Katie Lowe 0:06

Welcome back to another episode of The Wellness Conversation, an Ohio Health Podcast. I'm Katie Lowe, along with Marcus Thorpe, and today we're diving into a topic that's so often overlooked, yet has such an impact on our overall health.

Marcus Thorpe 0:20

Yeah, if you've ever had that fatigue that you just can't explain, maybe those body aches and pains, or brain fog, which I think we all have from time to time, you could be dealing with chronic inflammation. It is definitely something that a lot of people have, but maybe it gets swept under the rug. It's not something that you really even know that much about. So, we're going to dive deep into that, and we've got a great guest to take it on with us today. It's Dr. Jennifer Middleton, who is with Ohio Health. Dr. Middleton, first off, I'm gonna fanboy a little bit. You are easily one of my favorite people at Ohio Health. We have had you on the podcast before, and you do such a great job, but I've known you for a while here, and you just offer so much insight, but you also have just a great viewpoint of things. So, we're so glad you're back with us today.

Dr. Jennifer Middleton

Oh, thank you. It's truly my privilege to be invited back.

Marcus Thorpe 1:04

Yeah, I do think that inflammation is one of those things that we all probably have to deal with from time to time, but we simply don't know much about.

Katie Lowe 1:13

Yeah, and I was really excited to learn more, because I feel the same way. When I was researching this, I was like, okay, I don't even really know what chronic inflammation is, so let's start with that. What's can we talk about defining chronic inflammation versus acute inflammation?

Dr. Jennifer Middleton

1:30

Well, I'd like to take a step back and start first with just defining what inflammation itself is. Sure, if that's okay. So, inflammation is a normal body response to any threat, that threat could be an infection, it could be an injury, and the way your body responds is in a way that has evolved to help us survive since time immemorial. You get some white blood cells, you get some, you know, rah rah rah proteins coming in to the rescue. You kind of amp your body up, your cortisol level goes up to tell your body, hey, we've got some work to do here. We've got to fight off this infection, we've got to heal this injury that is acute or short-term inflammation. It's normal. It helps your body fight off viruses. It helps you heal from bruises, bumps, other sort of things. Where inflammation can start to cause problems and contribute to chronic disease. Chronic, meaning long standing, is when it gets triggered not by infection or injury, but by some of the other challenges that we see in our everyday life in modern society.

Marcus Thorpe 2:48

Yeah, we found on this podcast, now that we're about 60 episodes or so into it, is a lot of times no matter what the topic is, people brush it under the rug and say, oh, it's fine, I just need to put up with this, or I just need to deal with this. It's part of my normal life. Inflammation, again, it sounds like from what you're saying is something that we should really look at and dig into, and it's not just, well, it's lack of sleep, or I'm overworked, or something's going on, I'm aging. There's more to it than just that.

Dr. Jennifer Middleton

3:18

Well, absolutely, a lot of the things in modern day life can contribute to that sense of the body always being on high alert, and that can contribute to chronic inflammation, so high levels of stress that are not mitigated. It's okay to have some stress from time to time, but if it never gets a chance to take a break, that sends again that cortisol and all of those other proteins and cells in the body to like get to work. We have to fight an invader, we have to, and if there's no invader, then some of those proteins and cells can actually damage our own body, so that is what we worry about when we worry about that chronic inflammation, and that damage can take the form of predisposing folks to a lot of the chronic diseases that have become endemic.

Marcus Thorpe 4:11

Yeah, your body's working so hard all the time that it never gets to rest or recuperate from itself. It's crazy.

Katie Lowe 4:19

I know there are a lot of symptoms that come along with chronic inflammation, but let's talk about some of the earlier symptoms. When should someone start to notice this, and at what point should they make the decision? Okay, I need to talk to my doctor about this.

Dr. Jennifer Middleton

4:36

That's an excellent question, and it's challenging because one of the things that is worrisome about chronic inflammation is that it can go on for a long time and not really bring up a lot of symptoms at all, as Marcus said earlier, kind of the brain fog, the fatigue, aches, and pains, there's lots of things. Can cause that. I don't want to say, yep. If you've got those, you've got chronic inflammation. Please, please go see your primary care, your friendly family doc in the neighborhood to make sure that other things are not going on. But that sense of, I never feel rested, I can't turn my mind off, something just doesn't feel right. Don't ignore those symptoms; those deserve to be evaluated.

