transcript

Speaker 1:
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Speaker 2:
[01:12] Sometimes, I just want to know what is wrong. Like, why am I so tired? Why does life feel so hard? And I have come to learn that if you address that question not to your sister or your therapist, but instead to TikTok, you can get a blessedly simple answer.

Speaker 3:
[01:33] Inflammation is the root of all disease.

Speaker 4:
[01:35] The root cause of almost all chronic illnesses and aging itself.

Speaker 2:
[01:40] To hear some people tell it, inflammation is the cause of basically everything, like all of the problems with our health.

Speaker 5:
[01:49] Heart disease, diabetes, Alzheimer's disease, even some forms of cancer.

Speaker 3:
[01:54] Acne, eczema, hair loss, hormonal issues, PMS, bloating, irregular bowel movements.

Speaker 6:
[01:59] You can actually look better, look younger, feel better.

Speaker 7:
[02:03] Everything gets better when we lower inflammation.

Speaker 6:
[02:06] Are you worried?

Speaker 2:
[02:07] Because don't worry, there are also tips.

Speaker 5:
[02:11] First is supplements. Curcumin is extremely anti-inflammatory. Cinnamon is very anti-inflammatory.

Speaker 7:
[02:17] Tip number two, consider taking a break from food.

Speaker 6:
[02:20] Number three, more fish.

Speaker 2:
[02:23] Okay, and now I am confused, because it sounds like I'm supposed to eat a lot of fish sprinkled with curcumin, which I don't actually know what that is.

Speaker 1:
[02:31] The main active ingredient in turmeric is curcumin.

Speaker 2:
[02:34] Okay, great.

Speaker 1:
[02:34] Which on its own is not easily absorbed by your body.

Speaker 2:
[02:38] Uh-oh.

Speaker 1:
[02:39] Enter black pepper, specifically peppering.

Speaker 2:
[02:42] Okay, check. But then I'm also supposed to not eat food?

Speaker 8:
[02:45] The ancient practice of intermittent fasting can also help lower inflammation in the body.

Speaker 2:
[02:50] And I'm probably also supposed to buy something?

Speaker 9:
[02:53] Together, they really create this potent extract in this bottle.

Speaker 2:
[02:59] At this point, I'm like, as much as I wanted a nice, simple explanation, this just can't be real. Like, inflammation cannot be the root of all diseases. But then I came across a recent big piece by my colleague at Vox, health reporter Dylan Scott. And the science in this piece, it was really surprising to me. Because it sounds like there is something to the idea that chronic inflammation may be behind many of the diseases of modern life. But it also sounds like we've demonized inflammation without pausing to ask what it's good for. It's Unexplainable, I'm Sally Helm. And today, I ask Dylan Scott, what is inflammation? And what is it about the way we're living life that is causing something healthy and natural to creep further and further until it becomes bad for us? Dylan Scott, hello.

Speaker 7:
[04:17] Hi, Sally.

Speaker 2:
[04:19] All right, Dylan. I have seen many, many different TikToks about inflammation and how it's perhaps causing every single health problem in our lives. And I am curious, before you started looking into this, did you see those? Is that what sent you on this journey?

Speaker 7:
[04:35] Absolutely. I love something that's sort of at the intersection of, there is a genuine scientific question underlying all of this. This is a serious topic that a lot of well-credentialed researchers are spending their time looking into. But at the same time, it's sort of infiltrated the wellness influencer subculture that defines so much of how we talk about health these days. And it has become a catch-all culprit for a lot of different health conditions. And you've also got people out there talking about diets or supplements or some kind of other interventions that you can take to try to reduce your quote unquote inflammation.

Speaker 2:
[05:19] Do you have any favorites or least favorites?

Speaker 7:
[05:22] CMOS has become a fixation for some people on TikTok.

Speaker 2:
[05:27] It sounds so specific that I'm like, okay, let's do it. Maybe it works.

Speaker 8:
[05:32] Right.

Speaker 7:
[05:32] Well, and people, they talk about it with such confidence. Like that is the weird allure of a lot of this wellness content on social media. It's because, yeah, it's quick, it's whatever, a 90-second video, it's digestible, and they're like, here, here is the elixir, the solution that will help to reduce your chronic inflammation. I think any of us would be like, well, that sounds appealing. I'd like to try that out.

Speaker 2:
[05:59] But as you've already said, Dylan, this is not just TikTok nonsense. The thing about inflammation is that there is this real body of evidence suggesting that there's something important to think about here.

Speaker 7:
[06:13] Yeah.

