Integrated Approach to Reducing Low-Grade Chronic Inflammation

by luciano

(Low-grade chronic inflammation is not a disease in the strict sense, but a persistent biological state that promotes the development of numerous chronic conditions. This document proposes an integrated approach aimed at modulating it through lifestyle.)

Furthermore:
In the absence of unique and definitive solutions, the most rational strategy for reducing low-grade chronic inflammation consists of adopting a lifestyle model that minimizes exposure to potentially pro-inflammatory factors* and promotes protective ones.

The importance of low-grade chronic inflammation

Although intermittent increases in inflammation are essential for survival during physical injury and infections, recent research has revealed that certain social, environmental, and lifestyle-related factors can promote chronic systemic inflammation, particularly low-grade chronic inflammation (LGCI), which in turn may lead to several diseases that, taken together, represent the leading causes of disability and mortality worldwide, such as cardiovascular diseases, cancer, diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease, and autoimmune and neurodegenerative diseases.
(see article: https://glutenlight.eu/2025/08/21/infiammazione-cronica-basso-grado/)

This type of inflammation has multiple triggers:

Gut dysbiosis:

Alteration of the intestinal bacterial flora, which may be caused by an unbalanced diet, excessive use of antibiotics, or other toxic substances.

Unhealthy diet:

Excessive consumption of processed foods rich in refined sugars and saturated fats, which can promote inflammation.

Stress:
Chronic stress can negatively affect the immune system and increase susceptibility to inflammation.

Environmental pollution and toxins:

Exposure to chemicals present in the environment or in foods can contribute to oxidative stress and inflammation.

Smoking and alcohol:

These factors can aggravate oxidative stress and damage cells, promoting inflammation.
(see article: Oxidative stress)

Among the triggers, drug use is not mentioned because drugs are always and in any case considered to be avoided.

The integrated approach must necessarily involve the individual in all aspects of life. This is the central point: a lifestyle model must be “built.” And this model must be personalized.

Another consideration concerns the individual’s general health status, which should primarily remain “healthy,” that is, free from diseases, trauma, wounds, etc., which activate acute inflammation.

It is important to emphasize that, in the presence of acute inflammation, the biological markers used to assess low-grade chronic inflammation appear elevated, making it difficult to distinguish between the two phenomena and potentially masking improvements in LGCI.

With these clarifications, we can begin the integrated approach.

1 – Stress management

This is a very important factor, considering emerging scientific evidence regarding the gut–brain axis, a bidirectional communication system through which psychological stress, emotions, and mental states influence intestinal motility, barrier permeability, and microbiota composition, and vice versa. Alterations of this axis can promote inflammation, digestive disorders, and metabolic imbalances.
Stress should be managed either independently using available techniques or, if not possible, with the help of a psychologist.

2 – Environmental pollution (air, water, etc.)

It goes without saying that the more we can avoid it, the better. This factor is relevant to oxidative stress.

3 – Nutrition: here we can do a lot

Important point:

Diet must be strictly correlated with age, type of activity, eating habits, and general health status.

Foods to avoid

  1. Industrial foods: contain additives that, if taken occasionally and individually, do not cause problems, but if combined together may exert a more or less marked pro-inflammatory action depending on the subject’s health status [A].

  2. Industrial beverages: generally contain many sugars/sweeteners/additives.

  3. Many gluten-free products (especially industrial ones) are highly processed and contain additives (often many) that, if taken occasionally and individually, do not cause problems, but if combined together may have a pro-inflammatory action depending on the subject’s health status.

Foods to consume in moderation

  1. Wine/beer: in moderation.

  2. Alcoholic beverages: on rare occasions (spirits: NO).

  3. Coffee: in moderation.

  4. Processed meats: with great moderation.

  5. Sweets: in moderation. If there are issues with sugars (weight or glycemia), they must be consumed in appropriate amounts to avoid problems.

  6. Cheeses: with great moderation and in amounts compatible with the individual (if lactose/casein intolerant).

  7. Spices: in moderation.

  8. Gluten: in moderation. If possible, whole-grain/partially whole-grain pasta; bread: if possible, whole durum wheat/spelt. Soft wheat contains a gluten component that is very difficult to digest (33-mer). Considering the relationship between gluten strength and digestibility, products made with grains that have less tenacious gluten should be preferred. Among “ancient grains,” many with this characteristic can be found (in reality, even among modern grains there are cultivars with less tenacious gluten, often used for pastries rather than bread). These should be preferred.

