Facilitated

Infected & Inflamed: The Smoldering Forest Fire vs A Blowtorch

• The Facility Denver • Episode 4

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Dr. Mitchell and Kate discuss the critical difference between healthy immune reactions and chronic inflammation, explaining why many patients struggle with being both "infected and inflamed" simultaneously.

• The ideal immune response creates a targeted "blowtorch" of inflammation toward threats before returning to homeostasis
• Most people in Western societies live with a chronically elevated baseline of systemic inflammation
• This elevated inflammation makes it harder to effectively fight new infections
• Diet represents one of the biggest leverage points for addressing chronic inflammation
• Gluten and dairy are common inflammatory triggers removed during initial treatment
• Food sensitivity tests provide limited value compared to structured elimination diets
• Patients sometimes develop new food sensitivities after healing, indicating improved immune efficiency
• Anti-inflammatory supplements must be used strategically, not indiscriminately
• Treating chronic conditions requires respecting an "order of operations" rather than attacking all inflammation
• Focusing on promoting immune balance is more effective than simply suppressing inflammation



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Mitchell:

Welcome to Facilitated, where we bring you real stories, strategies and science from the world of functional medicine. I'm Dr Mitchell Rasmussen, a functional medicine practitioner.

Kate:

And I'm Kate Daugherty, a certified nutritionist. We are the owners of the Facility, a functional medicine clinic here in Denver, Colorado.

Mitchell:

We help people improve their biology and get out of their own way. In my view, our work is about getting to know the person with the condition much more than it's about understanding which condition the person has. As I always say, diagnose the biology, not the disease.

Kate:

On this podcast we break down complex health topics, share real patient cases anonymized, of course and explore cutting-edge wellness strategies so you can make informed decisions about your health. Quick heads up before we dive in this podcast is for education and general information only. We're here to share insights, not to diagnose or treat. So if you're dealing with a health issue, chat with a qualified healthcare provider before making any changes. All right, let's get into it.

Mitchell:

Good day, good morning, good evening.

Kate:

Good morning. Good morning to Mitchell is a whole different time zone to me.

Mitchell:

I've been getting up at seven, all right time zone to me. I've been getting up at 7.

Kate:

Alright.

Mitchell:

Going for my morning walk just because you've been working since 4.30.

Kate:

Mm-hmm.

Mitchell:

I would say the longer we're in practice together, the closer our circadian rhythms have gotten.

Kate:

Oh, is it like the menstrual cycle phenomenon?

Mitchell:

No, I mean it used to be essentially the opposite, and now I mean I get here around 8 on Fridays. That's pretty good.

Kate:

One out of five yeah 20% right.

Mitchell:

Is that the math?

Kate:

What are we?

Mitchell:

talking about today.

Kate:

I think we should get into something we say a lot but we haven't spent a lot of time explaining, and that is this idea of infected and inflamed.

Mitchell:

Well, typically when we think about inflammation, it's the body's goal or strategy to get rid of an infection. So you're saying that people can be both.

Kate:

I think people find themselves stuck with both.

Mitchell:

That is actually quite common with the people that we see. The way I like to think about it and explain it is number one. I'll say this I've done five years of immunology training and I probably don't know very much about it. I don't even know if immunologists know that much about the immune system.

Mitchell:

