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Inflammation is the body’s natural protective response to injury or infection. There are two types of inflammation, acute and chronic. Acute inflammation is a helpful healing response, while chronic inflammation is an ongoing destructive response.
In acute inflammation, there is an immediate and temporary reaction. You cut your finger and your body’s response stops the bleeding, and works to prevent infection and heal the wound. The body’s immune system releases white blood cells to fight off foreign bodies and infectious agents. Blood flow is increased to the area; and nerve endings and other cells send out signaling molecules and other chemicals to eliminate the cause of the cell injury, remove damaged cells and tissues, and handle repair.
In chronic inflammation, however, the body’s immune system initiates an inflammatory response even though there may not be an apparent “invader” to fight off. It is usually a low-grade or systemic inflammation, lingering on, with the body’s normally protective immune system now causing damage to its own tissues. The body responds as if its normal tissues are somehow abnormal.
Researchers and most of today’s medical community now believe that chronic inflammation is the root cause of most diseases, including many autoimmune diseases. In fact, of the ten leading causes of mortality in the United States, chronic inflammation contributes to the pathogenesis of at least seven. These include heart disease, cancer, chronic lower respiratory disease, stroke, Alzheimer’s disease, diabetes, and nephritis (Centers for Disease Control and Prevention 2011).
Some examples of autoimmune diseases, characterized by localized inflammation in a given part of the body, are specific to inflammation in a particular part of the body, such as the thyroid (Hashimoto’s disease), gut (Crohn’s disease), joints (rheumatoid arthritis) and lungs (chronic bronchitis).
As of 2012, about half of all adults in the United States – estimated to be about 117 million people – had one or more chronic health conditions.
Chronic inflammation is likely caused by a combination of genetic disposition for a particular disease, along with environmental and lifestyle impacts. This “multi-causal” aspect of chronic inflammation has made it difficult to evaluate, diagnose and treat prior to a specific disease diagnosis being made. Once a chronic disease has been diagnosed, the typical treatment has been focused on disease management using prescriptions and recommended lifestyle changes.
Until recently, conventional medicine has been slow to promote effective preventive lifestyle modifications to reduce the potential for chronic inflammation. Historically, the functional medical community and holistic practitioners have focused more on non-prescription preventative treatments such as diet (eliminating inflammatory foods), addressing gut issues (through probiotics, use of digestive enzymes and supplements), reducing stress and toxins, and generally improving one’s lifestyle choices to live an “anti-inflammatory” life.
Chronic inflammation is likely caused by a combination of factors. There are many theories as to why different individuals are affected. Genetics may play a role, but scientists think that it is environmental and lifestyle factors that ultimately “turn on” an inflammatory response in some people versus others. So two people in the same family carrying a particular gene for breast cancer may differ in these other factors, resulting in only one getting diagnosed with the disease.
Environmental and lifestyle factors may include:
Most people are not aware that they have chronic inflammation until they are diagnosed with major symptoms or a disease. Many people just feel that their symptoms are due to aging or “just the way it is.” People routinely underestimate the health impacts of chronic stress, for example, on their physical well-being.
Inflammatory “Inducers”
There are anti-inflammatory, or perhaps neutral, inducers which people have been exposed to for thousands of years. Most of these are natural (plants, animals/fish as foods, fruits, sunshine, clean air and water, and the like). People used to be more active, so activity is also an anti-inflammatory inducer. Antibiotics were not used routinely to treat minor infections, nor were they used in our food source (cattle, chicken, etc.). Humans had dramatically less exposure to toxins that have now been proven to be endocrine disruptors. All of these things were anti-inflammatory. Diseases used to be more specific to a germ or microbial infection of some kind.
In contrast, there are pro-inflammatory inducers which are more recent in our history and generally man-made.
These pro-inflammatory inducers are typically:
The risk factors for developing chronic inflammation are quite varied.
Genetics
Genetics is thought to play a role in chronic inflammation, but it is difficult to provide specifics without looking at a particular diagnosed chronic disease. For example, with breast cancer, it is estimated that 5-10% of diagnosed individuals get the disease primarily due to genetic inheritance. Most people who inherit breast cancer have 2 specific abnormal genes that have been linked with the disease. But not everyone with the 2 abnormal genes gets breast cancer. And people without these genes can get breast cancer. Scientists believe many other factors are at play. What turns the underlying inflammation into a cancer diagnosis? Risks associated with the disease increase or decrease a person’s chances of getting it; ethnicity, hormonal and reproductive factors, weight and overall health, all could play a role.
