Anti-inflammatory Diet

There are many similar elements in the anti-inflammatory diet compared to the

Mediterranean diet. The essence of an anti-inflammatory diet is to eliminate (or

minimize) foods that promote inflammation and maximize foods that moderate

inflammation.

There are several anti-inflammatory diets, but while emphasis may vary, the basic

elements of an anti-inflammatory diet are: optimization of fatty acid ratios, maximizing

vegetables and fruits (presence of fiber, antioxidants and other phytonutrients) and

avoiding processed foods, added sugar, potential food allergens and finally reducing red

meat and dairy consumption.

Processed foods

Perhaps the most emphasized element is elimination or minimizing of highly processed

foods. In our current times processing is unavoidable and not necessarily always

negative. As defined by the United States Federal Food, Drug and Cosmetic Act [32], a

processed food is "any food other than a raw agricultural commodity and includes any

raw agricultural commodity that has been subject to processing, such as canning,

cooking, freezing, dehydration, or milling." Humans have been cooking for thousands

of years as cooking makes some foods more digestible as well as preserving (pickling,

salting and drying) foods that might become scarce in upcoming seasons. Today,

processing is a necessity as few people are capable of providing their own nutrition year

round so food must be transported, and preserved on grocery store shelves and in the

home pantry. Additionally, our lifestyles are such that we have little time to prepare
meals and many of us have lost all but the most basic skills in cooking. Processed

foods offer convenience and variety to make up for our lack of time and food

preparation skills. To be avoided are the extremely processed foods that upset the

nutritional “balance” that unprocessed foods contain. In these foods the nutritional

density and content are often diminished while the caloric density is increased with

unhealthy added sugars, oils and refined grains. Highly processed foods often contain

high amounts of omega -6 fatty acids and added sugars. The omega 6 fatty acids skew

the omega 6/omega3 fatty acid ratio in favor of a pro-inflammatory state (See Chapter:

Nutritional Supplements and herbs , section on Essential Fatty Acids). Recommended

are foods that are minimally processed. This often requires some basic education from

a dietician/nutritionist as the information can be overwhelming for the average person.

A useful “handbook” for the average consumer is “Food Rules” by Michael Pollan [33].

The other concern raised with highly processed foods is that they can have an addictive

quality. This is especially true regarding added salt, sugar and fat according to David

Kessler in his book “The End of Over Eating” [34].

Sugars

Sugar is essential to life. Our bodies need (some) sugar or carbohydrates, which

serves as our natural fuel as well as serving as build blocks for certain cellular

components. Sugar is a component of nutritious foods such as fruits, vegetables.

However, the sugar in these foods is balanced with many other important nutrients.

These other components include antioxidants and other phytonutrients that help to stem

inflammatory activity in our bodies. Processed foods with added sugar distort the
dietary balance making food less nutrient dense and more calorically dense. Excess

sugar also acts as a pro-inflammatory agent. It has been linked to increased risks of

oxidative stress, inflammation, depressed immunity obesity and chronic diseases such as

metabolic syndrome (source) and type 2 diabetes [35, 36]. Fructose appears to be

the most problematic of the sugars targeting hepatic metabolism and associated with

the metabolic syndrome (increased abdominal adipose tissue, insulin resistance,

dyslipidemia, and hypertension). It increases inflammation and reactive oxygen

species and induce leptin resistance [37, 38]. Specific arguments against the use of

HFCS (vs sucrose) have been made though the amounts of fructose are roughly

equivalent; but because it is in free form and not chemically bonded as in fructose.

However the fructose and glucose are readily cleaved from sucrose and absorbed.

Also there are no differences with regards to short term energy regulating hormones or

appetite between the two sugars [39, 40, 41, 42, 43, 44]. This lack of difference in

effect between sucrose and HFCS leads back to the general underlying problem, which

is the excess amount of added sugars and the probable specific negative effects of

fructose as noted above.

Many people are oblivious to the sources of added sugar and often do not consider

such “natural” sources such as fruit drinks or sweetened tea. Many are also unaware of

the added sugars in pastries and processed foods such as cereal. The per capita

intake of sugar) in the United States has risen over the several decades increasing from

6.7 kg in 1968 peaking at to 38 kg in 2000 and at 29.2 kg in 2010 with similar increases

in the rest of the world as nations become more affluent and industrialized [45]. This

perpetuates its role in increasing ROSs an inducing a pro-inflammatory state.

anti-inflammatory diet as much of the nutritious layers of the grain containing essential

mineral, (mostly B) vitamins and fiber have been removed. Without the fiber the

carbohydrates in refined grains are more quickly absorbed inducing rapid rises in blood

sugar levels. The end product is a nutritionally poor, high caloric food product. Instead

whole grains are encouraged.

