B (3:01)

What is happening on a cellular level

A (3:02)

during inflammation, there's different types of blood cells in the immune system that are sent to the area of injury Such as lymphocytes, neutrophils. And there's also inflammatory mediators that are also released that can help the repair process. We call these cytokines.

C (3:25)

I remember hearing a lot about cytokines during COVID Yes.

A (3:28)

So that's using the example of a viral INF will trigger the immune system into releasing these inflammatory mediators or cytokines, to help fight the infection.

B (3:40)

And are there different kinds of inflammation? Because we've heard about inflammation in response to a wound, but there's also inflammation that can harm us, right?

A (3:50)

Yes. So you're bringing up an important point about the different phases of inflammation. There's acute inflammation, which is what we just alluded to with injuries, infections and so forth. That's the good kind of inflammation where it's short lived and it's helpful. And your body turns on that inflammatory response, it deals with the problem and then it turns it off once the healing is complete. The other face of inflammation is chronic inflammation where the inflammatory response doesn't turn off properly. And instead of resolving after the threat is gone, it can keep on going, sometimes for months or years. And it's this more persistent inflammation that might contribute to health problems.

C (4:41)

And so why doesn't it turn off?

A (4:42)

The brief answer is we really don't know. There can be different reasons depending on the type of inflammation. For example, with autoimmune conditions, where there may be certain autoantibodies, where the body manufactures antibodies against our own tissues that can perpetuate the inflammation, There can also be environmental or lifestyle behaviors that might increase the chance of persistent inflammation, such as smoking and other environmental toxins. Women tend to be more prone to autoimmune conditions compared to men in many cases. And there can be genetics involved where it runs in the family. But I don't think there's one single answer as to why the immune system goes awry like this.

C (5:36)

So you specialize in rheumatoid arthritis, which is an autoimmune condition?

A (5:41)

Yes.

C (5:42)

Could you define what is an autoimmune condition and how does it tie into inflammation?

A (5:48)

Certainly. So as you were mentioning, rheumatoid arthritis is an autoimmune condition where our immune system, which again you can think of as our alarm system, or even a security guard, if you will, mistakes its target. So instead of protecting our tissues, it targets it. And in the case of rheumatoid arthritis, it's targeting our joints and it sends its inflammatory signals, the lymphocytes, the cytokines, which are those inflammatory mediators. We just Discussed to target the joint, which can cause swelling, stiffness, discomfort, and over time, if this inflammation, inflammation is not checked, it can lead to damage to the joint. Autoimmune conditions, including rheumatoid arthritis, can be characterized by what we call flare ups, which means episodes of inflammation, episodes of pain, swelling, stiffness, and it can be caused by or triggered by psychological stress, smoking, environmental factors. Sometimes, however, it's not that simple. An autoimmune condition can just have times of ebb and flow when there's no specific trigger that can be identified.

C (7:12)

What are some other conditions that maybe aren't autoimmune conditions, but that can be caused by chronic inflammation?

A (7:19)

Chronic inflammation is increasingly recognized as a contributor for many different conditions such as cardiovascular disease, diabetes, neurodegenerative conditions and also cancer. Any tissue in the body could potentially become inflamed and systemic inflammation is just not good for one's general health. If you think about the immune system, the best state is for it to be in balance. So if there's any imbalance, for instance, in an autoimmune conditions where it's driven to sort of focus on attacking our own tissues, it's distracted, if you will, from its primary, primary objective, which is to protect our body from things that don't belong there, like infections and cancer. And that's why this persistent inflammation can lead to an increased risk of heart disease and cancer. The good news is that by controlling systemic inflammation, we've shown that we can also improve health outcomes outside of the joints, such as atherosclerosis, heart disease and cancer.

C (8:33)

Thank you, Dr. Meng.

B (8:34)

That's really helpful for understanding inflammation. Can you talk a bit about the treatment options?

A (8:40)

Prior to the late 1990s, we were treating inflammation with broader, if you will, more blunt instruments like nonsteroidal anti inflammatories and steroids, and more conventional medications that just blocked the immune system more non specifically and they would help. When more potent and targeted therapies arrived, many of them worked better and or they enhanced the effect of the more conventional disease modifying agents. The primary treatment is still those special medications that target the immune system to block the inflammation. It is very beneficial to combine these primary treatments, these immune blockers with healthy behaviors that always has the best chance for a good prognosis.

C (9:35)

What can we do to avoid chronic inflammation from a lifestyle perspective?

A (9:39)

So some drivers of inflammation can be related to obesity and the shift towards perhaps western diets high in processed foods and refined carbohydrates and sedentary lifestyles, which has been linked with more inflammation, perhaps increased exposure to industrial pollutants and some of the modern psychological stressors that can contribute to sustained inflammation. And certainly chronic sleep insufficiency has become widespread and can promote inflammation. We know that food choices that emphasize fresh fruits and vegetables and legumes and nuts and olive oil, and reducing smoking and increasing healthy sleep are all very good ways to help. If one were to look at a specific diet, then the one that has the most evidence to support it would be the Mediterranean diet. There's been recent meta analysis in 2025 that looked at over 30 studies showing that this diet can significantly reduce inflammatory markers such as the high sensitivity C reactive protein and some of the cytokines we've discussed, including interleukins. So again, shifting the overall pattern to a more whole plant based food and healthy fats, while reduc processed foods, added sugars and red meat, also increased physical activity. The General recommendation is 150 minutes a week of moderate intensity exercise or 75 minutes of vigorous aerobic exercise can reduce chronic low grade inflammation. And so sleep and exercise work together as a team. When we don't sleep well, our body's inflammatory alarm system can stay on. And when we exercise regularly, we're actively helping our body turn off that alarm and clean up inflammation.

B (11:40)

So you specialize in acupuncture. Would you talk about the benefits of acupuncture for inflammation?

A (11:46)

Yes, I'm certified in acupuncture and I found it a helpful treatment to address especially the symptoms of pain and stiffness in many of our patients with rheumatoid arthritis and osteoarthritis and other painful arthritic conditions, especially low back and neck pain. I'm familiar with the literature showing that acupuncture can stimulate endorphins which can help reduce pain.

B (12:12)

I've also heard some discussion about JLP1s helping with inflammation. Could you speak to that at all?

A (12:18)

Yes, yeah. Yes, the research is quite recent because these treatments have undergone a recent explosion of research and so it's still being looked at. But preliminarily we are beginning to understand that the GLP1 agonists, which were originally used to treat diabetes and now are being used to treat weight loss, have effects beyond weight loss that might be beneficial for people with inflammatory conditions. For instance, there have been studies that show that GLP1 medications can reduce some of the inflammatory markers that we've discussed, including those cytokine mediators. And what's interesting is that these anti inflammatory effects happen both because of weight loss and also through some direct effect on immune cells. And then certainly there have been some clinical trials showing that there are potential benefits of these GLP1 medications for other things, such as reduced risk of heart attacks and strokes and improvement in fatty liver disease, which can also be inflammatory.

B (13:29)

Thank you for being with us, Dr. Meng, and for this fantastic conversation, sharing this latest research and helping our listeners understand more about inflammation and what we can all do.

A (13:39)

I really appreciate these questions. They're so important for our listeners and I very much enjoyed our discussion.

B (13:49)

Our many thanks to Dr. Karis Meng. I'm Courtney Allison. Health Matters is a production of New York Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Meng's work with patients, check out the show Notes. New York Presbyterian is here to help you stay amazing at every stage of your life. Join us next time when we discuss joint health and how we can protect our joints as we age. That's in two weeks right here on Health Matters so you don't miss it. Be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get podcasts. Sam.