Speaker 2:
[06:13] So let's get into it. I actually want to start here in the realm of language, because this word inflammation, it's such a powerful word, maybe even a little too powerful, because it contains this feeling of fire, within it. And I just want to start by asking you, is that the right metaphor for inflammation?

Speaker 7:
[06:39] I completely agree with you. It's a very evocative term that gives you this image of your body being ablaze. But I do think fire is, I think, in some ways an appropriate metaphor for what inflammation does. But I think we have to remember that our relationship to fire is complicated. Like fire is certainly a destructive force at times, but it can also be a cleansing force. Like fire is natural. Even like, you know, huge forests need fire sometimes to sweep through and clean things up and allow something new to grow on top of it. And I think it's similar with inflammation, where we have a complicated relationship to it. Some level of inflammation is absolutely necessary for our bodies to function as they should, but much like fire, too much of it can start to cause serious problems.

Speaker 2:
[07:36] I do feel like I need to ask a kind of basic question before we go much further here, which is, Dylan, what is inflammation?

Speaker 7:
[07:44] In essence, inflammation is your immune system going into attack mode and either sending immunity cells or other kinds of chemicals that your body can release to try to get rid of some outside invader that your body perceives as having infiltrated it and wants to get rid of to keep you healthy. And so obviously, if that outside invader is a cold virus or the influenza virus or some bacteria or something like that, like that's what we call acute inflammation. And that's, you know, that's something that we've known about for ages, even like ancient doctors knew that like the body goes into some kind of response when you get sick.

Speaker 2:
[08:28] And it's like, okay, great. Yes, get it gone. I don't want that in there.

Speaker 9:
[08:31] That's exactly.

Speaker 7:
[08:31] I mean, yeah, for this kind of acute inflammation that we're talking about in response to a virus or bacteria or a wound, you know, back in the ancient times that you might have gotten on a battlefield or something, the red skin or puffy skin that can surround a wound, and it can be painful, it can feel hot. But at the same time, that is your body responding to a problem and trying to fix it. And so, I mean, my sense is that the word developed because it has these literal associations with heat. But I do think it's created this problem unintentionally where it just sounds like something negative. Inflammation sounds like something that you want to get rid of. And it certainly put me in a different mind space when I learned that, oh no, inflammation is your body repairing itself. That sounds positive, but it's not maybe where your mind naturally goes when you hear the word inflammation.

Speaker 2:
[09:27] I mean, and what you're saying, cold virus, wound, we've felt and seen that. I can imagine my throat being swollen if I have a cold. But the scary thing is that it sounds like there's this secret other inflammation that can happen where it's just like invisible, microscopic in your whole body. Tell me about that. Is that the bad one?

Speaker 7:
[09:49] So as one of the scientists I talked to for my story put it like, every cell in your body can experience inflammation.

Speaker 2:
[09:56] Oh God.

Speaker 7:
[09:57] A lot of that inflammation, to your point, is happening at the molecular level that we're never going to be able to perceive with our own eyes. But even there, even with this invisible type of inflammation, there's a good kind and there's a bad kind. So once again, it's more complicated than you might think. There's first what scientists call homeostatic inflammation. This is basically like your body doing routine maintenance. Like your cells, we don't like to stop and think about this, but they're degrading slowly over time. Your body's stepping in all the time to make repairs.

Speaker 2:
[10:33] And I'm even thinking like, I guess if you like lift weights or workout or something, like, do you...

Speaker 7:
[10:37] Exactly.

Speaker 2:
[10:38] Well, we want that. I mean, we need that type of...

Speaker 7:
[10:39] Yes, exactly. When you work out, when you lift weights, your muscles tear, they're injured basically. And part of the reason that you get stronger is because then inflammation takes hold, it repairs those muscles and it repairs them back stronger than they were before. I mean, that's the essence of strength training. So that is exactly, that kind of inflammation at the invisible level, that's desirable. That's just a part of your body functioning as it's supposed to. The third kind of inflammation and this other kind of invisible inflammation is what we're concerned about and I've come to think of it as this like chronic, low-grade inflammation that is above those routine maintenance levels, that is not like sort of your body's normal homeostatic state of being. And that kind of inflammation, which can persist over a long period of time, is the kind of inflammation that scientists and physicians are worried about that we're beginning to realize can be associated with a wide range of health problems.