Optimization of fatty acid ratios

Aside from added sugars and refined grains many highly processed foods also have

added (predominantly) omega-6 oils including cottonseed, safflower, corn and sunflower

oils that add to the inflammatory effect. Some fast foods still contain the pro-

inflammatory trans fats as partially hydrogenated oil or vegetable shortening. Also,

eating fish or supplementing with fish oils is encouraged to provide increase in omega 3

oils and improve the omega 6/omega 3 ratio away from a pro-inflammatory state (see

Chapter: Nutritional Supplements and herbs, section on Essential Fatty Acids). It is

primarily the oily cold water fish that contain the highest amounts of the EPA/DHA

essential fatty acids. There is a caution as most fish contain heavy metals. This is

somewhat problematic as identification of fish that are both high in n-3 PUFAs and low

in Methylmercury (MeHg) is difficult. The amount of both Omega 3 FAs and heavy

metals vary from specie to specie and many of the studies on fish as a source of

Omega 3 oils have not collected data on the specific species of fish that were

consumed. Thus interpretation of risk/benefit ratio is difficult [46]. What is generally

recommended is eating smaller (oily) fish such as herring or sardines as they do not

contain as high a toxic burden and are lower on the food chain so have not accumulated
as much of a toxic burden than fish higher in the food chain. Suggested intake is

several times a week. Selenium has also been recommended to be taken when eating

fish as it chelates mercury. The alternative option is fish oil supplements.

Red meat

Similar to the Mediterranean diet, the recommendation for red meat consumption is

limited to several times a month. When meat is eaten; organic (pesticide and herbicide

free) grass fed beef is recommended. Commercially raised cattle are fed grains such

as soy and corn for accelerated growth, allowing them to be slaughtered at a younger

age providing a financial savings for the business. However, due to living constraints

and diet in feed lots cattle gain extra fat that is mostly saturated fats and more pro-

inflammatory. Organic free range grass fed cattle are leaner with less saturated fat and

higher levels of the healthier Omega 3 oils and grass-based diets elevate precursors for

Vitamin A and E and antioxidants [47,48].

Another factor which may link red meat to inflammation is the discovery of the dietary

sialic acid, Neu5Gc, found primarily in red meat and dairy products. It may evoke an

antigen-antibody reaction promoting low grade chronic inflammation possibly a

contributing factor in diet-related carcinomas and other diseases in humans [49, 50].

Dairy, wheat and other food allergens

Food sensitivities other than documented IgE allergies are a controversial subject.

However, many practitioners of integrative medicine consider this an important element

in the causation or aggravation of disease and thus it is an important component of an

anti-inflammatory diet. Some are proponents of testing for IgE and/or IgG food
antibodies, while others feels that the sensitivity is not good enough and rely on

elimination diets. Practitioners vary in their recommendations as to what food to include

in an elimination trial ranging though most will eliminate dairy and gluten based food

products and others possibly eliminating additional foods such as corn and soy. As an

empiric trial the elimination trial may range from 4 to 12 weeks. Resolution or reduction

of symptoms and a greater sense of “well-being” during the elimination period and are

considered signs of a food sensitivity. Foods may then be returned to the diet one by

one to looking for a return of symptoms to determine which foods are responsible.

Based on clinical experience most integrative practitioners (author included) would

agree that dairy and gluten are frequently a significant component in chronic diseases

(including pulmonary) with an inflammatory component.

Phytonutrients

Encouraged in the anti-inflammatory diet is an abundance of vegetables and fruits along

with legumes nuts and seeds (similar to Mediterranean diet). A diet rich in vegetables

and fruits moderates inflammation [51, 52, 53]. Vegetables and fruits contain

necessary vitamins and minerals along with phytonutrient not found elsewhere. While

Phytonutrients are not considered essential dietary elements such as vitamins and

minerals; they are important plant constituents that can have an impact on disease and

health; and in particular diminish oxidative stress and modulate the immune system.

There are many thousands of identified phytonutrients. The most familiar recognized

groups are the carotenoids, polyphenols, phytoestrogens and catechins. The

carotenoids (yellow and orange foods such as pumpkins and carrots) include beta

carotenoid (precursor to vitamin A) but other recognized nutrients such as lycopenes

spinach, turnip greens). Polyphenols include the flavonoids (quercetin from apples,

berries, grapes and onions, resveratrol from grapes and red wine and components

found in turmeric. Phytoestrogens are comprised mostly of the isoflavones from soy

products and lignans with estrogen like activity mainly from flaxseeds and sesame

seeds. Catechins are found in high amounts in green tea.

In general, phytonutrients serve as antioxidants, enhance immune responses and

modulate cellular signaling processes and estrogen metabolism (Phytoestrogens).

They have anti-carcinogenic properties and support detoxification though cytocrome

P450 (Phase I) and Phase II enzyme systems [54]. Flavonoids and other polyphenols

in particular have an inhibitory effect on NF-κB signaling and down regulate the

expression of proinflammatory markers [55, 56].

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