones.
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