Speaker 2:
[11:41] All right. So I'm just recapping. Inflammation happens when your body goes into like defense mode and your immune system sends blood containing like chemicals to help fight pathogens or heal a wound. And I can imagine why blood flowing to an area could lead to redness and swelling and heat and all those things. But it sounds like the concern is that being in constant defense mode like this can actually cause its own problems. Yeah. And that is chronic inflammation. And okay, honestly, Dylan, I can see why it is a concept that people are gravitating towards. Because it's just like something in the world is leaving us in this constant state of being a little bit agitated and like a little bit overheated. And that just kind of feels true to me. But I want to dig in on whether it is true. Like what, what is going on here? So tell me first, like what causes chronic inflammation?

Speaker 7:
[12:46] So I do think that your idea of sort of our bodies being agitated is really appropriate because there is increasingly evidence that it is modernity itself, our industrialized lifestyles that are at least contributing to this rise in chronic low-grade inflammation that leads to chronic health problems over time. It was easily the most interesting thing that I learned in reporting out this story. I mean, if you think about human beings and our immune system, like those are things that develop over these really long timelines, tens of thousands, hundreds of thousands of years. When you think back to hundreds of thousands of years ago, when modern humans were developing and their immune systems were evolving, we didn't live very long. So any kind of problem of, well, your inflammation is starting to slowly increase over time had a pretty finite endpoint if you're not living past 40, it's not really going to become that much of a concern. And at the same time, we were living in a world where there are all kinds of pathogens out there, there are viruses and bacterias, as well as physical risks that our body is confronting all of the time, and we didn't have any kind of medical interventions to try to address it. So basically, our immune systems evolved for pretty short lifespans compared to how long we live today, and a really high infection risk compared to what we face today. An unfortunate byproduct of our longevity is that our bodies do experience more inflammation over time.

Speaker 2:
[14:25] I mean, and that's interesting, just to pause you quickly, Dylan, because that is kind of another example of like, it sounds bad, but maybe it's good. Like in that explanation of chronic inflammation, it's like, well, it's a trade-off for a longer life.

Speaker 7:
[14:37] Yeah, there's a lot of these things, all kinds. Honestly, Sally, like all kinds of chronic health conditions are at least in part a by-product of the fact that we live longer and our bodies just have more time for these problems to develop.

Speaker 2:
[14:55] Okay, I am hearing you that aging is a part of what's going on here, but can you go back to what you were saying at the beginning about the role that modernity might be playing here?

Speaker 7:
[15:07] So, there does seem to be this role of industrialization, you know, pollution, changes to our food production that is also playing a role in driving this chronic inflammation problem in addition to aging. We don't face nearly as many infection risks from like viruses or bacterias as we used to because we have modern sanitation and modern hygiene, but we are still being like exposed to all kinds of stuff like pollution and synthetic chemicals in our clothes. And our immune system's natural response to that is to kick in the inflammation and try to respond to it. But the thing is like, it's not necessarily that there's like a virus or bacteria or this sort of like short term health problem that our inflammation is able to respond to and then resolve. Instead, it's just this, you know, this this miasma that we're living inside of, that we're being exposed to all the time. And I do think it kind of not just agitates our immune system, but it causes our immune system to go a little bit haywire.

Speaker 2:
[16:12] Wow. Okay. So this is getting complicated, Dylan, because I think what you're saying to me is that we already talked about those two types of kind of systemic inflammation. One helps us stay at homeostasis. It like helps us kind of just respond to the stuff that's coming at us all the time and heal and move on. And one is like chronic inflammation, this like slightly elevated, but it doesn't need to be type of inflammation. And that one can cause disease, can cause all kinds of trouble. And it sounds like what you're saying to me is that like, maybe in the evolutionary past, it would have been one and now it's the other. Like in the evolutionary past, this type of inflammation would have been necessary. Like we would have been fighting all these pathogens. So heating up a little would have killed the bacteria and we would have moved on. But now it's almost like we're heating up a little, but it doesn't kill the plastic piece or whatever that's floating in our body. The plastic piece or whatever is just in our body.

Speaker 7:
[17:15] And you're continually being exposed to it.

Speaker 2:
[17:17] Right. Yeah. So it doesn't solve a problem. It just leaves us in a sort of slightly agitated inflamed state and then that causes other problems. That's what's going on?

