A Workplace on Fire

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By: Meghan Walsh

Parneet Pal grew up and went to medical school in Mumbai (then known as Bombay), the financial center of India and the world’s sixth-most populous city. It was an interesting time and place to be contemplating health. While the South Asian country remained rooted in its ancient traditions, it was also barreling forward into modernity. Ayurveda, considered by some to be the world’s oldest documented healing science, originated in India more than 5,000 years ago. Its teachings prioritize balance as the central tenet of wellness. Today, much of the population still practices ayurveda. Yet, despite having both new and old medicines to draw upon, Pal observed, the country suffered from tremendous health inequities that only seemed to be growing worse.

In her twenties, when Pal moved to the United States to continue her education, she was surprised to see that the health inequities there were just as stark. She eventually found her way to designing well-being programs for executives, but even this most privileged of clientele would come back to see her, and often little had changed. All of this—her childhood in Mumbai, clinical residencies in the US, and work with businesses—led Pal to begin to see health more systematically. If the larger systems—planetary, societal, corporate—were out of balance, the microscopic systems, down to the cellular level, must be as well.

“A healthy cell lives in a healthy body that lives in a healthy family that lives in a healthy community that lives on a healthy planet,” Pal says. “I realized health doesn’t happen at the doctor’s office. It happens where we spend most of our time: the workplace.”

It’s somewhat easier to observe the consequences of imbalance within a company. Bank accounts in the red. High employee turnover. Unsatisfied customers. But what happens when there is imbalance on the cellular level? Inflammation. In a way, it's a different type of toxic workplace. “Our bodies are always working to maintain balance between repair and growth,” Pal says. “Anything that disrupts that balance sets off a cascade of immune and metabolic events in the body—that’s what inflammation is.”

This biological response to systemic dysregulation is the common denominator unifying almost all chronic lifestyle-related diseases, including many cancers, diabetes, obesity, stroke, heart disease, autoimmune diseases, Alzheimer’s and Parkinson’s diseases, even psychiatric disorders like depression and anxiety. Roughly half of all people in the US suffer from a chronic disease, accounting for upward of 75 percent of healthcare spending—numbers that only continue to rise. Understanding and managing this invisible and silent attacker is at the forefront of medicine today.

As both a physician and executive educator, Pal is on a mission to show that understanding chronic inflammation should also be at the forefront of corporate leadership. This, she contends, is crucial to addressing employee burnout, improving business outcomes, and addressing sustainability, in the multiple meanings of that term. Because a hyperactive immune system doesn’t just underlie biological disease; according to new research, it also leads to poor decision-making, impedes social connection, and affects motivation and productivity. “The lives we’re leading are hitting up against the limits of our biology—that’s why we have inflammation,” Pal says. “We can’t outrun our biology.”

***

The word flammation comes from the Latin verb inflammare, which means to ignite. Roman physicians some 2,000 years ago noted that wounds become red, warm, swollen, and painful. It’s as if they’ve caught fire.

Inflammation is a natural and necessary response to injury and infection. Organisms as primitive as starfish rely on inflammation during the healing process. When we cut a finger or catch a cold, the affected area sounds an alarm to the rest of the body by releasing certain chemical communicators. In response, the immune system mobilizes, dispatching cellular firefighters to put out the flames. Once all is under control and the wound has healed, the immune system sends out a message that it’s safe to go back to business as usual—or, in biological speak, to return to homeostasis.

“Health doesn’t happen at the doctor’s office. It happens where we spend most of our time: the workplace.”

Problems arise when the system doesn’t shut off the way it’s supposed to and inflammation continues to smolder despite no immediate threat. As inflammation progresses from acute to chronic, it begins to subvert the body’s necessary rest, repair, and growth rhythms. Modern life, for a host of reasons—some known, some still obscure—has triggered the immune system’s inflammatory response to get stuck in the “on” position.

“In the last two decades there has been a paradigm shift,” says Shilpa Ravella, a gastroenterologist and assistant professor of clinical medicine at Columbia University. “When I was in medical school, inflammation was seen as the consequence of disease. Now, we’re seeing it as a root cause.”

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Diet has been identified as one of the primary culprits of chronic inflammation, as Ravella details at length in A Silent Fire: The Story of Inflammation, Diet, & Disease. Processed foods and many industrial animal products flood the gut with foreign substances; even if these ingredients are otherwise benign, the immune system often responds to them as dangerous invaders. Meanwhile, the foods we eat do not provide the micronutrients and fiber needed to maintain a robust microbiome that can calm inflammation. Fiber deficiency, which is reported in 95 percent of Americans, has been linked to many of the same diseases as inflammation. The greatest antagonist, however, may simply be carrying excess weight on the body.

Other threats include the chemicals present in personal care products, clothing, furniture, medications, cleaning supplies, and building materials, along with air and water pollution. These substances can make their way into the bloodstream and organs, including the brain. If the immune system can’t always discern friend from foe, it’s due at least partly to the modern human’s lack of exposure to microbial diversity, whether because of our minimal consumption of plants, decreased interaction with nature, or zealous sanitation practices.

Still, the story gets more complex.

*** 

Scientists theorize that because humans evolved as pack animals, with the tribe being essential to survival, cells can’t tell the difference between a physical and a social threat. “Our bodies respond to social pain, including witnessing someone else’s social pain, as if we’re physically hurt,” says Korn Ferry Institute neuroscience researcher Amelia Haynes. “Think of the implication of that.”

