One of the most complex biological processes that human biology is privy to is inflammation. Given how important muscle is for our health, wellbeing, longevity, and quality of life, it’s impressive that inflammation was initially a background concern for people in the health, nutrition, and bodybuilding industry.
This is changing now, as many veteran athletes and coaches have begun to develop a holistic, fact-based understanding of their bodies, as well as of the underlying physiological processes that enable muscle growth. In the past, people even tried to “treat” it by taking anti-inflammatory medicine, but now we know better, as this can actually prevent the natural development of lean tissue.
The amount of available literature on the topic is enough to draw several important conclusions that will help you in your quest to attain your much-desired figure. Without a doubt, medical research has uncovered and tested enough of the inner-workings of inflammation to help coaches give sound advice to their clients.
However, particularly with veteran athletes, inflammation can become a source of concern. As you may already know, there are two types of inflammation, acute and chronic. The first is good, while the second is bad.1 It’s more than bad; it’s downright dangerous, but more on that later.
What most of us don’t know is what each of the two kinds of inflammation does to the body, how to tell the difference between them, as well as what to do to manage the first and prevent the second.
Inflammation Is Necessary for Muscle Growth
Pain, redness, swelling, heat, and loss of function are the hallmarks of the inflammatory process. As an immune response, inflammation is supposed to protect us from hostile microorganisms, while enabling our body to heal and repair damaged tissue. First, let’s take a look at how this process is helping us stay in good shape.
Acute inflammation, the good kind, is generally short lived. It comes on in a flash and its first job is to destroy any foreign bodies. Once this is achieved, the antibodies switch gears and start carrying away any residue, while repairing damaged cells.
Depending on several factors, including the size and gravity of the lesion and whether the damage is purely physical or an immune response is also necessary, this beneficial cycle of cleansing and mending can take minutes, hours or, at most, several days. You’ve doubtless experienced this sort of inflammation when you accidentally cut yourself, bruised a part of your body, were stung by an insect, but also after a hard workout. For me, supersets trigger acute inflammation like nothing else does.
Three main processes occur in acute inflammation. These are increased blood flow, increased permeability, and the migration of neutrophils and macrophages. The amplified blood flow happens due to to the dilatation of the blood vessels, the smallest of which also become more permeable so as to allow blood fluid and vital proteins to move into the interstitial space. The latter, which is also referred to as the interstitial compartment, is like a bath where your tissue cells are permanently immersed. According to their needs, the cells can exchange water and nutrients with the space around them.
Together, the larger categories of neutrophils and macrophages represent the intervention team responsible for the protection and rejuvenation of the broken tissue. The squad arrives at the site of inflammation both through blood, as well as from fibers that are adjacent to the broken ones. This is the place where your body decides whether to enter an anabolic or catabolic state.
As a trainer, this is the part that has attracted my undivided attention, particularly from the point of view of what I can do to prevent the latter process and encourage the former. I’ve come to the conclusion that, in general, building muscle in a healthy, sustainable, and evidence-based way is the coaching of the future.
At a molecular level, it seems that anabolic signals during inflammation are activated by hormones such as insulin, IGF-1, human growth hormone, and various androgens,1 which tell the muscle to start using myosatellite cells (stem cells) in order to regenerate. The process is also referred to as myogenesis.
The field of molecular biology has focused a good deal of its research potential on reverting muscular dystrophy and combatting chronic muscle diseases by means of stem cell therapy. In addition, this is the reason why taking hormones helps build muscle mass very fast, as it drives your anabolic state in overdrive.
However, as I am sure you already know, the introduction of outside hormones for the sole purpose of building mass can have a serious and substantial health impact on human physiology.
Too Much Inflammation Is Bad
Chronic inflammation, on the other hand, leads to muscle breakdown. Although it starts in the same way as its better half, instead of switching gears to regeneration and then gradually shutting down, it morphs into an enduring state.
Chronic inflammation, also called chronic systemic inflammation (SI) or low-grade inflammation, can persist for months and even years on end without an appropriate immune response to shut it down or when the source that triggered it in the first place is not dealt with appropriately. As a result, the white blood cells that flood the area (the neutrophils and macrophages we discussed earlier) eventually end up attacking good, friendly tissue.
Chronic inflammation was found to be a significant contributor to a variety of diseases,3 including asthma, sarcopenia, Alzheimer’s, arthritis, peptic ulcer, Crohn’s disease, some cancers, and many others.