Speaker 7:
[17:28] Right. And I mean, I think like thinking about the food supply in particular is maybe helpful here. Like to simplify a very complicated story, like our food production has completely changed like within the last century. Like if we're talking about these long evolutionary timelines for our immune system to adjust and adapt, like we have we have sent a shock to the system just in like the last hundred years with the advent of you know, mass agriculture and things like ultra processed foods. And when you think about the ways that this kind of chronic low-grade inflammation continues to persist, like every day you're eating some kind of, you know, maybe even despite our best efforts, you're eating some kind of new ultra processed food or you're eating more sugar than is naturally healthy or maybe more fat, especially if you live in the United States. And so your body goes into this response to try to do something about it. But like, how can, there's nothing to resolve. The next day, you're gonna eat something again that's once again gonna continue to perturb your immune system and start these inflammatory responses. And so, yeah, it's like, you can't escape it. Like we live inside of modernity. Like you step outside and there is like air pollution. You, you know, like look at our clothes and they have these new synthetic chemicals that do inevitably seep into our skin and into our bodies a little bit. And then especially with food and food processing, like there's just this constant exposure to things that your immune system doesn't recognize and doesn't know what to do with and thinks that it wants to get rid of, but it never can because that exposure is continual and constantly renewed. And so I think that's, I hope that's sort of a, a helpful way of thinking about how like your body is doing something that's natural in response to these unnatural exposures, but it's sort of an endless cycle, an endless loop that continues to drive this inflammation over time, and eventually does lead to tissue damage and some of the more serious health problems that we worry about.

Speaker 2:
[19:36] Yes. I mean, I have heard of absolutely one million things that seem to be caused or worsened by inflammation. Like the range is huge. So what do we actually know about whether inflammation is contributing to all of these diseases and health problems?

Speaker 7:
[19:55] Yeah. So I do think it's important to pause and say, this is where a lot of science is happening right now.

Speaker 2:
[20:02] After the break, Dylan tells me about the work that is happening to find the line where healthy cleansing fire turns dangerous.

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Speaker 2:
[21:57] All right, so Dylan Scott told me, the science on this is evolving, but some serious health conditions do seem to be at least associated with chronic inflammation.

Speaker 7:
[22:09] There's heart disease, cancer, diabetes, Alzheimer's and dementia. Those are, I think, the most studied and the most commonly cited ones. With something like heart disease, there does seem to be a pretty clear relationship, but this picture is still coming into focus. Oftentimes, there is a question of, is inflammation causing this chronic health problem, or is inflammation a symptom of this chronic health problem that's being driven by other factors? Mechanistically, which direction are things moving? Is it time something that scientists are still in the midst of figuring out and can be murky to them even? So I want to be clear about that. But on a variety of things, there seems to be a pretty strong relationship. I do think that's why, for totally natural reasons, people hear that and they're like, okay, what can I do to prevent that and get rid of this thing that's going to cause me all of these problems?

Speaker 2:
[23:10] But it's interesting. I mean, we're back in the quagmire. We've been in the whole time because you're also saying, we still don't totally know when it's a symptom of disease and when it might be tipping into this chronic inflammation that causes disease. I mean, Dylan, how can I sort that out? How can I know when it becomes chronic inflammation?

Speaker 7:
[23:30] Look, it's a great question and we know at certain extremes, like if you have an enormous amount of some kind of inflammation-related biomarker, that probably means there's an underlying problem. But we're still in the process of establishing baselines for what's normal. There's something called immune monitoring programs at major health systems around the country. And basically, what they are trying to do is establish those baselines, collecting samples from all kinds of different people, collecting them from people over time, from people before they got sick, while they got sick, after they got sick, to try to just figure out at the most basic level what is normal, and what is normal for different kinds of people. If you went into your primary care doctor right now and said, what's my inflammation? I think they would just look at you like, huh? What are you talking about? And you probably wouldn't even necessarily think to ask that because all of this is so new in a lot of ways. But it does seem possible that we're working towards a future where we figured out the right things to measure to gauge your chronic inflammation. We've figured out the right baselines against which to judge or whatever we're able to measure. And it could be that in the future, you get an inflammation score that's similar to your blood pressure reading, or your cholesterol level, or your blood sugar, or something like that. The folks who are working on those programs today, that's the future they're envisioning and trying to work towards. But the work is still in progress. We aren't there yet. Right now, with a lot of these, and you'll see them hawked sometimes on these social media feeds of inflammation tests or something like that. Yes, we have gotten to the point now where if certain kind of proteins are associated with inflammation, but being able to interpret that information and saying whether this is good, whether this is bad, and what we do about it, that's much murkier as the science stands today. But trying to sharpen our understanding is work that a lot of inflammation scientists are doing right now.

Speaker 2:
[25:37] Wow, that's so interesting. So it sounds like we're kind of in like number soup world where it's like we can measure some stuff, like we can know what the proteins are and whether they're elevated, but we don't necessarily know what that means.