It is interesting to note that countries with more of a “Western” influence have higher levels of chronic diseases such as diabetes. China, for example, has more levels of inflammation and more “Western” diseases than other “less Western” Asian groups.
Some countries and ethnicities may have higher incidences of a smoking population, another inflammatory inducer, increasing the risk for lung diseases. Diet in different countries and ethnicities will also influence inflammation rates.
Environment (the community one resides in, for example) and lifestyle choices may be influenced by genetics, thus impacting the risk for developing chronic inflammation. For example, if you look at obesity prevalence by race/ethnicity, you’ll see varying outcomes indicating certain ethnic subgroups have a higher prevalence of obesity. In a 2008 study done by the National Health and Nutrition Examination Survey, 51% of non-Hispanic black women aged 20 years or older were obese, compared to 33% of whites. If obesity is a pro-inflammatory inducer, by this study, non-Hispanic black women could be at greater risk for inflammation.
Age
In response to normal aging, there is an increase of inflammatory cytokines (destructive cell-signaling chemicals) that contribute to the progression of chronic inflammation and many degenerative diseases.
Older adults have consistently elevated levels of inflammation, even in healthy older individuals. This is likely due to cumulative oxidative damage and mitochondrial dysfunction, or may be due to other risk factors more associated with age such as increased body fat or reductions in sex hormones.
Scientists theorize that aged people may also lose the ability to “turn off” inflammatory reactions. This can also happen in younger people with bad health habits such as smoking.
Obesity
Fat tissue is an endocrine organ, storing and secreting hormones and affecting metabolism in the body. Obesity is when there is an over-accumulation of abdominal adipose and/or subcutaneous fat tissue. Adipose tissue is an active tissue in the regulation of the body’s physiological and pathological processes, including immunity and inflammation. Having a large waist measurement (at or above 35 inches for a woman and 40 inches for a man) means you likely have a systemic inflammation as well as potentially an insulin resistance problem.
Other obesity-related issues include: having high blood pressure (at or above 130/85 millimeters of mercury), high triglycerides (150mg/dL or above, as measured by a cholesterol blood test), and high levels of glucose (at or above 100 milligrams per deciliter after fasting). The American Heart Association states that these factors point to an inflammatory condition called metabolic syndrome, which is a common precursor of diabetes and heart disease.
Obese individuals are more likely to be eating a poor diet, and less likely to be exercising and sleeping well. These are all additional factors increasing the risk for inflammation.
When you are obese, your fats cells bulge and your body’s immune system sends white blood cells to the stressed area. It inflames the cells and over time that inflammation can make healthy cells resistant to insulin (the hormone that regulates blood sugar), which can then lead to diabetes. Scientists know that foods which dump an excess of sugar into your bloodstream are more likely to set off inflammation.
During 2009–2010, more than one-third of adults, or some 78 million people were found to be obese (defined as body mass index [BMI] ≥30 kg/m2) in the United States.
Obesity has been definitively linked to elevated levels of inflammatory blood markers such as C-reactive protein.
Diet
Diet is key to inflammation. A diet high in saturated fat is associated with higher inflammatory markers. Consuming high-sugar, high-carb, high-fat foods, or when you eat a lot of saturated and Trans fats, increases your inflammation risk.
The well-known Attica study from the University of Athens that linked the Mediterranean diet to a lower risk of heart disease found that this diet also reduces inflammation.
90% of Americans are thought to have sodium intake that is too high, likely due to the amount of processed and packaged foods eaten. This increases the risk of high blood pressure and inflammation.
In a 2011 study, 38% of adolescents and 23% of adults said they ate vegetables less than once a day. The “Western” diet typically does not contain enough nutrient-dense foods, and may consist of a much larger amount of pro-inflammatory foods, as well serving sizes that are too large.
Stress
Inflammatory activity increases under chronic stress. Stress is also associated with decreased sleep and increased body mass (stimulated by the release of the stress hormone, cortisol), both of which are causes of inflammation.