  9. Those who are gluten intolerant but not celiac, considering that this intolerance is “dose-dependent,” can, with the help of a physician, try to identify the threshold (quantity) that does not cause problems. Grains with less tenacious gluten facilitate the possibility of consuming products made from them. Further reading: Difference between ancient and modern grains (published separately)

Foods to consume in abundance

  1. Fiber (compatible with any intestinal issues): 3–4 times per day.

Separately, the essential contribution of water in maintaining adequate hydration must be remembered.

4 – Eating behaviors

Nutrition rests on two main pillars: quantity and quality.

The quantity of food consumed should be what is necessary for physiological functions plus what is required for activities performed. This simple principle would greatly help maintain a correct and healthy weight. Not easy for two simple reasons: the first is “gluttony,” the second is that the “full/satiated” mechanism is delayed compared to actual fullness; the sensation of satiety does not coincide with real stomach filling but arrives later. Already 50 years ago, family doctors suggested leaving the table with a slight desire for more food.

Quality: it goes without saying that the more genuine and “clean” (i.e., free of toxic substances) foods are, the better.

The following should also be considered a general framework because, as stated, it must be “designed around the individual.”

A – Avoid consuming too much food in a single meal

The stomach should be allowed to work (digest) optimally. It is often preferable to eat more frequently rather than having a single very large meal. Ideally, one should finish eating and “not feel the stomach,” with the result of no postprandial “fog.”
Further reading: Why smaller, distributed meals work better (published separately)

Food that is not completely digested, in healthy individuals*, is subsequently processed in the intestine and then expelled. However, if the gastrointestinal system is compromised or altered, the passage of inadequately digested substrates into the intestine may promote bacterial fermentation and be pro-inflammatory. (https://glutenlight.eu/2025/06/12/cibo-non-digerito-e-infiammazione-intestinale/)

Not only the stomach, but also and especially the intestine must be able to function optimally and continue digesting food in order to make it absorbable. [B] [C]
*The critical point here is: does a truly healthy individual still exist?

B – Avoid mixing very different foods

The stomach works in an acidic environment, where pepsin digests proteins (further digested in the intestine by trypsin and other enzymes). Sugars begin digestion in the mouth (ptyalin) and are then mainly digested in the intestine (pancreatic amylase). Some clarifications are necessary:

Carbohydrates and proteins in the stomach generally do not cause problems.
A pasta course followed by fish, meat, cheese, and perhaps vegetables, in amounts appropriate to one’s digestive capacity, does not cause problems.

If the second course is very fatty, gastric digestion slows and, depending on quantity, gastric emptying may be delayed, with possible passage of incompletely digested food into the intestine.

The situation is different if a dessert is included.

Here we face a significant amount of simple sugars, not complex carbohydrates (pasta, for example, is mainly starch, and only part of it is transformed into sugars already in the mouth; therefore, mainly starch reaches the stomach).

Sugars are not digested in the stomach except to a negligible extent:

“The stomach has a highly acidic environment that prevents fermentation there; the undigested sugars travel to the small intestine and large intestine, where they are fermented by the gut bacteria.”

Dessert at the end of a meal (intended as a moderate portion) does not cause problems in a healthy person (who today is relatively rare), but it makes digestion more difficult for many people, not only because of possible subsequent intestinal effects, but also due to the sensation of heaviness that may appear.

It should be clarified that this is not a dogma: there are people who digest practically everything without difficulty—we are all different.

Age also plays a fundamental role. Elderly individuals tend to feel better when meals are simpler.
Further reading: Sugars and proteins in gastric digestion (published separately)

Important point

In the presence of diet-related pathologies, the intervention of a specialist (dietitian or nutritionist) is strictly necessary.

5 – Specific behaviors

  1. Engage in physical activity, even moderately.

  2. If working, avoid work that leads to stress. Stress must be managed, otherwise it becomes a cause of low-grade chronic inflammation.

  3. If overweight, weight must be reduced.

  4. After work, engage in activities that require concentration and, if possible, creativity. Developing projects is highly useful for keeping brain functions active.