In one study, speaking before a judgmental panel prompted the same immune response in subjects as exposure to a pathogen. For public speakers who faced excessive inflammatory-inducing stressors early in life, the response was even more pronounced. That at-risk subset was also more likely to develop depression (itself a common consequence of inflammation) in the months that followed. Interestingly, other research has shown that the body doesn’t have the same response to purely technological stressors, like email notifications, if they aren’t associated with social threats.

Inflammation can trigger the biological fight, flight, or freeze response. This, in turn, heightens vigilance, which is experienced as anxiety. Those suffering from chronic inflammation also are more likely to isolate and less motivated to expend effort. These evolutionary instincts once protected the sick or wounded by conserving energy and protecting against further attack, but in today’s world such a response is maladaptive.

“Running hot to fight infections was a great thing,” says Andrew Miller, a psychiatry professor and director of the Emory Behavioral Immunology Program at Emory University School of Medicine. “Without it we would not have survived as a species, but we don’t need a hot immune system anymore. It’s a legacy of the past.”

*** 

While employees at some companies kick off each New Year by competing to see who can lose the most weight or log the most steps in a given period of time, at Emory University, where Miller is a teacher and researcher, some compete instead to see who can most reduce their inflammation levels. 

The challenge is simpler than it might seem. It requires just a finger prick and a modest, easily operated machine to process the blood test, which measures the number of C-reactive proteins, a reliable marker of full-body inflammation. For many, Miller says, the test is less intrusive and emotionally charged than weight-loss or fitness competitions can be. But the behavior changes are similar: eliminate processed foods and eat a plant-forward diet, get the body moving, sleep more, and spend time in community and nature.

“If you’re in the game of productivity, inflammation is what you want to be thinking about,” says Miller, who specifically studies the relationship between inflammation and psychiatric phenomena. “Inflammation is living in a lot of different places in different people for different reasons, but it’s going to have the same effect on the brain and lead to the same symptoms: You’re going to be cognitively slowed; you won’t have much energy or motivation; you won’t be getting things done.”

“If you’re in the game of productivity, inflammation is what you want to be thinking about.”

Depression is the leading cause of worker disability across the globe. It’s associated with brain fog, inertia, and the loss of pleasure—the same inflammatory symptoms Miller identifies as impediments to thriving at work. To the dismay of doctors and employers, 30 to 60 percent of patients suffering from depression don’t respond to current treatments. There is growing optimism that targeting inflammation may be a way out of the darkness for some. Several months ago, the FDA approved
the first anti-inflammatory drug to treat cardiovascular disease. Miller and colleagues are hard at work to develop a similar treatment for mental-health disorders.

In another emerging field that is ripe for study, research is beginning to show associations between work-related stress, including long hours, effort-reward imbalance, and poor on-the-job social support, with chronic, low-grade inflammation—the kind that’s most deadly. It’s a vicious doom spiral: Stress worsens employee inflammation, and inflammation worsens employee productivity, creating even more stress.

This equal-opportunity adversary is targeting leaders in insidious ways, too. A recent study suggests that inflammation influences poor decision-making. To be sure, many factors guide the choices people make, but the body, when it’s in survival mode, is more impulsive, primal, and likely to discount the future in favor of immediacy. After all, what good is a reward tomorrow if cells think they might not make it through today? While
leaders may assume they’re making decisions based on fact and reason, Pal and others contend that, in actuality, ancestral biology is calling the shots. “When the body is in fight or flight, we develop tunnel vision,” Pal says. “We become self-focused. We lose our ability to trust others. It’s really hard to break out of that tunnel vision.”

Hard, perhaps, but not impossible.

*** 

For the most part, corporate-health initiatives—and the studies measuring their effectiveness—have been focused on individual behavior change. But what Pal and others have learned is that personal change is excruciatingly hard when not supported by the environment. After a heart attack, for example, only 25 percent of people follow through with the medical recommendations.

Pal believes people need to be in environments that are both  physically and emotionally supportive of change. “Burnout is not an individual fallibility; it’s a byproduct of organizational structure and culture,” she says. Safety, reward, and connection—three basic needs for survival, yes, but also prerequisites for collaboration, creativity, and cultivating purpose. “As we understand human biological health, we can understand business health—because the two are inextricably linked,” Pal says.

Modernization has supported life and longevity in many ways, including through sanitation, vaccination, and other technological breakthroughs. But the system has gotten out of whack, which is evidenced through social disparities, health outcomes, and environmental collapse. By returning to the basics of biology, Pal hopes to make personal health an asset rather than a liability in the ongoing sustainability transformation. “This requires companies to direct their conception of sustainability inward and to reconsider how work is structured and managed,” Pal says.

What would it mean to reverse the doom spiral? What if the spiral, a shape that can be defined mathematically as a Fibonacci sequence, burgeons from a locus of coolness, calm, curiosity, and compassion? The Fibonacci spiral appears throughout the natural world, from the bracts of a pine cone to the human fingerprint to the cosmic whirlpool of a galaxy. It’s a poignant symbol of both balance and the interconnectedness of all of life. “Understanding our biology, the connections between inner and outer webs of life, naturally evokes awe,” Pal says. “Confronted with this beauty, we can’t help but be moved to protect it.”