When it comes to chronic illnesses, particularly those that cause pain and fatigue, including rheumatoid arthritis and spondylitis conditions, an anti-inflammatory diet is a good bet. While the inflammatory processes create our symptoms, the chronic inflammation in our bodies also increases our risk for heart disease and other health conditions. But what is an anti-inflammatory diet? How does inflammation work?
What is inflammation?
Inflammation is an essential tool for our body’s immune system and healing processes. We need inflammation; our survival depends on it.
However, it can and does go off the rails. If the inflammation sticks around too long after the acute illness, it can become a chronic issue. Some people also have genetic health conditions, like psoriatic arthritis and psoriasis, in which inflammation is a key mechanism.
But how does it work?
Inflammation works through ‘mediators,’ messengers that go throughout our body as a call-to-arms for the immune system. These are called pro-inflammatory mediators. Then there are the anti-inflammatory mediators; the signals that are sent out to calm and balance the immune system once the illness or injury is taken care of.
That’s how it is suppose to work, anyhow.
For people with inflammatory conditions or chronic low-grade inflammation, the system either gets turned on when it isn’t needed or doesn’t fully shut down. This is where an anti-inflammatory diet may help. However, it’s important to recognize that for many people it is far from enough by itself. Medication is a powerful and amazing tool that has improved the quality of life for so many of us. But there are things we can do to feel even better, and improve our health in other ways at the same time.
Are antioxidants involved in inflammation?
Before doing my latest dive into the research, I didn’t quite understand the connection between antioxidants and inflammation. To get to the aha moment, there are a few terms to understand:
Oxidation is a chemical process.
The bonds holding a molecule together can sometimes be unstable. When this happens, it will ‘steal’ electrons from other molecules to stabilize itself. This can make the second molecule unstable, creating a chain reaction when this second molecule goes looking for an electron to stabilize itself. [footnote: As I edited this article, I realized that someone could read this explanation as though the molecule has thoughts and intentions. It’s just a chemical process, but the thought of anthropomorphized molecules amused me while I read back my writing!]
To prevent or stop this chain reaction, our body makes antioxidant compounds, including gluthione, which you might read about if you’re doing a lot of reading about antioxidants. We can improve levels of these ‘homemade’ antioxidants by eating a well-balanced diet and get additional dietary antioxidants by including lots of fruits and vegetables, as plants are our best source of antioxidants.
Oxidative stress is an imbalance.
When there are more reactive molecules and not enough antioxidants, our body is exposed to oxidative stress.
Reactive molecules are a natural byproduct of many processes in our body, so we can’t completely avoid them. However, some lifestyle factors increase the amount of reactive molecules in our body, like smoking.
We can support our body by having a well-balanced diet that includes lots of colorful plants. The same compounds that make fruits and vegetables colorful are also generally antioxidants!
Balance goes both ways
Too many antioxidants can be a bad thing. The reason why antioxidants work is because they are a little unstable themselves. However, unlike reactive molecules, which are missing an electron, antioxidants have an extra electron. This means that they easily lose that electron, stabilizing the reactive molecules AND themselves at the same time. This prevents the chain reaction because both molecules are now stable.
However, if there are no molecules missing an electron (i.e. no reactive molecules) around, the antioxidants will lose their extra one anyway, creating new unstable molecules, starting a new chain reaction.
This is not something that you need to worry about when it comes to just eating foods. However, taking antioxidants in high doses can cause this variety of oxidative stress.
The aha moment
Oxidative stress and specific reactive molecules trigger inflammatory pathways in our body. Therefore, oxidative stress leads to chronic inflammation and antioxidants and also anti-inflammatory.
How does diet affect inflammation?
There are several ways that what we eat affects inflammation. One is the connection between oxidative stress and inflammation, reviewed above. Another way is by providing the raw material our body uses to create the pro-inflammatory and anti-inflammatory mediators, those compound that either excite or balance the immune system’s inflammatory processes.
Omega-3
Omega-3 fats are well-known for being anti-inflammatory. This is because they are the building blocks for the primary anti-inflammatory mediators, especially EPA and DHA, which we get directly from fish. Fun fact, most of the EPA and DHA we eat was originally produced by microalgae. The microalgae1 were then eaten by zooplankton2, which were eaten by something bigger and so on until we get to the fish and seafood that we ate. The EPA and DHA in the salmon, herring, trout, etc. that we eat have been accumulated from the food chain.
This also means that if you are allergic to fish or are a strict vegan, you can find EPA and DHA supplements made from algae, and it will have the same biologic effect as a fish-based EPA and DHA supplement.
In addition to marine-based omega-3s, the best source is oily seeds, especially chia and flax. However, these do not have EPA and DHA, which have been shown to be the most anti-inflammatory of the omega-3 fats.
Omega-6
Omega-6 fats are essential, particularly one called linoleic acid. In the context of inflammation, important pro-inflammatory mediators are made from omega-6 fats. As I have already mentioned, and will continue to mention, this is necessary.
However, similar to antioxidants, we need to be in balance. We need enough omega-6 to provide the ingredients for necessary biologic functions, without having too much to where our body is out of balance.
So what is the right balance? Recent research3 suggests that the average diet is providing 20-50 times as much omega-6 as omega-3. However, we should probably be closer to a 4 to 1 ratio or less.
This is one reason why increasing your intake of omega-3 fats can improve inflammation and your overall health. It increases the omega-3 side of the equality, reducing the ratio. Eating less omega-6 is generally a good move as well.
Corn, safflower, sunflower or soybean oil and hydrogenated oils are the most common sources of these fats. Replacing them with a high omega-3 fat or olive oil is what I would generally recommend.