Low sex hormones
Along with many other chores, the body’s sex hormones also modulate the immune/inflammatory response. Experiments in cell cultures have demonstrated that testosterone and estrogen can repress the production and secretion of several pro-inflammatory markers. So as the body’s sex hormone levels drop (due, for example, to chronic stress) it results in inflammation.
Smoking
Cigarette smoke contains several inducers of inflammation. Chronic smoking increases production of several pro-inflammatory cytokines, while simultaneously reducing production of anti-inflammatory molecules. More than 42 million adults said they currently smoked cigarettes in a 2012 study.
Sleep disorders
Scientists at Emory University School of Medicine in Atlanta, Georgia, studied the effect of sleep deprivation on inflammation and the risk of developing heart disease, and found a link. Sleep deprivation or poor sleep quality raised inflammation. Other studies have linked a lack of sleep to raising cortisol levels, obesity, metabolic disorders and a pro-inflammatory response.
Even short-term sleep reduction adversely affects inflammatory levels. In one study, modest sleep deprivation caused a 40-60% average increase in pro-inflammatory markers in men and women.
Lack of exercise
In a 2011 study it was found that more than half of adults aged 18 years or older did not meet the recommendations for physical activity and aerobic exercise. Another study done by Mark Hamer, PhD at University College London found that a moderate level of exercise – about 20 minutes a day – lowered the markers of inflammation by at least 12%. It is thought that when you exercise your adipose and muscle tissue release cytokines into the blood stream, reducing inflammation. Hamer also found it was never too late to gain the benefit of exercise.
Periodontal disease
Gum inflammation produces a systemic inflammatory response that may cause inflammation of several other systems throughout the body, such as the cardiovascular system.
People often do not know they are suffering from chronic inflammation; they just may not feel well and have a variety of symptoms such as fatigue or brain fog. Or, they may already have the initial symptoms of a specific disease, such as diabetes.
Aging people in particular may not realize they are suffering from chronic inflammation and think their symptoms are simply due to the aging process.
A doctor will take a medical history and do a physical examination, paying particular attention to the areas related to chief symptom complaints. The medical history will involve a close examination of family history in regards to inheritable diseases.
Blood tests: Often a blood-test is given to look for elevated white blood cell count and other markers. Elevated levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can be seen when inflammation is present.
The C-reactive protein test is the most widely used “inflammation” test. CRP is a substance produced by the liver that increases in the presence of inflammation. Results will indicate if there is inflammation in the body and the degree of inflammation, but will not indicate the location of the inflammation. If the results of the blood test indicate a high marker for C-reactive protein or other inflammatory markers, further lab work or testing will be done based on symptomology (do symptoms point to a particular type of chronic disease), family history and patient’s lifestyle (a family history of crohn’s disease, smoking).
Additional bloodwork may be done for thyroid testing or for evaluating hormone levels and other markers. Stool tests may be done to test for pathogens. X-rays or ultrasounds may also be indicated to search for specific inflammation locations.
Symptoms are varied, and not everyone experiencing these symptoms will have chronic inflammation. Most people will experience more than one symptom prior to a diagnosis.
Some signs of chronic inflammation are:
Chronic inflammation is a progressive disease. The rate of progression is influenced by the degree to which an individual is able to reduce their risk factors (obesity, exercise, diet, etc.), control underlying infections (yeast, candida), and prevent the development of chronic disease (diabetes, cancer).
There are many lifestyle changes that you can make to reduce the effects of chronic inflammation.
Eliminate the top food allergens from your diet. Top food allergens are:
Although there are skin prick allergen tests and blood tests (radioallergosorbent, or RAST) to test for food allergies they are not always accurate. Many in the medical community believe that a food elimination diet is the best way to determine which foods are causing you problems. This type of diet consists of removing the top food allergens from your daily diet for a period of time and reintroducing them while evaluating for any symptom re-occurrence (or possibly not reintroducing some). While the skin prick test will pick up allergens causing you immediate allergic response such as hives, it may not pick up more latent responses, such as digestive issues 24 hours later.
A poor diet may cause chronic inflammation.
A poor diet is one that contains a lot of “white” simple carbs, sugar and packaged foods; or one that contains a lot of high glycemic foods. High glycemic foods cause glucose to be released from the digestive system into the blood at a very quick rate, causing havoc with a person’s blood sugar. Some of the adverse effects of this blood sugar issue are raised insulin levels, pre-diabetes or diabetes, obesity, increased triglyceride levels, among others.
