The Resolution of Inflammation: A Nutritional Issue

Active Hydrogen Adrenal Extracts Alanine Alpha-Linolenic Acid Alpha-Lipoic Acid AMP Amylase Inhibitors Arginine Bee Pollen Beta Carotene Beta-glucan Betaine Beta-Sitosterol Biotin Borage Oil Boron Bovine Cartilage Bovine Colostrum Brewer's Yeast Bromelain Calcium Capsaicin Carnitine Carnosine Chitosan Chloride Chlorophyll Chondroitin Chromium CLA Cobalt Coenzyme Q10 Copper Creatine Cysteine DHA DHEA DMAE EGCG Evening Primrose Oil 5-HTP Fiber (Insoluble) Fiber (Soluble) Fish Oil Flavonoids Fluoride Folate Fumaric Acid GABA Gamma-Linolenic Acid Glucomannan Glucosamine Glutamic Acid Glutamine Glutathione Glycine Grape Seed Extract Histidine HMB Hydroxycitric Acid Indole Inosine Inositol Iodine Ipriflavone Iron Isoleucine Lactase Lecithin Leucine Lipase Lutein Lycopene Lysine Magnesium Malic Acid Manganese Mannose Melatonin Methionine Methoxyisoflavone Molybdenum MSM N-Acetyl Cysteine NADH Naringin Niacin Octacosanol Oligosaccharides Olive Leaf Extract Ornithine Oryzanol PABA Pancreatic Enzymes Pantothenic Acid Phenylalanine Phosphatidylserine Phosphorus Phytic Acid Policosanol Potassium Pregnenolone Probiotics Propolis Psyllium Pyridoxine Pyruvate Quercetin Resveratrol Retinol Riboflavin Ribose Royal Jelly SAMe Selenium Shark Cartilage Silicon Sodium Spirulina Spleen Extracts St. John's Wort Strontium Sulforaphane Sulfur Taurine Thiamine Tocopherol Tea Tree Oil Tyrosine Usnic Acid Valine Vanadium Vinpocetine Vitamin A Vitamin B1 Vitamin B2 Vitamin B3 Vitamin B5 Vitamin B6 Vitamin B9 Vitamin B12 Vitamin C Vitamin D Vitamin H Vitamin K Whey Protein Xylitol Zinc