Olive Oil
Olive oil is well-known for being heart healthy. Extra virgin olive oil doesn’t use heat, like the processing to make regular or light olive oil. Most of the research on olive oil focuses on cardiovascular benefits, in part due to the type of fats, such as oleic acid. However, olive oil also contains several compounds that are antioxidants.
One study I reviewed performed a meta-analysis on olive oil supplementation. A meta-analysis takes the raw data from single studies and combines them. This gives us a different view on the research and can give more confidence in the effects that we may see. This meta-analysis was especially interesting because it was looking at the effects of inflammatory markers like CRP that are typically measured in people with inflammatory markers along with some other markers that are less commonly measured by your doctor.
Olive oil was shown to decrease these inflammatory markers. It even had slightly more of an effect than omega-3 supplements!
Of course, unlike in a research study, you don’t have to choose. Your diet can include both omega-3 fats and olive oil — in fact, it’s recommended!
Turmeric / Curcumin
Turmeric is another popular option for inflammation. It has been used for centuries in many traditional medicine systems in Asia. While not a foolproof indication of the usefulness of an herb (we’ve all heard some of the interesting things our ancestors did), traditional systems are right more often than they are wrong. This has lead to a fair number of research studies into turmeric and the compounds found in this herb.
Curcumin is the compound in turmeric that has been the subject of quite a lot of research and is a popular supplement for inflammation. The research shows a consistent effect on reducing inflammatory markers; however, most of this research is looking at individual cells, animals, or small scale human studies. This means we do have to reserve judgment on how beneficial curcumin supplementation is. This is particularly important when we consider just how strong the placebo effect can be.
I am hopeful that curcumin can be beneficial, and the research is stronger than I thought before my recent dive into the research. However, some studies show that it has much less effect in people with chronic inflammatory health conditions [footnote: source, examine.com], which is particularly important for us to note.
That said, the side effects that have been reported have generally been very mild so it may be worth experimenting with to see if curcumin supplementation works for you!
A word on experimenting with supplements
Supplements containing herbs, extracts, or fatty acids (like omega-3 supplements or curcumin) can be a part of your treatment plan. However, when you are running these self-experiments, you do need to exercise some caution. For example, high dose omega-3 supplementation can slow clotting, which can be particularly concerning for people who are taking blood thinners. For curcumin, though most reported side effects have been very mild, very high doses could lower iron levels.
It is very valuable to review any supplements you plan to take or are currently taking with your medical team. Pharmacists are a key part of this as their background is all about medications and their interactions.
When you plan to start a supplement, I recommend that you limit the number of other changes that you are implementing so you can see whether this supplement is helping you. If you start multiple supplements at once or start exercising at the same time, you won’t know what part of the change is helping. Alternatively, you could start a few things at the same time and then stop the supplement later to see if you feel worse when stopping it.
However, when you start or stop supplements, it is important to try to keep a non-judgemental and curious mindset. Placebo and nocebo effects are very powerful: if you think you will feel better, you are much more likely to do so; if you think you will feel worse, that is also more likely. The best way to minimize this, aside from setting up a blinded research study, is to keep an open and curious mindset towards change.
So how do I put this all together?
One pattern of eating that covers your anti-inflammatory bases is the Mediterranean Diet. It is one of the most studied dietary patterns, and for good reason. It has shown benefits across several different health conditions, especially those related to inflammation, such as heart disease and arthritis.
One key thing to note, because I’ve had a few clients ask about this, is that the Mediterranean Diet, as studied, isn’t necessarily the same things as the Mediterranean cuisine. The specific recipes aren’t necessarily the important factor, but rather the pattern of eating:
Daily:
- Fruits and vegetables
- Whole grains
- Nuts, seeds, and legumes
- Olive oil
- Spices and herbs
- Dairy (may also be a few times a week rather than daily)
Weekly:
- Fish, especially fatty fish, 2 times or more a week
- Eggs
- Dairy (may also be daily)
- Poultry
- Sweets (homemade/less processed more often)
Less often:
- Red meat (includes pork as well as beef)
- Highly processed foods
This overall pattern is something that you can move towards regardless of your preferred flavour profile or cuisine.
Can I get more support?
Of course you can! There are 2 ways that I can help you. I offer individual appointments to people living in Ontario, New Brunswick, Nova Scotia, Newfoundland and Labrador, Northwest Territories, Yukon, and Nunavut.
If you live outside those areas or want a different type of support, check out the Anti-Inflammatory Path to Wellness, a new course that will help you learn about anti-inflammatory habits and chart your unique Path to Wellness.
What if this all feels like too much?
If you feel overwhelmed by the thought of changing your eating or because you are exhausted, in pain, and struggling to keep the wheels turning, the Bare Minimum Health Plan may be right up your alley. Sign up below to get the free eBook!
- Overconsumption of Omega-6 Polyunsaturated Fatty Acids (PUFAs) versus Deficiency of Omega-3 PUFAs in Modern-Day Diets: The Disturbing Factor for Their “Balanced Antagonistic Metabolic Functions” in the Human Body https://www.hindawi.com/journals/jl/2021/8848161/ ↩︎
- My daughter is obsessed with Magic School Bus, to the point where I started picturing the episode with the phytoplankton and zooplankton as I was writing this. ↩︎
- Overconsumption of Omega-6 Polyunsaturated Fatty Acids (PUFAs) versus Deficiency of Omega-3 PUFAs in Modern-Day Diets: The Disturbing Factor for Their “Balanced Antagonistic Metabolic Functions” in the Human Body https://www.hindawi.com/journals/jl/2021/8848161/ ↩︎