High glycemic foods are things like:
Healthier choices include:
Mediterranean-style diet is anti-inflammatory
This so-called “Mediterranean” diet differs dramatically from what the majority of Americans eat (a “Western” diet). Interestingly, the way a food is cooked or in the case of fruits, ripened, can have an effect on the glycemic index (GI). Generally, the more cooked a food is the higher the GI, and the riper a fruit is the higher the GI.
A Mediterranean diet typically is rich in vegetables, fish (which lowers the level of pro-inflammatory chemicals in the body), legumes, nuts and healthy fats (olive oil). This diet is high in omega-3 fatty acids (and low in omega-6), which are anti-inflammatory; also low in saturated fats and Trans fats. Many studies exist supporting the fact that eating a Mediterranean diet lowers inflammation.
Consider probiotics to balance your gut flora
Beneficial bacteria found in probiotic supplements, probiotic yogurt, and fermented foods can help keep the “bad” bacteria that reside in your gut in balance by introducing “good” bacteria. Too much bad bacteria can generate an inflammatory response. If dairy is one of your food sensitivities stick to the probiotic in pill or powder form. UCLA School of Medicine researchers found that intestinal inflammation in mice caused DNA damage in blood cells elsewhere in the body, increasing the likelihood of cancer. There have been many studies showing positive effect; however, more studies are needed due to the number of different bacteria strains that are available. Some conditions may or may not be affected depending on the strain(s) of bacteria in a given probiotic.
The Western diet can deplete good bacteria in your gut through antibiotic use, toxins from personal products and the environment, as well as aging.
Foods with probiotics include: probiotic yogurt, pickled/fermented vegetables, kefir, kombucha, tempeh, kimchi, miso and sauerkraut.
Reduce stress and get adequate quality sleep
Stress means your body generates an ongoing stress response. Stress is healthy when temporary, it helps you respond to an emergency (known as “fight or flight” response). But ongoing stress, and the sustained levels of the stress hormone, cortisol, create a variety of ill-effects on your body. It impacts the activity of other critical hormones (including sexual hormones), creates inflammation, and even adds belly fat.
Having hobbies or interests outside of work can help reduce stress. Moderate exercise can reduce levels of cortisol. Getting a good night sleep, seven to eight hours per night, can reduce stress. Going for a walk in nature, deep breathing, meditation, listening to music and other relaxation techniques can help decrease your body’s stress level. There are resources online as well as many iPhone apps that provide a resource for stress reduction in your daily life.
Clean up the toxins in your life
Take more responsibility for removing toxins in your everyday life. You can start by choosing to purchase healthier foods (non-GMO, wild-caught fish, grass-fed beef, etc.).
Your personal care products – those that come into routine contact with your skin – contain a variety of chemicals. The Environmental Working Group maintains a website rating the toxicity levels of many personal care products, household cleaning products, household pesticides, and more. Many products contain known endocrine disrupting chemicals (EDCs) which mean that a person’s sex hormones can be affected.
Get active
A sedentary lifestyle can lead to obesity as well as inflammation. Exercise protects against metabolic syndrome, for example. Moderate daily exercise has been proven to be best for fighting inflammation versus rigorous exercise.
Make improved choices relating to smoking, alcohol, and drug use
Cigarette smoking has been shown to cause significant inflammation (2012 Mayo Clinic and Foundation, Lee, et al.), cancer and death. However, the inflammation can be reduced if the smoker quits (2009, Chest journal, Metz, ET all). Alcohol causes inflammation to the liver, pancreas and immune system; the inflammation can lead to pancreatitis, liver disease and cancer. Many medications, both prescription and illegal drugs, have side effects relating to inflammation, often relating to liver, kidney, and digestive systems of the body.
Take care of your oral hygiene
The bacteria that cause inflammation in the gums may be a source of inflammation and thickening of the arteries. Floss and brush twice every day.
There is no established screening protocol for chronic inflammation, although there are many preventive things you can do to reduce your risk.
Regular check-ups and generic screening recommendations for your sex and age may identify an inflammation issue.
For those with a family history of chronic disease; talk with your doctor about specific screening recommendations available for those particular diseases (breast cancer, diabetes, colorectal cancer, obesity, etc.).