In recent times, an increasing number of elderly people are trying to address sarcopenia, which is the loss of muscle mass, quality, and strength associated with aging, by paying more attention to their physical activity. We know that, for instance, physical activity can actually help the body manage inflammation better,4 whereas obesity, smoking, and a sedentary lifestyle tend to exacerbate it.
At the opposite end of the spectrum from IGF-1, which is the main regulator of muscle hypertrophy, we have myostatin. Also known as growth differentiation factor 8 (GDF-8), myostatin is a protein whose main role is to inhibit myogenesis. In humans, when someone is born with a defect in the myostatin-producing gene, their muscle mass is considerably bigger and stronger than that of their peers.5
Currently, there’s no research to indicate the long-term effect that myostatin inhibitors would have on healthy subjects or on people suffering from muscular dystrophy. However, several myostatin drugs are being developed, and one has been commercially available for at least three years. The fact that the latter has only four reviews does not inspire confidence to me, however.
A not-so-clinical observational study on recreational gym goers found that the group on the commercially available myostatin blocker did increase their lean mass as compared to the control group (almost three times more),6 but the authors acknowledged that the neural adaptation might have played a significant part in this result. They effectively did not keep track of a host of variables that apply to recreational training, and not accounting for the initial adaptation (newbie gains as we refer to them) was a big drawback of their research.
A more potent clinical trial performed on mice found enough evidence to suggest that the anabolic impact of myostatin inhibition can actually lead to more muscle damage in healthy subjects. Despite this, the adverse effects of myostatin inhibition in subjects that suffered from any form muscle dystrophy were not as great.6
This suggests that myostatin blockers will likely be recommended for those who suffer from muscle diseases that gradually weakens and breaks down their lean tissue. As is the case with hormones, messing with our physiology to such an extent without good reason is likely to have a bad outcome in the long run.
One interesting finding that I’ve come across is that creatine supplementation is actually a healthy, albeit not as effective (when compared to drugs that are designed for this purpose alone) way to decrease myostatin levels.7 Unlike myostatin blockers, creatine is not banned by WADA or other anti-doping agencies, which speaks volumes for its safety.
Stay Away from NSAIDs and Other Anti-Inflammatories
Ibuprofen, naproxen, acetaminophen, and even aspirin can be lifesavers for professional bodybuilders and athletes alike. They don’t usually resort to them just for muscle soreness, but also for other big culprits like elbow, knee, or shoulder pain. In my experience with heavy lifters and veteran bodybuilders, these pains can be as common as a sneeze.
Some don’t mind giving up on a week’s worth of training, but most people would rather take a pill and get their work done. While this may be necessary in remote cases, research shows that NSAIDs (non-steroidal inflammatory drugs that include the ones I’ve previously mentioned) actually prevent muscle synthesis.8
The main purpose of NSAIDs is to reduce the production of inflammatory and pain-signaling cells. As you may have already surmised from knowing that inflammation is a double-edged sword, these drugs work to cancel out both the good and the bad.
Some studies of elderly populations showed that these OTC medications were beneficial towards preventing muscle loss. Luckily, however, the former study performed by the Karolinska Institutet also dealt with this hypothesis.
Their conclusion was that, in cases of chronic inflammation, NSAIDs will quite often prevent age-related muscle loss, since the latter mainly happens due to inflammation gone haywire. This will not be the case when chronic inflammation is not present, though. Some even take anti-inflams prior to exercise. Needless to say that this practice is very dangerous.
When chronic SI is not present, taking pills often means inhibiting the very means that will help you achieve lean tissue growth. NSAIDs are actually cyclooxygenase (COX) inhibitors. Some of them are quite long-lasting, with effects lingering for up to 12 hours from just one dose. The problem is that COX enzymes are conductive to muscle growth, so much so that administration of COX inhibitors is detrimental to myofiber rehabilitation even after atrophy.9
These recent findings have determined many physicians to re-examine patients’ post-intervention treatment. The fact is that, if you can work through the pain and the latter is not chronic, there’s a good chance that you should do so despite the discomfort.
More importantly for all of you athletes and go-getters, using these medications to train through the pain will worsen your condition.10
And you don’t even need to be a doctor to realize what’s going on—you take a pill and push to get through whatever it is that you’re doing, but the very drug you’re taking for a short-term benefit is stopping the process that’s supposed to heal the damaged tissue. At the end of the day, instead of being able to recover in a few days, the aggravated injury will bench you for a week or more.