Speaker 7:
[25:49] I do think one of the things that a scientist said to me was like, I can see a future where measuring your inflammation is a way to get ahead of health problems that are sort of asymptomatic, at least for a long time before they get really serious. So that, to your point, sounds super appealing to me if it's like we can now have this indirect measure of things that are going wrong in your body before you ever sort of feel or notice them naturally going about your day. That seems like the ideal for early intervention, which we know usually leads to better outcomes. But we're still in the process of refining our understanding to be able to do that.

Speaker 2:
[26:32] So the hope is that this will become something almost like cholesterol or something, where you can go in, you can measure it, you can get a number, and then you can take some sane and reasonable steps to address that number. Maybe that helps you prevent future health problems.

Speaker 7:
[26:47] Yes.

Speaker 2:
[26:48] That sounds great.

Speaker 7:
[26:49] I should say, we do know things now that can help to improve your inflammation. It's just like the most basic health advice in the world. Yes, Dylan.

Speaker 2:
[26:57] Cut through the fog for me. What can I actually do? Do I need to wrap a tumeric supplement in sea moss and then intermittently fast while I only eat that? What should I be doing here?

Speaker 7:
[27:08] Look, it's the old standby, Sally, of eating a healthy diet and especially eating a diet of whole foods, vegetables, fruits, things like that, exercise, stress, things like that, that can perturb your immune system.

Speaker 2:
[27:23] You know, it's funny, Dylan, that makes me think, do you think it's possible that we're causing more inflammation by stressing about inflammation?

Speaker 7:
[27:32] I would make, yes, it makes some sense. I mean, I'm not a doctor, but yeah, I mean, it's this funny thing where it's like, I think that brings us back to the top of our conversation where it's like, there are, you know, there are these tests, there are these measures that you can take to try to assess the state of your inflammation. And there's a lot of unscrupulous people who are willing to sell those to you and who are presenting more confidence about what you can understand from those measures than like actual scientists who work on this would say is appropriate. And so I do think just the whole universe of inflammation testing, of interventions or tonics like CMOS, like that's, that's I think what arises in this gap between we know there's something going on here and we're understanding it more by the day and like people wanting like an answer right now. And I think what these scientists worry about is like people either trying out these approaches that are unproven and may just be pointless and not lead to anything, or obviously, God forbid, like you have some kind of other health problems arise from whatever you're trying to do to address your inflammation. Like this is in a way, I think one of the more underappreciated stories about modern medicine in general, which is like our ability to detect things often outpaces our ability to interpret them. That's true not just for inflammation, but for all kinds of things because we have developed these amazing technologies that can detect things at the cellular subcellular level. But you have to detect things before you can then create a working understanding of what's going on with them. That often obviously takes a lot of time and failure and refinement. And so, we're in the middle of that story right now where it's like people are rushing in to provide answers that are beyond what science has actually learned and figured out yet.

Speaker 2:
[29:35] I thought what I was doing, when I looked at all those inflammation TikToks, was seeking out a simple answer in a complicated world. And I thought Dylan would probably school me on that, like remind me that there are no quick fixes here. And he did. But after our conversation, I also realized that another thing I was doing, and that I think those TikTokers are actually doing, is nurturing a very legitimate hope. That chronic inflammation really does have a lot to teach us about why we sometimes feel so bad living in this very weird world that we've built. It's a mistake to think that one supplement will solve all our problems, but I think it's also a mistake to ignore the promise here. We just gotta make sure that our legitimate hope doesn't make us try to leap too quickly to the end of the story. We are actually still in the middle, and we need to stick it out so that we can really earn whatever revelations are coming at the end. This episode was produced by me, Sally Helm. It was edited by Lyssa Sowep, with help from Joanna Salataroff. Mixing and sound design from Christian Ayala. Fact checking from Melissa Hirsch. Meradith Hoddinott runs the show. Amy Padula and Noam Hassenfeld are Kirk Human and Pippurine. And Byrd Pinkerton listened to the beak beeper as it started beeping more and more. And then she noticed something off about the overhead lights. One of them was facing the wrong way. Thanks as always to Brian Resnick for co-creating the show along with Byrd and Noam. If you have thoughts about the show, please send us an email. We are at unexplainableatvox.com. We really do read every single email and we love hearing from you. So please write to us. You can also leave us a review or a rating wherever you listen. Or you can just tell people in your life about the show. If you're into supporting the show and all of Vox in general, join our membership program. You can go to vox.com/members to sign up. Unexplainable is part of the Vox Media Podcast Network and we'll see you next time.

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