The best way to prevent chronic inflammation is through improved lifestyle decisions. You may have an underlying genetic predisposition for certain diseases, but many scientists think that it is lifestyle choices that “turn on” a particular gene or set of genes. Reducing your overall inflammation levels may help in reducing risk of disease.
Along with diet changes and other lifestyle modifications there are a variety of non-steroidal and steroidal anti-inflammatory drugs that can help with chronic inflammation.
While short-term use of anti-inflammatory drugs can be very effective, long-term use of any of these drugs (beyond a few weeks) can lead to life-threatening side effects (stomach ulcers, hemorrhage, osteoporosis and heart disease). Do not use even over-the-counter medications for lingering pain or other symptoms without consulting your doctor.
Non-steroidal anti-inflammatory drugs (NSAIDs). These drugs are taken to alleviate pain caused by inflammation. They work by stopping particular enzymes in your body from working. These enzymes (called COX enzymes, or cyclooxygenase enzymes) speed up your body’s natural production of substances called prostaglandins. Prostaglandins irritate the body’s nerve endings which result in the feeling of pain. By reducing the prostaglandins, NSAIDs can offer pain relief and also reduce inflammation in the body. A few examples of NSAIDs include aspirin, ibuprofen and naproxen. People should take NSAIDs under the supervision of a doctor due to possible side effects of stomach ulcers and hemorrhage. NSAIDs can also worsen asthma symptoms and cause other issues such as kidney damage. NSAIDs, with the exception of aspirin, may also increase the risk of heart attacks and strokes.
Aspirin or ibuprofen can lower C-reactive protein levels, one of the hallmark markers of inflammation. But the higher overall doses of these drugs that are needed to reduce C-reactive protein could cause side effects such as deterioration of the stomach lining.
A different type of NSAID, known as a COX-2 inhibitor, provides the same pain relief as other NSAIDs but is less likely to result in stomach ulcers and related problems. Celebrex is an example of a COX-2 inhibitor, available only through prescription.
Acetaminophen (Tylenol). Acetaminophen is a class of pain relievers that do not offer anti-inflammatory relief.
Corticosteroids. Corticosteroids mimic steroid hormones that are naturally produced in the body’s adrenal glands. They are synthesized in laboratories and then added to medications as an anti-inflammatory.
There are two types of corticosteroids, glucocorticoids and mineralocorticoids. Medications are designed based on both of these for different reasons.
Corticosteroids can be given by cream, orally, using an inhaler or via injection. Some examples of glucocorticoids are cortisone, hydrocortisone and prednisone. There can be dramatic side effects when using high dosages and/or if taken for lengthy periods. Side effects can include suppression of the immune function (which can leave the body more susceptible to pathogens and disease), bone-thinning and weight gain. Because the body adjusts to levels of corticosteroids, if you are prescribed them your doctor will work to wean you off of them slowly versus simply stopping their use.
Disease-Modifying Antirheumatic Drugs (DMARDs). For people having rheumatoid arthritis, psoriasis, ankylosing spondylitis and other types of arthritis, a classification of medications called DMARDs may help reduce their joint pain and inflammation. While DMARDs don’t cure these autoimmune diseases, they can help minimize symptoms, improve quality of life and help keep join damage from getting worse. Rheumatoid arthritis is just one of the many chronic diseases that, while the cause is unknown, have inflammatory markers that are used in its diagnosis.
Drugs like Enbrel have demonstrated significant anti-inflammatory effect in rheumatoid arthritis patients. The medication is used alone or in conjunction with an immunosuppressant.
Type II Diabetes Anti-inflammatory (Metformin). Metformin is a drug used to treat type II diabetes. It appears to have the ability to lower elevated blood insulin levels and has been shown to significantly lower C-reactive protein levels in several human studies.
Cholesterol Lowering Statin Drugs (Lipitor, Crestor). Statin drugs are taken by people who have too high of cholesterol levels; the drugs also have been found to lower C-reactive protein levels, but there are side effects, most notably with muscle inflammation and pain. Another possible side effect is actually an increased risk of diabetes.
Other Medications: Some doctors will prescribe chemotherapy drugs and pain narcotics to address significant inflammatory issues.