Abalone Shell (shi jue ming)
Abutilon Seed (dong kui zi)
Acanthopanax Bark (wu jia pi)
Achyranthes (niu xi)
Aconite (fu zi)
Acorus (shi chang pu)
Adenophora Root (nan sha shen)
Agkistrodon (bai hua she)
Agrimony (xian he cao)
Ailanthus Bark (chun pi)
Akebia Fruit (ba yue zha)
Albizzia Bark (he huan pi)
Albizzia Flower (he huan hua)
Alfalfa (medicago sativa)
Alisma (ze xie)
Aloe (lu hui)
Alum (bai fan)
Amber (hu po)
Ampelopsis (bai lian)
Andrographis (chuan xin lian)
Anemarrhena (zhi mu)
Antelope's Horn (ling yang jiao)
Apricot Seed (xing ren)
Areca Peel (da fu pi)
Areca Seed (bing lang)
Arisaema (tian nan xing)
Ark Shell (wa leng zi)
Arnebia (zi cao or ying zi cao)
Arnica (arnica montana)
Artichoke Leaves (Cynara scolymus)
Ash bark (qin pi)
Ashwagandha (withania somniferum)
Aster (zi wan)
Astragalus (huang qi)
Aurantium (zhi ke [qiao])
Bamboo Juice (zhu li)
Bamboo Shavings (zhu ru)
Belamcanda Rhizome (she gan)
Benincasa Peel (dong gua pi)
Benincasa Seed (dong gua xi/ren)
Benzoin (an xi xiang)
Bilberry (yue ju)
Biota Leaf (ce bai ye)
Biota Seed (bai zi ren)
Bitter Melon (ku gua)
Bitter Orange Peel (ju hong)
Black Cohosh (sheng ma)
Black Plum (wu mei)
Black Sesame Seed (hei zhi ma)
Bletilla (bai ji)
Boneset (ze lan)
Borax (peng sha)
Borneol (bing pian)
Bottle Brush (mu zei)
Buddleia (mi meng hua)
Buffalo Horn (shui niu jiao)
Bulrush (pu huang)
Bupleurum (chai hu)
Burdock (niu bang zi)
Camphor (zhang nao)
Capillaris (yin chen hao)
Cardamon Seed (sha ren)
Carpesium (he shi)
Cassia Seed (jue ming zi)
Catechu (er cha)
Cat's Claw (uncaria tomentosa)
Cephalanoplos (xiao ji)
Celosia Seed (qing xiang zi)
Centipede (wu gong)
Chaenomeles Fruit(mu gua)
Chalcanthite (dan fan)
Chebula Fruit (he zi)
Chinese Gall (wu bei zi)
Chinese Raspberry (fu pen zi)
Chrysanthemum (ju hua)
Cibotium (gou ji)
Cinnabar (zhu sha)
Cinnamon (rou gui or gui zhi)
Cistanche (rou cong rong)
Citron (xiang yuan)
Citrus Peel (chen pi)
Clam Shell (hai ge ke/qiao)
Clematis (wei ling xian)
Cloves (ding xiang)
Cnidium Seed (she chuang zi)
Codonopsis (dang shen)
Coix Seed (yi yi ren)
Coptis (huang lian)
Cordyceps (dong chong)
Coriander (hu sui)
Corn Silk (yu mi xu)
Cornus (shan zhu yu)
Corydalis (yan hu suo)
Costus (mu xiang)
Cranberry (vaccinium macrocarpon)
Cremastra (shan ci gu)
Croton Seed (ba dou)
Curculigo (xian mao)
Cuscuta (tu si zi)
Cuttlefish Bone (hai piao xiao)
Cymbopogon (xiang mao)
Cynanchum (bai qian)
Cynomorium (suo yang)
Cyperus (xiang fu)
Dalbergia (jiang xiang)
Damiana (turnera diffusa)
Dandelion (pu gong ying)
Deer Antler (lu rong)
Dendrobium (shi hu)
Devil's Claw (harpagophytum procumbens)
Dianthus (qu mai)
Dichroa Root (chang shan)
Dittany Bark (bai xian pi)
Dong Quai (tang kuei)
Dragon Bone (long gu)
Dragon's Blood (xue jie)
Drynaria (gu sui bu)
Dryopteris (guan zhong)
