Diabetes Forecast

How to Avoid and Fight Chronic Inflammation

Chronic inflammation is the equivalent of a persistent low-grade infection

By Kimberly Goad , ,


You stub your big toe, and within moments it’s red, swollen, and painful—all signs of inflammation. Before you can utter so much as an “ouch,” your body dispatches an army of white blood cells to your injured toe, where they release chemicals to jumpstart the healing process. Acute inflammation—the term for this particular short-term response—is a good thing, and part of the body’s natural healing process.

Chronic inflammation, on the other hand, is altogether different—and anything but beneficial. Unlike acute inflammation, chronic inflammation is the equivalent of a persistent low-grade infection: The body’s immune cells are active when they shouldn’t be, and over time that can damage the heart, trigger strokes, and cause insulin resistance. Chronic inflammation also is linked to other complications, such as damage to nerves and kidneys.

“It’s a culprit in many diabetes-related illnesses [such as cardiovascular disease and kidney problems],” says Mary de Groot, PhD, associate professor of medicine at Indiana University School of Medicine in Indianapolis and a member of the American Diabetes Association National Board of Directors. “It isn’t a specific condition but an underlying process that’s happening within multiple conditions. When you have more than one condition going on—and many folks with diabetes have different kinds of diseases happening simultaneously—there is a greater risk of inflammation. Whether it’s a cause or effect is unclear, but inflammation can be an important component.”

That explains why scientists are digging for answers. If doctors can devise medication, food, and physical activity regimens that take into account chronic inflammation—in addition to the standard focus on blood glucose, blood pressure, and cholesterol levels—then they may be able to achieve better outcomes for their patients. If people with diabetes can be grouped based on their inflammation status in addition to glucose level, then doctors can better choose the ideal treatment for their patients.

Unlike acute inflammation, chronic low-grade inflammation doesn’t typically produce symptoms. There are blood tests for inflammatory markers (certain substances that increase when inflammation is present), but doctors don’t routinely run them. There is “no reason whatsoever” to do so, says Vivian Fonseca, MD, FRCP, professor of endocrinology at Tulane University School of Medicine. “They don’t tell you that you’re going to get diabetes,” he says. And there’s no course of treatment for chronic inflammation, beyond losing weight. “If you lose the weight, inflammation goes down. If you don’t, the inflammation is going to be chronic.”

For now, there are more questions than answers about the link between inflammation and type 2 diabetes (but not type 1—that involves acute inflammation in the pancreas). Here’s what scientists know so far about three major risk factors:


Research shows that excess body fat is linked to chronic inflammation—especially when it’s concentrated in the abdomen. That’s because inflammatory markers such as C-reactive protein (CRP), tumor necrosis factor alpha (TNFa), and interleukin 6 (IL-6) like to park in the visceral fat found there. “Inflammation is best associated with gaining weight,” says Steven Shoelson, MD, PhD, professor of medicine at Harvard Medical School and associate research director of the Joslin Diabetes Center in Boston. “If you compare people who are obese to those who are lean, you’ll see evidence of inflammation that’s almost assuredly a reflection of what’s happening in the adipose [fat] tissue itself. It contracts and expands as you lose and gain weight.”

Some believe following a diet packed with certain foods, such as vegetables, whole grains, healthy fats, fruits, andnuts, can help reduce inflammation. The American Diabetes Association’s 2017 Standards of Medical Care in Diabetes suggests a healthy diabetes eating plan rich in these sorts of nutrient-dense foods and low in added sugar and saturated fat. But there’s no evidence specific foods will reduce inflammation, unless they’re part of a weight-loss plan, says Edward Horton, MD, professor of medicine at Harvard Medical School and senior investigator at the Joslin Diabetes Center. “Inflammatory markers come down with weight loss,” he says.

Physical Inactivity

Research shows that regular exercise can act as a potent anti-inflammatory. Here’s how: During a bout of exercise, your muscles release inflammation-fighting molecules into your bloodstream. At the same time, the production of a pro-inflammatory marker involved in insulin resistance is suppressed. The combination reduces inflammation, says Bente Klarlund Pedersen, MD, DMSc, professor of integrative medicine and director of the Centre of Inflammation and Metabolism and Centre for Physical Activity Research at Rigshospitalet and the University of Copenhagen in Denmark.

That’s not all. “In addition, indirect anti-inflammatory effects of long-term exercise are brought about through improvements in body composition,” says Pedersen, lead author of a 2015 study in Current Diabetes Reports that showed the inflammation-reducing effects of lifestyle changes such as regular exercise. “Exercise training leads to a decrease in the amount of visceral fat found in the abdomen, which is more inflamed than subcutaneous [just under the skin] fat.”

What sort of exercise regimen might work best? The focus on aerobic, strength, and balance/flexibility activities recommended by the ADA’s Standards of Medical Care in Diabetes is a good place to start. Aim for 150 minutes or more per week of moderate to vigorous physical activity (brisk walking, bicycling, or playing tennis, for instance). Spread it out over at least three days, and go no more than two days in a row without some sort of activity. Also do two to three sessions per week of strength training, such as lifting dumbbells or using resistance bands. And do two sessions focused on flexibility and balance, such as tai chi or yoga.


Researchers are in the early stages of understanding the connection among inflammation, diabetes, and depression. Almost 1 in 3 adults with type 2 diabetes experiences depression profound enough to negatively impact their blood glucose levels, increase the severity of diabetes complications, lower their ability to stick with self-care regimens, and increase their risk of early death. A study published in a 2013 issue of the Journal of Psychosomatic Research suggests that inflammation is the likely culprit.

“We looked at four groups of people: healthy people who had neither diabetes nor depression; people who had type 2 diabetes; people who had depression; and a group who had both diabetes and depression,” says Todd Doyle, PhD, an assistant professor at Loyola University Medical Center in Maywood, Illinois, and lead author of the study. “What we found was that the people in that combination diabetes and depression group had the highest levels of [inflammation].”

Other research suggests that successfully treating depression in people with type 2 diabetes—through psychotherapy and/or antidepressants—has a surprising side effect: It reduces inflammation. “When we treat depression, we can reduce inflammation, as well as improve glycemic control,” says de Groot. “Antidepressant medications don’t work on the inflammatory system directly, but they do have an impact on reducing inflammation by treating the depression. It’s a byproduct of treating depression.”

Researchers aren’t sure why, but they have a couple of theories: One suggests that treating depression may reduce the production of a specific inflammatory marker (interleukin-1) and therefore reduce inflammation.Another theory centers on stress. “Many studies have demonstrated that there are greater levels of inflammation when we feel stressed,” says de Groot. “Whether it is the direct result of changes in brain chemistry or the reduction of stress when depression is treated, we have some good reasons to believe that the treatment of depression has the potential to reduce inflammation.”

Are Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) an Option for Reducing Chronic Inflammation in People With Diabetes?

No. “[NSAIDs] will suppress the inflammation, but they all have side effects,” says Vivian Fonseca, MD, FRCP, professor of medicine and chief of endocrinology at Tulane University School of Medicine. “The classic anti-inflammatory is aspirin, but you need to take a lot of it to suppress the inflammation. It’s too risky to take the amount of aspirin you need to suppress inflammation.” Your doctor may prescribe a daily low-dose aspirin, however, to protect your cardiovascular system.



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