Immune Selective Anti-Inflammatory Derivatives (ImSAIDs). Perhaps for future use and under current study are immune selective anti-inflammatory derivatives. ImSAIDs are a class of peptides developed by IMULAN BioTherapeutics, LLC. Scientists found that they have anti-inflammatory properties. This is a new category of anti-inflammatory medication. ImSAIDs have shown promise in studies as potential veterinary drugs for controlling and reducing inflammation. Experts believe that with additional study they might eventually be suitable for human use.
A stronger, healthier digestive system and a healthy immune response will generally help improve inflammation. Reducing the risks identified in this Condition Center, such as changing diet and removing pro-inflammatory lifestyle and other inducers, will all help.
There are also a variety of supplements, spices, and herbs that may help; as well as alternative therapies. Be sure to speak with your doctor to see what is right for you. Many of these alternative treatments are supported mainly by anecdotal evidence versus studies and human trials, but they are listed so that you can discuss their feasibility with your doctor.
Supplements. There are a number of supplements that have been found to help with chronic inflammation. Among them:
Spices. Commonly occurring culinary herbs and spices have been shown to be anti-inflammatory and have been embraced by many in the holistic community. These include garlic, onions, green tea, cinnamon, turmeric, rosemary, curry, ginger, parsley, and cayenne. Preliminary findings from laboratory and animal studies suggest that a chemical found in the spice turmeric, called curcumin, may have anti-inflammatory, anticancer, and antioxidant properties. However these findings have not been confirmed in clinical trials (National Center for Complementary and Integrative Health). A 2009 study found that ginger extract prevented inflammation and anti-arthritic effects on rats. Clinical studies are lacking; however there continues to be strong anecdotal evidence for ginger, as well as many spice’s effects as anti-inflammatory agents.
Herbs. A variety of other herbs – beyond kitchen and cooking spices – have been referenced as possible anti-inflammatories, but there is not enough data at this time to validate their effects. Some of the herbs are: alfalfa, echinacea, goldenseal, silymarin from milk thistle, red clover, and yucca.
Medical Marijuana. Medical marijuana has not been approved by the Food and Drug Administration (FDA) and is still illegal in many states, but proponents – including many in the medical community – believe it has merits in regards to pain management associated with chronic inflammation and chronic disease. There are many risks associated with using medical marijuana (lung issues relating to smoking, side-effects as well as potential addiction) and there are specific groups of people have greater risks with medical marijuana (under the age of 18, pregnant, certain genetic predispositions relating to mental health, etc.) but if you are in a state that has legalized medical marijuana’s use you may want to discuss it with your doctor.
Alternative Therapies. These therapies like reiki may be helpful for reducing pain and improving overall mood and quality of life for those suffering from chronic inflammation and chronic diseases.
Moderate exercise via yoga, tai chi, walking – Most experts agree gentle to moderate exercise is good to increase mobility, reduce pain and improve mood. In a 2012 review in Aging and Disease, regular exercise reduced fat mass and adipose tissue inflammation, which is known to cause systemic inflammation in the body. Moderate exercise has also been shown to increase anti-inflammatory cytokines.
Cognitive behavioral therapies, such as relaxation therapy (breathing, mindfulness techniques) may help improve emotions and a person’s ability to cope with pain
Stress reduction techniques – Chronic stress is a cause of inflammation. Reducing it may cause an improvement in symptoms and mood.
Massage and acupuncture – May improve pain, range of motion and stiffness, and overall function of joints in people suffering from arthritis, according to The Arthritis Foundation. The World Health Organization has also recognized acupuncture as a treatment for pain.
Ideally you should be maintaining at least an annual visit to your doctor for a regular health check-up. At these appointments you can discuss with your doctor the recommended screenings for your age and sex (i.e. breast cancer screenings for women, colonoscopies, etc.), as well as ask about any additional screenings your doctor recommends based on your family history of chronic disease. This is a great time to review any symptoms you may be experiencing with your doctor, as well as to discuss lifestyle and other environmental changes you might benefit from making based on your risk factors and family medical history.
Pre-Diagnosis: If you are experiencing symptoms, especially those related to any type of pain, contact your doctor for an evaluation.
Emergency: In an emergency, go to your local hospital emergency room or dial 9-1-1.
Typically you will want to consult with your Primary Care Physician (PCP) or family doctor if you experience symptoms. That individual is most familiar with your overall health and any underlying conditions you might have, along with medications you might take.
Pre-Diagnosis of chronic inflammation or disease:
Post testing/diagnosis:
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