Earthworm (di long)
Eclipta (han lian cao)
Elder (sambucus nigra or sambucus canadensis)
Elsholtzia (xiang ru)
Ephedra (ma huang)
Epimedium (yin yang huo)
Erythrina Bark (hai tong pi)
Eucalyptus (eucalyptus globulus)
Eucommia Bark (du zhong)
Eupatorium (pei lan)
Euphorbia Root (gan sui or kan sui)
Euryale Seed (qian shi)
Evodia (wu zhu yu)
Fennel (xiao hui xiang)
Fenugreek (hu lu ba)
Fermented Soybeans (dan dou chi)
Flaxseed (ya ma zi)
Fo Ti (he shou wu)
Forsythia (lian qiao)
Frankincense (ru xiang)
Fritillaria (chuan bei mu)
Gadfly (meng chong)
Galanga (gao liang jiang)
Galena (mi tuo seng)
Gambir (gou teng)
Gardenia (zhi zi)
Garlic (da suan)
Gastrodia (tian ma)
Gecko (ge jie)
Gelatin (e jiao)
Genkwa (yuan hua)
Germinated Barley (mai ya)
Ginger (gan [sheng] jiang)
Ginkgo Biloba (yin xing yi)
Ginseng, American (xi yang shen)
Ginseng, Asian (dong yang shen)
Ginseng, Siberian (wu jia shen)
Glehnia (sha shen)
Glorybower (chou wu tong)
Goldenseal (bai mao liang)
Gotu Kola (luei gong gen)
Green Tea (lu cha)
Gymnema (gymnema sylvestre)
Gynostemma (jiao gu lan)
Gypsum (shi gao)
Halloysite (chi shi zhi)
Hawthorn (shan zha)
Hemp Seed (huo ma ren)
Homalomena (qian nian jian)
Honey (feng mi)
Honeysuckle Flower (jin yin hua)
Honeysuckle Stem (ren dong teng)
Houttuynia (yu xing cao)
Huperzia (qian ceng ta)
Hyacinth Bean (bai bian dou)
Hyssop (huo xiang)
Ilex (mao dong qing)
Imperata (bai mao gen)
Indigo (qing dai)
Inula (xuan fu hua)
Isatis Leaf (da qing ye)
Isatis Root (ban lan gen)
Java Brucea (ya dan zi)
Jujube (da zao)
Juncus (deng xin cao)
Kadsura Stem (hai feng teng)
Katsumadai Seed (cao dou kou)
Kelp (kun bu)
Knotweed (bian xu)
Knoxia root (hong da ji)
Kochia (di fu zi)
Lapis (meng shi)
Leech (shui zhi)
Leechee Nut (li zhi he)
Leonorus (yi mu cao)
Lepidium Seed (ting li zi)
Licorice (gan cao)
Ligusticum (chuan xiong)
Ligustrum (nŸ zhen zi)
Lily Bulb (bai he)
Limonite (yu liang shi)
Lindera (wu yao)
Litsea (bi cheng qie)
Lobelia (ban bian lian)
Longan (long yan hua [rou])
Lophatherum (dan zhu ye)
Loquat Leaf (pi pa ye)
Lotus Leaf (he ye)
Lotus Node (ou jie)
Lotus Seed (lian zi)
Lotus Stamen (lian xu)
Luffa (si gua luo)
Lycium Bark (di gu pi)
Lycium Fruit (gou qi zi)
Lygodium (hai jin sha)
Lysimachia (jin qian cao)
Magnetite (ci shi)
Magnolia Bark (hou po)
Magnolia Flower (xin yi hua)
Maitake (grifola frondosa)
Marigold (c. officinalis)
Massa Fermentata (shen qu)
Milk Thistle (silybum marianum)
Millettia (ji xue teng)
Mint (bo he)
Mirabilite (mang xiao)
Morinda Root (ba ji tian)
Mugwort Leaf (ai ye)
Mulberry Bark (sang bai pi)
Mulberry Leaf (sang ye)
Mulberry Twig (sang zhi)
Mullein (jia yan ye)
Musk (she xiang)
Myrrh (mo yao)
Notoginseng (san qi)
Notopterygium (qiang huo)
Nutmeg (rou dou kou)
Oldenlandia (bai hua she she cao)
Omphalia (lei wan)