I think I went through what say that again I'm not even sure if immunologists know much about the immune system and that's not a slight whatsoever. It's more about how complicated and complex it is. I probably went through a period of time five years ago with a little bit of that Dunning-Kruger effect where I knew just enough to think it was fascinating but also simple. The more I learn, the more I'm realizing how complicated it is. But I do think that there are some common threads that can be leveraged with the patients we see. So when we say infected and inflamed, essentially your body is supposed to create an inflammatory burst. When there is an infection or an injury in a tissue cascades a bunch of protein signaling where the body can essentially create a burst of white blood cells and T cells. And we've got multiple arms of this immune response with the ultimate goal of saving you, creating the burst, and then the hope is that you will come back down to homeostasis. I would say the problem is and we saw this big time during COVID the baseline level of inflammation of the people in the Western world is quite high. Your ambient level of inflammation is quite high Chronic stress, poor diet, sleep disruption, lack of human connection, various nutrient deficiencies, disruption, lack of human connection. Various nutrient deficiencies, pesticides and plastics, household chemicals that muck up the system All of these are not really programs that we've evolved to detoxify and get rid of. So we're naturally living with a higher baseline level of inflammation and then we get something like a upper respiratory virus and our body is simply already flamed out too high to where the new inflammation from that illness creates a cascade of events that leads to serious injury, illness or death. We know the less inflamed you are going into an illness, the more likely you are to get out of it safely. One of the reasons I believe that we saw vitamin D deficiency and COVID being so tightly linked linked. Some studies showed that maybe 80-ish percent of the people that were in the serious COVID category had quite deficient vitamin D. And we know vitamin D on one arm cranks up the immune system to respond to threats, but it's also very tolerogenic where it calms inflammation on the adaptive arm. So we can have the initial innate response to the infection and then the goal is to get over it and calm back down. How I describe it to a patient who comes in with fatigue and insulin resistance and elevated LDL and maybe an Epstein-Barr virus, some sort of herpes infection and they're struggling to get over. It is what we want is your body creates a blowtorch of inflammation toward the threat and then it comes back to homeostasis, and then it comes back to homeostasis. But most of the people, because of everything I just explained, are living with a smoldering forest fire of inflammation it's nonspecific, it's systemic and it's chronic. So when that threat comes, the body is either too ramped up fighting all these other fires, or it's exhausted from all of that work so that it cannot adequately resolve that pathogen that it's encountered. We want a three to five day response followed by homeostasis. That is the goal of the response to infection.

Mitchell:

But what do we see? This baseline level of inflammation a massive arm, I would say is. We mentioned stress, but it's diet. And, kate, you recently made a post about food not being medicine. But it could be, but it could be your poison. And essentially, I think what you're getting at is this idea that when an immune system is trending toward a reaction to a protein in the diet, that will become an independent driver of body inflammation. That will burden the system, leave it more likely to create autoimmune disease and also make it more difficult to heal from the variety of threats that we're facing. What kind of foods do you see? Do that typically with our patients.

Kate:

Yeah, so I was going to say most of these patients. They'll be in front of us and I don't think that all of them have an immune problem with gluten or dairy, but those are the two proteins that I absolutely take out. In this phase of, we have to limit as many inflammatory triggers as possible, and gluten and dairy are the easiest targets for that.

Mitchell:

What you put in your mouth is probably the biggest leverage point for your chronic inflammation. You can look up this idea of molecular mimicry. We've written a blog about this. It's a pretty well-known topic. But essentially, if your immune system is engaged with a food protein that it deems is antigenic, every single time you interact with that protein it will cause immune stimulation. And this is absolutely a part of this chronic inflammation, chronic infection piece. If you are eating a food protein like soy that you have a reaction to twice a week even, you might tell me well, I'm 90% soy free or dairy free the immune system is not reasonable in the sense that it's going to say, oh, this time I won't react to it. It will react stereotypically to any thing it deems as deems as a threat every single time. So if you're coming into us with chronic inflammation, chronic infection, the first lever point, besides stress management and parasympathetic activation, will be an elimination of the most obvious food targets. Is this when we would run a food sensitivity test?

Kate:

Never. Why is that? Food sensitivity tests really don't give us much information beyond? Are you tolerating what you're eating? And we can already make that assumption with this patient population. So instead, that's where the elimination diet is really the gold standard. Let's take out gluten, dairy soy, sometimes eggs, absolutely sugar, alcohol, and then we can very specifically reintroduce these once you're out of this inflammatory storm and see where your tolerance to those proteins lies.

