What's actually keeping your inflammation switched on

In the last post I talked about why inflammation itself isn't the villain, it's what happens when the body can't switch it back off. This time I want to get practical about the second half of that question. If your immune system is stuck in the "on" position, what's actually keeping the finger on the switch.

Chronic inflammation is rarely caused by one single thing. It's usually several of these layered on top of each other, each one adding fuel rather than being the sole cause. Here's how I break it down.

Blood sugar

High insulin levels and elevated advanced glycation end products (AGEs, formed when sugar molecules attach to proteins or fats in the body) are read by the immune system as danger signals, in much the same way as a pathogen would be. If your blood sugar is swinging around a lot, your immune system may be responding to that as a genuine, ongoing threat, not just a metabolic inconvenience.

This is one reason I bang on so much about protein and fibre with breakfast. It's not really about weight, it's about giving your immune system one less thing to react to all day.

Hormones and stress

Reproductive hormone imbalances, an under or overactive thyroid, a dysregulated stress response, and a disrupted circadian rhythm (your natural sleep-wake cycle) all feed directly into inflammation. Cortisol is a particularly interesting one here. In the early stages of an inflammatory response it's truly anti-inflammatory, doing its job of calming things down. But with chronic, ongoing inflammation, that relationship flips, and cortisol starts to amplify the very inflammatory pathways it was meant to suppress.

This is part of why sleep and stress management aren't soft add-ons to a treatment plan, they're doing real biochemical work.

Gut and immune regulation

Dysbiosis (an imbalance in gut bacteria), increased gut permeability, and loss of immune tolerance all sit in this category, alongside underlying autoimmunity and persistent low-grade tissue damage. Mucosal surfaces, the gut lining, the vaginal microbiome, are essentially border control for the immune system, and when that border is compromised, the immune system has to work much harder and much more often.

In TCM this overlaps closely with how we think about Spleen Qi and its role in transforming and transporting, and with damp accumulation when digestion isn't working as it should. A gut that isn't processing and clearing properly leaves residue behind, whether we're talking about undigested food or bacterial byproducts, and the immune system has to keep responding to that residue.

Toxic load and clearance

This is about how well your body is processing and clearing what it's exposed to, whether that's alcohol, medications, or environmental toxins. The liver's Kupffer cells (immune cells that live in the liver) can become upregulated either through genetics or through the sheer volume of what they're being asked to process, and if your antioxidant reserves are already stretched thin, you've got less capacity to buffer any of this.

Infection

Chronic viral infections, persistent bacterial infections, and pathogens that are particularly good at evading the immune system (eg Lyme disease and salmonella) can sit in the background driving inflammation for far longer than most people realise. This is often the piece that gets missed, because by the time someone's in front of me, the original infection may feel like ancient history. The immune system doesn't always see it that way.

Body composition

Higher visceral fat and lower muscle mass both push inflammation in the wrong direction. Visceral fat isn't just stored energy, it's metabolically active tissue that produces its own inflammatory signalling molecules (called adipokines).

Ageing

And simply, ageing itself. Immune function shifts as we get older, and that's a normal part of the picture rather than a failure of anything.

Why this matters more than "just take turmeric"

I see so many people reach for the anti-inflammatory supplement aisle before anyone has asked which of these categories is actually driving their picture. Curcumin, omega 3s, all useful tools, but they work on calming the response down. They don't touch what's calling the response up in the first place.

When someone comes to me feeling constantly inflamed, whether that's joint pain, skin flares, period pain, or just a sense of being permanently run down, I'm working through this list with them. Is it blood sugar. Is it the gut. Is it a stress response that's never had a chance to properly reset. Is there something infectious sitting underneath that hasn't been looked at. Usually it's not one answer, it's two or three working together, and that's exactly why a personalised approach matters so much more than a generic anti-inflammatory protocol.

In the next post I'll talk through how some of this shows up on a standard full blood count, and what your white cells in particular can tell a practitioner about which of these drivers might be most relevant for you.

If you recognise yourself in more than one of these categories, that's really common, and it's exactly the kind of pattern I help patients untangle in clinic. Get in touch if you'd like to look at what's driving yours.