Onion (yang cong)
Ophicalcite (hua rui shi)
Ophiopogon (mai dong)
Oroxylum Seed (mu hu die)
Oryza (gu ya)
Oyster Shell (mu li)
Passion Flower (passiflora incarnata)
Patrinia (bai jiang cao)
Pau D'Arco (tabebuia avellanedae)
Peach Seed (tao ren)
Pearl (zhen zhu [mu])
Perilla Leaf (su ye)
Perilla Seed (su zi)
Perilla Stem (su geng)
Persimmon (shi di)
Pharbitis Seed (qian niu zi)
Phaseolus (chi xiao dou)
Phellodendron (huang bai)
Phragmites (lu gen)
Picrorhiza (hu huang lian)
Pinellia (ban xia)
Pine Knots (song jie)
Pipe Fish (hai long)
Plantain Seed (che qian zi)
Platycodon (jie geng)
Polygala (yuan zhi)
Polygonatum (huang jing)
Polyporus (zhu ling)
Poppy Capsule (ying su qiao)
Poria (fu ling)
Prickly Ash Peel (hua jiao)
Prinsepia Seed (rui ren/zi)
Prunella (xia ku cao)
Prunus Seed (yu li ren)
Pseudostellaria (tai zi shen)
Psoralea (bu gu zhi)
Pueraria (ge gen)
Pulsatilla (bai tou weng)
Pumice (fu hai shi)
Pumpkin Seed (nan gua zi)
Purslane (ma chi xian)
Pyrite (zi ran tong)
Pyrrosia Leaf (shi wei)
Quisqualis (shi jun zi)
Radish (lai fu zi)
Realgar (xiong huang)
Red Atractylodes (cang zhu)
Red Clover (trifolium pratense)
Red Ochre (dai zhe shi)
Red Peony (chi shao)
Red Sage Root (dan shen)
Rehmannia (shu di huang)
Reishi (ling zhi)
Rhubarb (da huang)
Rice Paper Pith (tong cao)
Rose (mei gui hua)
Rosemary (mi die xiang)
Safflower (hong hua)
Saffron (fan hong hua)
Sandalwood (tan xiang)
Sanguisorba Root (di yu)
Sappan Wood (su mu)
Sargent Gloryvine (hong teng)
Saw Palmetto (ju zong lu)
Schefflera (qi ye lian)
Schisandra (wu wei zi)
Schizonepeta (jing jie)
Scirpus (san leng)
Scopolia (S. carniolica Jacq.)
Scorpion (quan xie)
Scrophularia (xuan shen)
Scutellaria (huang qin)
Sea Cucumber (hai shen)
Sea Horse (hai ma)
Seaweed (hai zao)
Selaginella (shi shang bai)
Senna (fan xie ye)
Shiitake (hua gu)
Siegesbeckia (xi xian cao)
Siler Root (fang feng)
Slippery Elm (ulmus fulva)
Smilax (tu fu ling)
Smithsonite (lu gan shi)
Sophora Flower (huai hua mi)
Sophora Root (ku shen)
Spirodela (fu ping)
Stellaria (yin chai hu)
Stemona (bai bu)
Stephania (fang ji [han])
Sweet Annie (qing hao)
Teasel Root (xu duan)
Tiger Bone (hu gu)
Torreya Seed (fei zi)
Tortoise Plastron (gui ban)
Tremella (bai mu er)
Trichosanthes Fruit (gua lou)
Trichosanthes Root (tian hua fen)
Trichosanthes Seed (gua lou ren)
Tsaoko Fruit (cao guo)
Turmeric (jiang huang)
Turtle Shell (bie jia)
Tussilago (kuan dong hua)
Urtica (xun ma)
Uva ursi (arctostaphylos uva-ursi)
Vaccaria Seed (wang bu lui xing)
Valerian (jie cao)
Veratrum (li lu)
Viola (zi hua di ding)
Vitex (man jing zi)
Walnut (hu tao ren)
Watermelon (xi gua)
White Atractylodes (bai zhu)
White Mustard Seed (bai jie ze)
White Peony (bai shao)
Wild Asparagus (tian men dong)
Windmill Palm (zong lu pi/tan)
Xanthium (cang er zi)
Zedoary (e zhu)

