The Inflammation Upstream Check
Separate acute defence from persistent inflammation, then investigate drivers
- Difficulty
- Moderate
- Time to result
- ~weeks to results
- Steps
- 4
- Confidence
- 90%
Mills frames inflammation as a defence response that can help clear damage or infection but can become harmful when it persists. His decision rule begins by separating short-term acute inflammation from chronic inflammation. Acute swelling after an injury may be part of healing, whereas persistent inflammation warrants investigation of an ongoing driver. He then asks what creates the continuing need for the response, rather than relying only on suppression. The framework does not claim that anti-inflammatory medicines are unnecessary: Mills explicitly allows that they may be the only practical option in some diseases or when short-term function matters. Its value is in holding two questions together—what relief is needed now, and what may be sustaining the problem—under qualified clinical guidance.
Origin
Extracted from The Diary of a CEO
Core principles
- 01Inflammation can be a protective response
- 02Acute and chronic inflammation require different reasoning
- 03Symptom suppression does not explain the driver
- 04Immediate function and long-term recovery may require trade-offs
How to run it
- 1
Classify the time course
Determine whether the inflammation follows a recent injury or infection, or whether it has persisted or repeatedly returned.
Pro tip Write down onset, duration, triggers, and changes over time.
Watch out Redness, swelling, pain, or fever can require urgent assessment depending on severity and context.
- 2
Define the immediate goal
Clarify whether the priority is safe recovery, tolerable pain, essential short-term function, or management of a diagnosed disease.
Pro tip Make the trade-off explicit rather than assuming zero inflammation is always the goal.
Watch out Medication decisions belong with a qualified prescriber.
- 3
Look upstream
For persistent inflammation, work with a clinician to investigate plausible drivers, including injury, infection, diagnosed disease, and relevant lifestyle factors.
Pro tip Prioritise evidence-supported explanations before speculative ones.
Watch out The transcript's emphasis on the gut is Mills's clinical view, not a universal explanation.
- 4
Treat and monitor
Use appropriate symptom control while tracking recovery and addressing an identified driver where possible.
Pro tip Monitor both pain and function; either alone can give an incomplete picture.
Watch out Do not stop prescribed medicines without clinical advice.
In the wild
The host describes conflicting advice after an ankle-ligament injury before a charity football match. Mills distinguishes acute inflammation, which he generally views as part of healing, from the short-term need to become functional for an event. He acknowledges that temporary symptom control may sometimes be chosen for that immediate goal.
→ The example exposes the trade-off between short-term function and allowing an acute response to run its course.
Common mistakes
Calling all inflammation the enemy
This ignores its protective role in some acute situations and collapses distinct clinical contexts into one rule.
Calling all inflammation helpful
Persistent inflammation can itself cause harm and may need medical treatment. The framework is a prompt to investigate, not a veto on care.
Is it for you?
Best for
It is best for clinician-guided decisions about recurring pain or inflammation and short-term symptom trade-offs.
Not ideal for
It is not a reason to avoid indicated anti-inflammatory treatment or to self-diagnose the cause of inflammation.
From the transcript
“inflammation is not the enemy. Inflammation is the defense measure that can sometimes overstay its welcome.”
“if it's a short-term we call it acute inflammation then overwhelmingly the advice is don't suppress it”
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