Marcus Thorpe 5:27

Is it hard for a physician to kind of take a look at this and say, well, this is definitely that? Are there tests? Are there markers that you all in your field can be kind of pulling out and looking at, and then making determinations on what they're seeing and what you're dealing with.

Dr. Jennifer Middleton

5:42

Well, chronic inflammation is not a diagnosis that you're going to get from a medical professional most of the time, again, because it's kind of this low-level underlying cause instead of more familiar disease states, such as it can contribute to cardiovascular disease, contribute to diabetes, obesity. So you're more likely to get a diagnosis in terms of your risk or the presence of one of those diseases than to be actually diagnosed with chronic inflammation itself.

Marcus Thorpe 6:19

Okay,

Dr. Jennifer Middleton

6:20

There are a couple of lab tests that we can do to look at the inflammatory markers in the body. They're not always as helpful in chronic inflammation, though. They can be helpful in acute inflammation, so when we're worried about infection or some other acute stressor in the body, but for going into your doc and asking for those lab work, if you're worried more about chronic inflammation, your doc will probably tell you, I don't have the science to back up that any level that is not in this super high range is meaningful in terms of your risk when

Katie Lowe 7:00

We talk about some of the symptoms that someone might be feeling, you know, I was just thinking in my head, oh, I've certainly felt that way plenty of times, you know, the brain fog, not being able to shut your brain off, feeling tired. So, is that something that you see a lot from patients, is that they are brushing off these things and delaying getting treatment?

Dr. Jennifer Middleton

7:21

Yes, and the treatment, the way to combat that again. You might not ever hear your medical professional use the word chronic inflammation, but you've almost certainly heard them tell you what it is you can do to help yourself feel better. And I'm sorry, they're not that exciting and new of things, there are things like make sure you're getting restorative sleep, and enough of it. Make sure that you are mitigating stress, and if we want to talk more specifically about what science says we can do to do that, we can make sure you're getting some kind of regular exercise. It actually doesn't have to be a ton of exercise to be meaningful. Make sure that most of the time you're consuming a whole food, mostly plant-based diet. These are all signs to the body that hey, we're okay, this is not stressful, you know. A lot of the very heavily fried foods, the ultra-processed foods, they can, in fact, be pro-inflammatory. They are stressful for the body to deal with and digest.

Marcus Thorpe 8:32

Does age matter? Do you think? I mean, I think about, like, what I was able to do and eat and sleep when I was in my teens and 20s, compared to where I am now, where I'm nearing 50 years old, which is scary to say out loud, but it's true. But I feel like inflammation, or those kind of symptoms, hit me differently than it may be used to, when I was able to just kind of push through, or I was doing a lot more exercise, and those kind of things. What's your take on age when it comes to inflammation?

Dr. Jennifer Middleton

9:03

Well, I can't quote any science for you, but as an unashamed member of the 50 year old club, I can certainly attest that our reserves are perhaps not as great as we age as they were when we were younger, so it is easier to, you know, eat an entire pizza and not feel terrible the next day, but if you do that at 50, you're not going to probably feel as great the next day. That's not to say that, you know, aging automatically equals poor health or automatically equals an inability to respond in a positive way to these things, exercise, restorative sleep, stress management, you know, a mostly healthy, I'm all about moderation, a mostly healthy diet can all go a really long way to helping us live our best life, no matter what our age is.

Katie Lowe 10:00

it's so interesting. We talk about so many topics on this podcast, and I feel like the part of the solution always comes down to making these smart lifestyle choices.

Marcus Thorpe 10:11

That's the hardest part, like the simple things you should always be thinking about, and we just go, you know, I kind of like this. There's got to be medications.

Marcus Thorpe 10:19

Where's my magic pill??

Katie Lowe 10:21

Exactly.