6 – Medical evaluations

With one’s physician, define the routine general tests necessary for good monitoring of one’s health, as well as specific tests for any conditions.

Final Summary

We must build a personalized lifestyle model for reducing low-grade chronic inflammation.
In a healthy person, a meal containing proteins and sugars in moderate amounts does not create problems. The association becomes potentially problematic when sugars are highly concentrated, especially in liquid form and in large quantities. In individuals with a sensitive or altered gastrointestinal system, even moderate portions (such as dessert at the end of a meal) may cause digestive discomfort.

The integrated approach to reducing low-grade chronic inflammation is based on the available scientific evidence reported in the bibliography section.

Since many studies show significant associations without demonstrating an absolute causal relationship, a precautionary principle is adopted: reduce or eliminate, where possible, potentially harmful factors, favoring choices with low biological risk.

Final Notes

Note [A]: Intestinal barrier and additives.

The following factors compromise the integrity of tight junctions and increase intestinal barrier permeability: Western diet, saturated fatty acids, gluten, salt, alcohol, and chemical additives present in ultra-processed foods. These “barrier disruptors” act directly or by modulating the microbiota. Stress also damages the gastrointestinal tract by activating the CRF–mast cell axis.
Protective factors for the barrier include: caloric restriction or fasting, prebiotics, probiotics, butyrate (SCFA), vitamins D and A, flavonoids, omega-3 polyunsaturated fatty acids, zinc, and mucoprotective agents (gelatin tannate and tyndallized probiotics).

Note [B]: Fermentation and gastric emptying.

Prolonged food retention in the stomach can generate fermentation, especially if food remains longer than normal due to slow digestion. This may cause gas accumulation, bloating, abdominal tension, and belching. Causes may include delayed gastric emptying or consumption of certain foods.

Symptoms:

  • Bloating and abdominal tension

  • Frequent belching

  • Flatulence

  • Sensation of fullness even after eating little

Common causes of slow digestion:

  • Large meals or eating too quickly

  • Unbalanced diet rich in sugars and carbohydrates

  • Diseases or disorders that slow gastric emptying

Note [C]: Symptoms of poor digestion.

A sandwich swallowed quickly and poorly chewed during a rushed lunch break or while on the phone; an extra bite to avoid leaving that excellent baked pasta; dessert ordered out of gluttony despite already feeling full; an ice-cold carbonated drink or slushie because “it’s so pleasant in the heat.” The result is always the same: a feeling of stomach heaviness that is difficult to tolerate, often accompanied by pain, acidity, heartburn, abdominal bloating, belching, and all other symptoms of poor digestion.

Occasional stomach heaviness is not linked to specific diseases or major health problems, but almost always to excessive and/or difficult-to-digest food intake, which forces the gastric mucosa to secrete in a short time an amount of gastric juices beyond its capacity and requires liver, gallbladder, and pancreas to rapidly release enzymes to support digestion and absorption of fats, proteins, and carbohydrates.

Conversely, if digestive discomfort tends to recur often or even after every meal, possible underlying causes include:

  • Functional dyspepsia (often worsened by anxiety and stress)

  • Irritable bowel syndrome or chronic inflammatory bowel disease

  • Food allergies or intolerances

  • Liver dysfunction, biliary obstruction, or, more rarely, chronic pancreatitis

If, in addition to heaviness, bloating, and mild nausea, there are also (or mainly) acidity, heartburn, acid reflux, cramps, and stomach pain, possible causes include gastritis, gastric ulcer, hiatal hernia, or, in a very small minority of cases, stomach cancer.

Footnote ()*

For certain factors, such as food additives, many studies suggest an association between intake and possible negative health effects. These results must be interpreted in the context of the research methods used, which often include observational studies, experimental models, or numerically limited samples. In this approach, such evidence is considered sufficient to adopt a precautionary principle, even in the absence of definitive causal proof.

This document is for informational purposes only and does not replace medical advice.