Opiods (such as codeine, morphine, fentanyl, methadone, oxycodone, etc.), albeit unconnected to any of the drawbacks that are associated with lack of good inflammation, can be much worse. Excessive use of the latter is significantly linked to addiction, which tends to happen in 2 out of 3 cases, as was shown by a survey of over 600 former NFL players.11
I don’t know about you, but I wouldn’t risk my physical and mental health on 30% odds, not if I have anything to say in the decision at hand.
Treat Inflammation Naturally
Body pain, constant fatigue and insomnia, weight gain, frequent infections, and gastrointestinal problems such as acid reflux and diarrhoea are common signs of chronic inflammation. If you have these symptoms, it may be a good idea to undergo some blood tests to see if you can get a better picture of what’s going on.
Although there are no highly effective lab measures for chronic SI, there are two relatively inexpensive blood markers that will show some signs if this is the case. These are high-sensitivity C-reactive protein (hsCRP) and fibrinogen. Another common examination you can perform is serum protein electrophoresis (SPE), which is still affordable.
You can try to detect specific pro-inflammatory cytokines, like IL-6, IL-8, TNF-alpha and IL-1bet, but these are not standardized and they won’t come cheap. Still, if you’re suffering from chronic inflammation, they might be worth it as the cytokines will give your more specific information about what’s causing the inflammation.
For me, the best part about inflammation is that it can be managed and reversed with diet and lifestyle changes. A meta-analysis of 40 case-controls, clinical trials, and cross-sectional studies has definitively confirmed that dietary patterns are intrinsically linked to inflammatory biomarkers.12
The foods that were found to elicit inflammation responses from our bodies are meat, dairy, eggs, alcohol, and processed, fried foods. Generally, it was those foods that had high amounts of sugar, fat, and salt that were positively associated with inflammation. On the other hand, diets that were rich in fruits and vegetables considerably reduced oxidative stress and low-grade inflammation markers.
The Mediterranean eating pattern, the DASH (dietary approach to stop hypertension) eating regime, as well as the whole-foods, plant based (WFPB) diet were the most successful at combating inflammation. This is a major reason why many athletes have switched to plant-based diets, as they were shown even by the most rigorous studies to significantly reduce systemic inflammation.13
There’s enough evidence to warrant each and every one of us to give the WFPB a try, as it has been linked to improved mood, overall health, training, recovery, and even athletic performance for a number of professional athletes.14
Do What’s Best for You
Throughout this article, we’ve uncovered some of the more complex aspects of inflammation and its crucial role in muscle building. We’ve seen how it helps to have it, how it can be detrimental to continue having it after a certain amount of time, as well as what you can do to deal with persistent, low-grade inflammation in a healthy and effective way.
An often exaggerated aspect of medicine is to treat symptomatically, an approach which continues to be prevalent in many medical systems. This means that, if something hurts, you’ll most likely take something to get you through the pain.
What we haven’t really been paying attention to and has been recently proven right is that some pain is instrumental towards proper healing. This is not to be confused with medical advice, although I do believe it is not only healthy, but necessary to question why we take certain medications in the same way I often question why we eat certain things because we think it helps with building lean tissue.
At the end of the day, it seems that some of the diet and lifestyle changes can go a long way towards dealing with the feared inflammation biomarkers, while enabling us to train better overall.
1. “Understanding Inflammation, Harvard Medical School Guides“
2. “Role of Inflammation in Muscle Homeostasis and Myogenesis“
3. “The inflammation theory of disease. The growing realization that chronic inflammation is crucial in many diseases opens new avenues for treatment“
4. “Strength Training Decreases Inflammation and Increases Cognition and Physical Fitness in Older Women with Cognitive Impairment“
5. “A Very Muscular Baby Offers Hope Against Diseases“
6. “Muscle hypertrophy induced by myostatin inhibition accelerates degeneration in dysferlinopathy“
7. “Effects of oral creatine and resistance training on serum myostatin and GASP-1“
8. “Anti-inflammatory drugs can inhibit muscle growth“
9. “The COX-2 pathway regulates growth of atrophied muscle via multiple mechanisms“
10. “Non-steroidal anti-inflammatory drugs for athletes: An update“
11. “Injury, pain, and prescription opioid use among former National Football League (NFL) players“
12. “Dietary Pattern and Macronutrients Profile on the Variation of Inflammatory Biomarkers: Scientific Update“
13. “Anti-inflammatory Effect of Whole-Food Plant-Based Vegan Diet vs the American Heart Association – Recommended Diet in Patients With Coronary Artery Disease: The Randomized EVADE CAD Trial“
14. “Six Reasons Athletes Are Running Toward a Vegan Diet“