Dr. Jennifer Middleton

10:21

And to validate you, it is hard to do those things, and one of the reasons that it's hard is that our current society is not set up in a way to make it easy to make those good choices. So, forgive me for putting my Master's of Public Health hat on there for a minute, but there are a lot of things in terms of our built environment. It's hard to get outside and exercise in a lot of areas around Columbus right now, and to do that safely, we have food deserts in the Columbus area where it's hard to get access to fresh Whole Foods, so it's not just in fact it's not willpower at all, I don't want to say it's just willpower, it has nothing to do with willpower and everything to do with how everything in our modern environment colludes to make it harder for us to make those good choices, so every time you want to make one of those good choices, you have to push against a lot of those pressures, so congratulations, you're normal humans. Yeah, it's hard for me too.

Marcus Thorpe 11:25

It's interesting because I think about the food that I consume and the lack of sleep that I can get from time to time, but then I think about the time where I was really focused, like I did the whole 30 a long time ago, right? And it's a, it's a diet that everybody seems to know about, but it cut down a lot of the sugar intake and some of the other things, fat fast foods and fatty foods, and I was sleeping better. I didn't feel the inflammation. My brain fog was kind of cleared up, so it was a short burst. Obviously, it's called the whole 30 because it's 30 days, but for those 30 days, even though the first 10 were absolute hell, where you're just like, oh my gosh, I think I'm going to die by the time my body adjusted to some of that, I felt so much better. So, there is something to be said for consistency and cleaning out the body, because that's what your body really needs.

Dr. Jennifer Middleton

12:15

Yes, our bodies were not designed to be under chronic, crazy levels of stress 24/7 We were not designed to be bombarded by lights 24/7 Don't get me started on daylight savings time, it's very anti what our body circadian rhythms really need, and we were not designed to have easy, cheap access to over-processed foods, and the sugar is also so important. Marcus, I'm glad you brought that up. We eat way more sugar than we need to, and that is toxic to the body.

Marcus Thorpe 12:54

You don't even know sometimes what you're eating that has sugar in it. Oh my gosh, the amount of bread that we consume, myself included.

Katie Lowe 13:01

it's a good reminder for me too, as a mom of a two year old who you know always wants the pouches and the juice boxes and stuff like that. You really have to be cognizant of the ingredients in there, but I did also want to ask you, you know, we're talking about lifestyle changes you can make, and it seems, it seems to me like that is really the the first steps you should be taking when addressing this inflammation, but I know there are other ways, or well, I should ask you, would you ever recommend a non-steroid anti-inflammatory drug or corticosteroids? How does that fit into the picture?

Dr. Jennifer Middleton

13:39

In an ideal universe, we would be limiting the use of the medications that you have described to a short term. You got it, because both of those groups of medicines, both the non-steroidal anti-inflammatories, or what are sometimes called NSAIDs, and corticosteroids can, in the short term, help decrease inflammation, but in the long term, paradoxically, can worsen it and can cause stressors on the body in different ways. So, an NSAID medications like ibuprofen or naproxen, wonderful in the short term for a lot of conditions. If you have kidney disease or high blood pressure, please talk to your doctor before taking those over the counter, but we have some data showing that long-term high dose use of those medications put stress on the kidneys and on the heart, potentially, so they're not really intended most of the time for long time use, unless you have a specific medical indication where that is recommended, the same is true for corticosteroids. Corticosteroids are wonderful for helping with acute joint injuries. They are critical in managing patients who are having breathing problems, such as asthma or emphysema, but when used long time. They can actually turn up that cortisol switch and increase those pro-inflammatory molecules in the body and cause even more damage.

Marcus Thorpe 15:11

I know you work with residents kind of at the beginning of their careers quite a bit. Do you think that the outlook on inflammation has changed from maybe an older physician who's kind of been at it for a while, versus maybe this younger generation who looks at things maybe just a little bit differently. Do they look at inflammation? Do you think any focus is any sharper or more focused than maybe we did 1015, 20 years ago?

Dr. Jennifer Middleton

15:39

The difference that I see is that patients are asking about it in a different way. I would say the way that we train future family doctors to think about everything that we've been talking about is more related to risk factors, and how do we mitigate those risk factors to decrease your chance of developing those chronic diseases we talked about, and underneath all of that is this idea of turning down the inflammation, but that's often not something that's coming directly into the conversation with the patient, because if you do all of those preventative things, the inflammation is one of those mechanisms by which you're reducing that risk,

Marcus Thorpe 16:23

So the conversation at the beginning is maybe not only on inflammation, but it's about sidestepping some of those potholes you could be running into later in life.