by David Seaman, DC, MS, DABCN

No matter if one is a DC, ND, MD, DO, or PT, one of the many things that we have in common is that we all learn about inflammation; and we all typically learn from similar texts, including Robbins Pathology and Guyton's Physiology.

One major problem with these texts is that they do not address inflammation in a clinical context; that is, we are not told how to treat inflammation.

We do learn that acute inflammation is caused by many agents, such as microbial infection, and tissue injury via physical, chemical, and thermal mechanisms. However, no approach to treatment is discussed that applies to chiropractic practice. Concerning chronic inflammation, we learn from Robbins Pathology that the most common cause is infection or autoimmune disease - two agents about which natural treatment options, if any, are not discussed.

The primary passive applications include adjusting and therapeutic modalities, and while inflammation may be influenced by such interventions, we have little information about whether or not the resolution of inflammation occurs ... and this holds true for conventional interventions as well, such as drugs and surgery.

"We need to eat less inflammatory foods rich in n-6 fatty acids, and eat more n-3-rich foods"

Charles Serhan, from Harvard Medical School, has been studying the mediators of inflammation for many years, and notes that "inflammation resolution" is an area that has received little research attention. In fact, he states that, "Resolution is essentially uncharted terrain."¹

There is a seemingly endless list of chemical mediators that participate in the inflammatory process, such as eicosanoids, cytokines, kinins, and growth factors. In this regard, Serhan asks the following poignant questions:¹

"Should we make each 'pro-inflammatory mediator' a drug target? Should we try to selectively inhibit each of the hundreds if not thousands of important molecules?"

He notes that selective COX-2 inhibitors, for example, can disturb resolution inflammation, and lead to a delay in the return to homeostasis, which is likely to be an unwanted side-effect.

In 2000, Serhan first published his research about omega-3 fatty acid-derived mediators that function to resolve inflammation, and he referred to them as "resolvins." Eicosapentaenoic acid (EPA) is the precursor for 18R-resolvin, and docosahexaenoic acid (DHA) is the precursor for 17S-resolvin.¹ Resolvins create "stop signals" and thus dampen inflammation; they appear to reduce cytokine activity and the chemotactic recruitment of neutrophils and their pro-inflammatory activity,¹ and also reduce NFkB activity.²

Serhan points out that chronic inflammation is known to be involved in the pathogenesis of many chronic diseases, such as arthritis, periodontal disease, cancer, heart disease and Alzheimer's disease, and notes that lay magazines, such as the Feb. 23, 2004 issue of Time Magazine, have picked up on this fact. Serhan's research suggests that nutrition is likely to become the premier candidate to drive the resolution of inflammation.

From a nutritional perspective, it is known that our consumption of omega-3 (n-3) fatty acids from green vegetables, fish, wild game, and pasture-fed animals is quite low, such that researchers estimate that our average dietary omega-6 to omega-3 fatty acid ratio is about 20-30:1. Omega-6 (n-6) fatty acids from grains, flour products, corn, safflower, sunflower, and soybean oils serve as the precursors for pro-inflammatory eicosanoids such as prostaglandin-E2 and leukotriene-B4, and also promote free-radical generation and pro-inflammatory cytokine release.³ We know that this imbalance of fatty acid intake is far from the 1:1 ratio of n-6 to n-3 to which we are genetically adapted, and the likely cause of the inflammation-driven diseases mentioned above, including type 2 diabetes.³

In the clinical setting, we should consider viewing this fatty acid imbalance as a possible cause of pain syndromes that do not resolve. A 20:1 n-6 to n-3 fatty acid ratio and our high intake of trans-fatty acids are likely to result in a negligible production of eicosanoids and resolvins derived from EPA and DHA. This is because the same enzymes are utilized in the biosynthesis of n-6 eicosanoids and n-3 eicosanoids and resolvins, such that our substantial n-6 intake serves to functionally inhibit the production of n-3-derived anti-inflammatory mediators.

Chronic inflammation is known to be involved in the pathogenesis of many chronic diseases, such as arthritis, periodontal disease, cancer, heart disease and Alzheimer's disease

Without resolvins, it is likely that inflammation will persist without resolution, leading to chronic inflammatory disease in the long term and persistent pain throughout life. For this reason, we need to eat less inflammatory foods rich in n-6 fatty acids, and eat more n-3-rich foods. Supplementation with n-3 fatty acids is also very important. Most individuals are not likely to achieve appropriate n-6:n-3 ratios with diet alone. Taking 1-3 grams of EPA/DHA is reasonable and without side-effects, and this is because such supplementation merely restores n-3 intake to an appropriate level.

Only patients taking coumadin need to be wary of EPA/DHA supplements and other anti-inflammatory supplements, such as ginger and turmeric. Blood-clotting activity must be closely monitored in any patient taking coumadin or anti-inflammatory supplements.

References

Serhan CN. Novel omega-3 derived local mediators in anti-inflammation and resolution. Pharmacol Ther 2005;105:7-21.
Arita M, Bianchini F, Aliberti J, et al. Stereochemical assignment, antiinflammatory properties, and receptor for the omega-3 lipid mediator resolvin E1. J Exp Med 2005;201(5):713-22.
Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr 1999;70(3 Suppl):560S-569S.