Instalment 5: behaviours that reduce inflammation

Do more of:

Vigorous exercise

Both high-intensity intermittent exercise and moderate-intensity continuous exercise produce anti-inflammatory responses1, perhaps by reducing insulin secretion during the exercise and by improving insulin sensitivity2.

Get out of bed at the same time every day (no exceptions!)

I have successfully treated hundreds of patients with depression by having them get up out of bed earlier (which reduces REM sleep). This approach improves depressive symptoms the same day! Conversely, having patients with mania sleep longer (typically by prescribing sleep-inducing medication) improves manic symptoms, by increasing REM sleep. Since REM sleep is most powerfully controlled by circadian rhythm, stabilizing that rhythm by getting up and out of bed at the same time every day, without exceptions, may be necessary in some individuals to have a stable mood. This topic is further explored in talks I have given to both clinicians and laypersons. Regular hours of sleep, and spending less time in bed, is also the most effective way to improve insomnia (see my brief article requested by the Scientific American magazine on this topic).

But what does stable mood and/or sleep duration have to do with inflammation?

Probably the most important is that depressed people typically lack the energy and the motivation to follow any of the other guidelines for reducing inflammation. Conversely, manic individuals often believe that there is nothing wrong with their health, and so do not need to do anything to improve it. So a stable mood may improve a person’s capacity to follow anti-inflammatory guidelines.

Another issue is that people with mood disorders may be prescribed medication which can raise insulin levels as a side effect. This manifests as weight gain, metabolic syndrome or type 2 diabetes, and increased inflammation3. While exercise has been shown to mitigate these effects for antipsychotic medication4, motivation to exercise may be in short supply.

And finally, it appears that there is a U-shaped association between sleep duration and markers of inflammation5, possibly mediated by the finding that both short sleepers (5-6 hrs/night) and long sleepers (9-10 hrs/night) have higher fasting insulin levels as well as higher amounts of insulin being secreted in response to glucose intake6. This may also explain why both groups have higher mortality than people who sleep about 7 hours per night7, although longer sleep is worse than shorter sleep. Sleeping longer as one gets older is particularly problematic8.


Any recommendation to increase cannabis use is greeted by a chorus of negative feedback especially from parents of adolescent children. So it’s important to be clear: I do not recommend this for everyone, but for individuals who are suffering from painful or life-threatening inflammatory conditions, medical marijuana may be something to explore.

The two compounds found in cannabis that have been widely studied are cannabidiol (CBD) and tetrahydrocannabinol (THC). Both appear to have significant anti-inflammatory properties9 but CBD is probably more useful for this as it does not have the psychoactive effects of THC.

The mode of action may involve microRNA and the gut microbiome, but it is also likely that insulin is involved, suggested by the possibility that cannabis may be a useful anti-obesity treatment10. The insulin-producing cells in the pancreas have cannabinoid receptors which modulate insulin secretion11.

Hope you enjoyed instalment 5! Please visit the next instalment where I discuss behaviours that promote inflammation and should therefore be reduced or avoided altogether.

  1. Cabral-Santos C, Gerosa-Neto J, Inoue DS et al. Similar Anti-Inflammatory Acute Responses from Moderate-Intensity Continuous and High-Intensity Intermittent Exercise. J Sports Sci Med. 2015;14:849-856. PMID 26664283
  2. Richter EA, Sylow L, Hargreaves M. Interactions between insulin and exercise. Biochem J. 2021;478:3827-3846. PMID 34751700
  3. Tickell AM, Rohleder C, Ho N et al. Identifying pathways to early-onset metabolic dysfunction, insulin resistance and inflammation in young adult inpatients with emerging affective and major mood disorders. Early Interv Psychiatry. 2021PMID 34852406
  4. Sylvester E, Yi W, Han M, Deng C. Exercise intervention for preventing risperidone-induced dyslipidemia and gluco-metabolic disorders in female juvenile rats. Pharmacol Biochem Behav. 2020;199:173064. PMID 33127383
    Shamshoum H, McKie GL, Medak KD, Ashworth KE, Kemp BE, Wright DC. Voluntary physical activity protects against olanzapine-induced hyperglycemia. J Appl Physiol (1985). 2021;130:466-478. PMID 33382959
  5. Lee YC, Son DH, Kwon YJ. U-Shaped Association between Sleep Duration, C-Reactive Protein, and Uric Acid in Korean Women. Int J Environ Res Public Health. 2020;17PMID 32294936
  6. Chaput JP, Després JP, Bouchard C, Tremblay A. Association of sleep duration with type 2 diabetes and impaired glucose tolerance. Diabetologia. 2007;50:2298-2304. PMID 17717644
  7. For example: Svensson T, Inoue M, Saito E et al. The association between habitual sleep duration and mortality according to sex and age: the Japan Public Health Center-based Prospective Study. J Epidemiol. 2020PMID 32009104
    Kabat GC, Xue X, Kamensky V et al. The association of sleep duration and quality with all-cause and cause-specific mortality in the Women’s Health Initiative. Sleep Med. 2018;50:48-54. PMID 29982090
  8. Soh AZ, Chee MWL, Yuan JM, Koh WP. Sleep lengthening in late adulthood signals increased risk of mortality. Sleep. 2018;41PMID 29394410
  9. Chandra LC, Kumar V, Torben W et al. Chronic administration of Δ9-tetrahydrocannabinol induces intestinal anti-inflammatory microRNA expression during acute simian immunodeficiency virus infection of rhesus macaques. J Virol. 2015;89:1168-1181. PMID 25378491
    Dopkins N, Miranda K, Wilson K, Holloman BL, Nagarkatti P, Nagarkatti M. Effects of Orally Administered Cannabidiol on Neuroinflammation and Intestinal Inflammation in the Attenuation of Experimental Autoimmune Encephalomyelitis. J Neuroimmune Pharmacol. 2021PMID 34757526
  10. Cavalheiro EKFF, Costa AB, Salla DH et al. Cannabis sativa as a Treatment for Obesity: From Anti-Inflammatory Indirect Support to a Promising Metabolic Re-Establishment Target. Cannabis Cannabinoid Res. 2021PMID 34242511
  11. Aseer KR, Egan JM. An Autonomous Cannabinoid System in Islets of Langerhans. Front Endocrinol (Lausanne). 2021;12:699661. PMID 34290671

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  1. Pingback: Instalment 4: About beverages, and things to try to eliminate from your diet –

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