Dr. Jennifer Middleton

16:32

Yeah, exactly. So it's, you know, when we are working with our pediatric patients, so you know, we're family medicine, every age, every stage, we spend a lot of time talking about prioritizing whole foods as much as possible. I get it. Hey, my kid had chicken nuggets for dinner last night. I get it. Sometimes it happens, but most of the time, are we able to prioritize whole foods for kids? Are we able to prioritize those lower sugar options? Are we encouraging our kids to get outside and to run around, setting those good habits, hopefully that will set them up for success later in life, and then when we're seeing our adult patients working with them to brainstorm ways around the barriers that are keeping them from doing those same things.

Katie Lowe 17:17

Yeah, excuse me, I can imagine. I mean, just setting up those habits when you're young makes it so much easier to continue those healthy choices when you're older. We talk a lot about how this inflammation seems to be precursors of diseases. Can you talk about some of the most common diseases where you would see that inflammation?

Dr. Jennifer Middleton

17:40

So pretty much any chronic disease you can think of probably has an element of that, so certainly we know cardiovascular disease does blood vessels when they are getting bombarded again by these stress molecules over and over again it changes the way that they work, and that can contribute to heart disease, that can contribute also to kidney disease, to high blood pressure. High blood pressure, in and of itself, is rarely going to be, you know, what does somebody in, but it increases your risk. Again, you've got this whole cascade, it increases your risk for heart disease, for kidney disease, for blindness. On a slightly different path, diabetes, especially type two diabetes, what we consider adult diabetes in most folks. So we are seeing it in younger ages sometimes that constant stress and attack of the body's immune system that gets targeted against the pancreas cells that make insulin and gets targeted against all the cells in the body in terms of how they use sugar and glucose.

Marcus Thorpe 18:56

This is such a tough topic, because I do think inflammation is still one of those things that you know is there, and you don't really.. it's hard. I mean, it's really hard to drill down as to what you're dealing with, you know? Whether it's I just don't feel good, or I'm achy, or I'm swelling here or there, and trying to pinpoint exactly what's going on. Does that.. is that why it's so challenging? Because it's.. look, I come in and I've got a bad shoulder, and you put an x-ray on it, and they're like, "Oh, I know what's wrong with your shoulder. Boom, here we go, and we can fix it. This is one of those things that it's kind of like, what can we take away, what can we put here, what can we do here, and then maybe you see the slow gains versus where we are in life. It makes it really hard, doesn't it, for everybody.

Dr. Jennifer Middleton

19:39

No, I agree. I think that's a really important point. I mean, you're not going to see somebody you know in an hour episode of the pit come in and magically have their information cured, right? And again, what we are focusing on most of the time as clinicians is less that mechanism itself and. More, what can we do to flip it off as much as possible to help protect against chronic disease, and, like you said, Marcus, when you were describing your whole 30 experience, it's an adjustment sometimes, you know, getting started with an exercise program when you haven't for a while, or maybe ever, it's an adjustment, it's not easy at first, making changes to the food that you eat when your taste buds have been acclimated to eating a certain way is not easy, prioritizing sleep is not easy, so these are things that are hard for all of us to do, when I see a patient who comes in and says, "I'm tired, I just don't feel well, things aren't working well for me. My job as a family physician is number one, hopefully I already have known them for a while, because we get to enjoy long-term relationships with our patients, so I have some sense of what might be going on, but I need to ask more questions. Is there a specific medical diagnosis here that I need to deal with, and or what from a lifestyle standpoint can I coach my patients on to help them to feel better? Also, and often it's both of those.

Marcus Thorpe 21:16

Yeah, and if you have chronic inflammation and you don't really know what's going on? Starting that exercise is going to be painful sometimes, because you've had that inside of your body for so long, you've been dealing with it. Those first like week of exercise, you'll be like, I hate this, I'm in so much pain, my joints are achy, and that'll be your first line of, I'm done, I don't want to do this.