Essential Bibliography

Infiammazione cronica di basso grado (ICBG) e rischio cardio-metabolico

  1. Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes — Sharif S, et al. (2021). Cardiovascular Diabetology. DOI: 10.1186/s12933-021-01409-0. (PubMed)

Dieta “occidentale”, permeabilità intestinale e disbiosi

  1. Western diet components that increase intestinal permeability with implications on health — Jaquez-Durán G, Arellano-Ortiz AL. (2024). Int J Vitam Nutr Res. DOI: 10.1024/0300-9831/a000801. (PubMed)

Stress → permeabilità intestinale (CRF, mastociti) e asse intestino-cervello

  1. Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism — Vanuytsel T, et al. (2014). Gut. DOI: 10.1136/gutjnl-2013-305690. (PubMed)

  2. CRF induces intestinal epithelial barrier injury via the release of mast cell proteases and TNF-α — Overman EL, et al. (2012). PLOS ONE. DOI: 10.1371/journal.pone.0039935. (Semantic Scholar)

  3. Role of corticotropin-releasing factor in gastrointestinal permeability (review/overview utile per collegare i pezzi) — Rodiño-Janeiro BK, et al. (2015). J Neurogastroenterology and Motility. DOI: 10.5056/jnm14084. (jnmjournal.org)

Attività fisica e riduzione dei marker infiammatori

  1. Effect of exercise training on C reactive protein: a systematic review and meta-analysis of randomised and non-randomised controlled trials — Fedewa MV, Hathaway ED, Ward-Ritacco CL. (2017). Br J Sports Med. DOI: 10.1136/bjsports-2016-095999. (PubMed)

  2. Effect of exercise training on chronic inflammation (review) — Beavers KM, Brinkley TE, Nicklas BJ. (2010). Aging and Disease (PMC). (Ottimo come quadro generale “stile di vita → infiammazione”). (PMC)

Dieta mediterranea e biomarcatori infiammatori

  1. Mediterranean Diet Reduces Inflammation in Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials — Keshani M, et al. (2025). Nutrition Reviews. DOI: 10.1093/nutrit/nuaf213. (OUP Academic)

Alimenti ultra-processati e infiammazione (CRP/hs-CRP ecc.)

  1. Ultra-Processed Food Consumption and Systemic Inflammatory Biomarkers: A Scoping Review — Ciaffi J, et al. (2025). Nutrients. DOI: 10.3390/nu17183012. (PubMed)

Inquinamento, stress ossidativo e infiammazione sistemica

  1. Particulate air pollution, systemic oxidative stress, inflammation, and atherosclerosis — Araujo JA, Nel AE. (2010). Air Quality, Atmosphere & Health. DOI: 10.1007/s11869-010-0101-8. (PMC)

“Zuccheri + proteine”, ormoni intestinali e svuotamento gastrico

  1. Ghrelin, CCK, GLP-1, and PYY(3–36): Secretory Controls and Physiological Roles in Eating and Glycemia in Health, Obesity, and After RYGB — Steinert RE, Feinle-Bisset C, et al. (2017). Physiological Reviews. DOI: 10.1152/physrev.00031.2014. (Riviste di Fisiologia)

  2. Effects of a Protein Preload on Gastric Emptying, Glycemia, and Gut Hormones After a Carbohydrate Meal in Diet-Controlled Type 2 Diabetes — Ma J, Stevens JE, et al. (2009). Diabetes Care (PMC). (Studio sperimentale: proteine → ↑CCK/GLP-1 e rallentamento svuotamento). (PMC)

  3. Effects of GLP-1 and Its Analogs on Gastric Physiology in Diabetes Mellitus and Obesity — Maselli DB, Camilleri M. (2021). DOI: 10.1007/5584_2020_496. (Semantic Scholar)

  4. Evaluation of interactions between CCK and GLP-1 in their effects on appetite and gut function — Brennan IM, et al. (2005). Am J Physiol Regul Integr Comp Physiol. DOI: 10.1152/ajpregu.00732.2004. (Riviste di Fisiologia)

“Dessert stomach” e sazietà sensoriale specifica

  1. Sensory specific satiety in man — Rolls BJ, Rolls ET, Rowe EA, Sweeney K. (1981). Physiology & Behavior. DOI: 10.1016/0031-9384(81)90310-3. (PubMed)

  2. Sensory-specific satiety (review breve/classico) — Rolls BJ. (1986). Nutrition Reviews. DOI: 10.1111/j.1753-4887.1986.tb07593.x. (PubMed)