Mitchell:

And an interesting thing that we see with the chronically inflamed population I mentioned a few minutes ago. Sometimes the system becomes so burned out from these chronic threats that we will actually have people. We take out gluten for 45 days and they never thought they had an issue with it. They just maybe had some dermatitis and joint pain, never, ever a gut issue. When we add, add it back in, they'll tell us wow, I never reacted to it and now I can't tolerate it. And I typically get happy for them because I view that, as your T cells have improved their efficiency to respond, they are now showing you the response they were always trying to have. But the system was so burned out that it essentially couldn't keep up with all the threats that it was being handed. So I view that response as potentially a sign of improved efficiency within the immune system.

Mitchell:

I wish I had a womp womp sound effect it is sad for the people, but the light bulb moment comes when they add it back in and they realize well, you've only gotten healthy over the last two months and now your body is showing you this. So be thankful that your body is so swift at responding to threats. Now, with this infectious idea, this is where I get a little nervous about taking too many natural anti-inflammatory substances or antioxidants when you're infected. We want to help starve the body of something called NF-kappa B, which we could talk about later, not today. Nf-kappa B is actually part of what viruses use to hijack cellular machinery to replicate NF-kappa B I call the kindling of inflammation. It's actually a transcription factor within our genes that helps activate proteins that assemble to create inflammation. So you'd think starving the body of it would be a good thing Absolutely.

Mitchell:

To a certain point, too many antioxidants on board can actually tilt the scales the other way, to where we can no longer respond.

Mitchell:

So we might be getting less inflammation, but that's actually going to drive more an infection, and one of my mentors, Dr Sam Yannick, has taught so much about this to us this idea that there's an order of operations when we have inflammation and infection. Pull out the obvious threats, get the person sleeping, get the person eating in a congruent way with their biology and then work typically on creating these what are called Th1 immune responses, where we can actually respond to these threats internally while at the same time maybe some simple antimicrobials if they have a gut infection or a sinus infection or a chronic UTI. It's amazing how many people walk around with urinary tract infections and they don't know it. Remove those threats, but let's not think so much about dampening inflammation across the board. Let's work on getting their body to kill things and then we can come in and promote tolerance so that we can come back to this homeostatic balance of less inflammation, less infection.

Mitchell:

You will burn out if you just attack inflammation when you're inflamed and infected. And this is where I get frustrated with this natural medicine world where it's all about anti-inflammatories and antioxidants. We need to be thoughtful with that. It is not it works for everyone type strategy. It has to be personalized to you.

Kate:

And it's not. More is more. In that case, I'm specifically thinking about turmeric. People just want to. Oh, it's good for me, let me take as much as I can, and it can get them into a sticky situation, or even vitamin D.

Mitchell:

Sometimes we will see your blood level of vitamin D is 22, and that might not be my first place to attack If you have chronic infection. I might go after the T cells a little bit before we're actually thinking about filling up the reserves of vitamin D, even though we know that that will be a part of your plan. So infection and inflammation big issue in our patient population Please don't get carried away with all these anti-inflammatories. You have to respect the order of operations, respect the fact that we know very little about the immune system, even though I will spend the rest of my career trying to understand it and please realize big levers get pulled first. We have to create a state of balance in the immune system before we can really go after killing this idea of inflammation as a bad guy.

Kate:

And that's a wrap for this episode of Facilitated. If you enjoyed it, hit subscribe because, let's be honest, you'll forget otherwise. And if you really loved it, please leave us a review. Not only does it make Mitchell feel warm and fuzzy inside, but it also helps more people find functional medicine without falling into a Google rabbit hole. For more about what we do at the facility, check out our website, wwwthefacilitydenvercom. You can also follow us on Instagram at the facility Denver for extra tips behind the scenes, fun and updates on new episodes. Thanks for listening. Now go facilitate your own health and we'll see you next time.