Katie Lowe 21:39

And, well, what I was going to say, too, is thinking about, okay, you know, trying to get more sleep, exercising more, improving your nutrition, those are huge changes to make, and to try and tackle all three at the same time sounds so overwhelming. How would you recommend going about this when you, when a patient comes to you and explains they're not feeling well, they explain the symptoms, and you think lifestyle improvements is where they need to start. What are the first couple steps that they can take?

Dr. Jennifer Middleton

22:08

Well, that's a very individualized process, I think. When it's done well, you're right, nobody can change everything at once. We got tons of behavioral science on that one thing at a time, and ideally when we're talking with patients and working collaboratively with patients, it's one piece of that one thing at a time. So part of that is me hearing what's going on with my patient and maybe having a sense about where I think the biggest opportunity is. Some of it may be more patient led, after you know, wow, I think that there's opportunities here, here, and here, and the patient may say, I really want to start with this cool, so it should be a collaborative process, but ideally it's one piece of one thing, so if it's I really want to start eating healthier, okay, why is that important to you, you have to have a why, or it's really hard to sustain when things are tough, as Marcus said. And what's one thing we could do? It's not all right. Most folks, I mean, I applaud you, Marcus, but most folks are not going to dive into whole 30 and just like go for it.

Dr. Jennifer Middleton

23:19

which is awesome, but it might be, oh, you know what, I'm going to make sure we have a vegetable on the dinner table most nights. It's going to be, I'm going to start my day with some kind of protein. It's identifying one thing, and then when you succeed at that, adding another thing and adding another thing. And I agree that incremental change is not exciting, and it doesn't yield immediate results. Having a relationship with a patient where you can stand by them, be available to them, I think that's what a good family doc has to do as they're working through that process.

Marcus Thorpe 23:56

Small wins lead to more wins, right?

Dr. Jennifer Middleton

23:58

Yeah, exactly.

Katie Lowe 24:00

That's a good point, too, though. Not, you know, everybody wants to see the results right away, so it's hard when you don't,

Marcus Thorpe 24:05

and it helps you if you're gonna fail, fail small, so that we can figure out how to, like, get turned that around, and let's figure out ways to start.

Dr. Jennifer Middleton

24:12

Yeah, I mean, it's an opportunity to learn, is how I try to reframe that. Well, it didn't work. Okay, why? Why didn't it work? Maybe we started with something that wasn't that realistic. Maybe we need to just go in a completely different direction. That's a conversation you can have, hopefully with your family doc to work out what is what is the next step.

Marcus Thorpe 24:32

Well, I just hope this encourages people to have conversations with their docs, right? When you go in there, like, say, "Look, this is how I'm feeling, let them help you lead down the path of understanding what's going on. I think that's the biggest part here, and that's why we love having you on, Dr. Middleton. It is awesome to see you explain things so clearly for us, especially on a confusing topic like this. So, I think it's really important.

Katie Lowe 24:54

Yeah, thank you so much for your time. Again, I know this is a condition with a lot of nonspecific. Symptoms, so I think this information can really go a long way in helping people navigate what those first steps should be for them.

Marcus Thorpe 25:07

It's great to see you. Thank you so much.

Dr. Jennifer Middleton

25:08

Thank you so much again. It's always a delight to be with you.

Marcus Thorpe 25:12

We thank you for joining us for this episode of The Wellness Conversation in Ohio Health Podcast. Before we wrap up, we invite you to follow us on all social media channels, as well as Spotify, Apple, wherever you get your podcast, you can like, favorite, subscribe, maybe share this episode with somebody else who you think might get a little bit out of it. That's how we grow, and how we grow with you too.

Katie Lowe 25:32

Yeah, excuse me. And now, all the information, excuse me, guys, 30 about to be 38 weeks pregnant, so we got some stuff going on. All the information in this episode will be available in written form on the Ohio Health Wellness blog. You can find that at the blog at.ohiohealth.com Thanks for joining us. Be sure to subscribe as we continue our exploration of important health and wellness topics with Ohio health experts.

Marcus Thorpe 25:59

We'll see you next time.

Unknown 26:00

Bye.