1. Angelita B. Frando, MD Board Certified in Family Medicine Board Certified, Medical Acupuncture

2. Definition: complex biological response to harmful stimuli (pathogens, damaged cells or irritants) Protective attempt to remove the injurious stimuli and initiate the healing process Important for survival Causes wounds and infections to heal (acute) Chronic = progressive destruction of tissue =>disease and degenerative changes

3. Manifestations (Signs): Calor (Heat) Rubor (Redness) Tumore (Swelling) Dolor (Pain) Functio laesa (loss of function)

4. Causes: Burns Chemical irritants Frostbite Toxins Infection by pathogens Physical injury, blunt or penetrating Immune reactions due to hypersensitivity Ionizing radiation Foreign bodies (ie., splinters, dirt and debris) Stress Trauma Alcohol

5. Types: Acute & Chronic Names Based on body systems / organs involved: ( “-itis”) Appendicitis Arthritis Bursitis Colitis Cystitis Dermatitis Myositis Meningitis Tendonitis Tonsillitis Vasculitis

6. Acute vs Chronic Causative agent: Bacteria, injured tissues Immediate onset Duration: Few days Outcome: Resolution, abscess, or chronic inflammation Persistent acute inflammation, viruses, persistent foreign bodies, autoimmune reactions Delayed Onset Up to many months or years Outcome: Tissue destruction, fibrosis, necrosis

7. Process of Acute Inflammation: Injury/pathogen => cells activated to release inflammatory mediators: Vasodilatation => Increased blood flow => redness and heat Increased blood vessel permeability => leakage of plasma proteins and fluid into tissues (swelling) Some mediators increase sensitivity to pain Other biochemical reactions occur (complement system, coagulation and fibrinolysis systems, etc.)

8. Cell derived mediators: Lysosome granules Histamine Interferon (cytokines) IL-8 (Interleukin 8) Leukotriene B4 Nitric oxide Prostaglandins TNF-alphaand IL-1

9. Inflammatory Markers: CRP (C-reactive protein) Increased levels associated with increased risk of heart attacks, strokes, high blood pressure, muscle weakness and fragility ESR (erythrocyte sedimentation rate) Homocysteine levels Tumor necrosis factor –alpha (TNF-@) Interleukin 6, 8, 18 (IL-6, IL-8, IL18) Blood glucose, insulin and leptin (especially for obese)

10. Disorders associated with Inflammation: Acne vulgaris Allergies Asthma Atherosclerosis Autoimmune disease Cancer Celiac disease Chronic prostatitis Degenerative arthritis, Hypersensitivities Interstitial cystitis Inflammatory bowel / Digestive tract disordes (Pancreatitis, Crohn’s disease, Regional enteritis, Enteropathies, Hepatitis, etc.) Kidney diseases (Diabetic Nephropathy, Glomerulonephritis, etc) Myopathies Obesity Osteoporosis Pelvic inflammatory disease Reperfusion injury Rheumatoid arthritis, Lupus, and other connective tissue disorders Skin: Psoriasis, Dermatitis Sarcoidosis Transplant rejection Vasculitis

11. Medications vs Inflammation Aspirin Works on prostaglandins Watch for gastrointestinal ulcers and bleeding NSAIDS May cause gastric/duodenal ulcers May damage kidneys with prolonged use Cox-2 inhibitors Steroids: Problems with prolonged use Weight gain, metabolic syndrome, gastric ulcers, blunts adrenal function, etc.

12. Supplements vs Inflammation Arthritis: OPC3 Omega 3 Glucosatrin (Boswellia with Cox-2 inhibition)

13. Supplements vs Inflammation Acne vulgaris: Prevaderm Digestive enzymes

14. Supplements vs Inflammation Asthma/ Allergies: OPC3 Aloe ORAC

15. Supplements vs Inflammation Atherosclerosis OPC3 Heart Health Omega 3 Activated Vitamin B Resveratrol

16. Supplements vs Inflammation Autoimmune diseases: OPC3 Omega 3 Resveratrol (do not give with Coumadin or breast cancer) Co-Q-10 Vitamin B Multivitamins/Minerals

17. Supplements vs Inflammation Cancer During remissions Breast Cancer B complex Vitamin D3 Calcium CoQ-10 OPC3 Multivitamins/multiminerals

18. Supplements vs Inflammation Cancer During remissions (not during treatment) Colon Cancer Resveratrol Fiber powder B complex CoQ-10 OPC3 Multivitamins/multiminerals

19. Supplements vs Inflammation Celiac disease Digestive enzymes Aloe

20. Supplements vs Inflammation Degenerative arthritis: Omega 3 OPC3 Glucosatrin

21. Supplements vs Inflammation Inflammatory GI/bowel disorders, etc. Crohn’s disease – OPC3, Digestive enzymes, Aloe Irritable Bowel Syndrome – OPC3, Aloe, Digestive enzymes Diverticulitis – (after bowel rest and antibiotics) Aloe, Digestive enzymes, fiber powder (for diverticulosis), OPC3 Pancreatitis – Digestive enzymes Gastric / Duodenal Ulcer – Aloe, Digestive enzymes Hepatitis – Digestive enzymes, Hepatocleanse

22. Supplements vs Inflammation Kidney disease due to diabetes: OPC3 Interstitial cystitis OPC3

23. Supplements vs Inflammation Osteoporosis: Calcium plus Vitamin D3 with K2 (IF Vitamin D deficient) D3 levels should be optimally placed at around 40-60 nmol/l Monitor blood levels to avoid toxicity

24. Supplements vs Inflammation OBESITY: Associated with chronic inflammation Waist circumference correlates to inflammatory response OPC3 Resveratrol Omega 3 Transitions

25. Supplements vs Inflammation Reperfusion Injury (Heart and Brain): Post- Myocardial infarction and Post-Stroke OPC3 Resveratrol Omega 3 Psoriasis: OPC3

26. Keep Inflammation in moderation