Managing Inflammation with Diet Dr. Michael Raucci
There are many ways to categorize the different chemicals in our body and the things we consume. A simple way is to divide them into 2 general categories: pro-inflammatory and anti-inflammatory. While this categorization does not do justice to the complexity of chemical interactions, it does provide a framework upon which healthy dietary choices can be made. Pro-imflammatory foods promote or cause inflammation in the body. Anti-inlfammatory foods counteract inflammation in the body, neutralizing its effects.
In order to understand why some foods are categorized pro-inflammatory and other anti-inflammatory, one must first have a rudimentary understanding of what inflammation is and why our bodies allow for the inflammatory process.
Simply, inflammation in gross terms is the body's reaction to fight infection or foreign invasion. It is a chemical process whose purpose is to excite the immune system to prepare for battle. Our immune systems are very effective at eliminating infection and foreign substances, however, they can also at times be indiscriminate as they wage war and can often damage indigenous/needed cells. When you have an infection, you want inflammation because it helps to kill off the offensive organism or substance but if there is no such foreign invasion you do not want to have any inflammation because it can kill off your own properly functioning cells. This is why you put a hot towel over an infected boil. You want to bring in more white blood cells to fight the infection (Note: the pus that forms is dead white blood cells and foreign invaders. Often the immune process, of which inflamation is a part, is referred to as a war. In keeping with this analogy then pus is dead soldiers). When you twist your ankle but the skin is not broken, you put ice on it to limit the amount of blood and thus inflammation that accumulates. The more inflammation, the more indiscriminate destruction of healthy cells occurs. Whenever our skin has been cut or some organism has made its way into our body then inflammation is a good thing which accounts for the majority of the healing process.
It is chronic, subclinical, or systemic inflammation which is a problem. It is a problem because in addition to the continuous degradation of healthy cells, inflammation has been implicated as a cause or a major factor in nearly every disease process including cardiovascular disease and some cancers.
Defining what exactly constitutes inflammation can be a tricky endeavor. The chemicals Prostaglandin E2 (PGE2), lactic acid, K+, histamine, leukotriene B4, serotonin, bradykinin, and glycosaminoglycans represent the most common pro-inflammatory chemicals in the body. In this article, I will focus on PGE2. Prostaglandins E1 and E3(PGE1 and PGE3) are the most commonly cited anti-inflammtory chemicals and in this article I will limit my discussion to them. Again there are many more.
In addition, there are enzymes and hormones in our bodies which can act on the nutrients we consume transforming them into either pro-inflammatory or anti-inflamatory chemicals.. The most prominent of these is insulin.
For the most part, foods that are anti-inflammatory fit into a common sense model: dark green and other deeply colored vegetables, brightly colored fruits, whole grains (not processed), most nuts, spices, extra virgin olive oil, egg whites, various beans - especially lentils, and cold salt water fish such as salmon, tuna, scrod, cod, and haddock. When insulin levels are high, many biochemical pathways are shunted towards the production of pro-inflammatory chemicals whereas low insulin levels can inhibit this. One exception is Omega 3 fatty acids which are unaffected by insulin levels and lead to the production of eicosopentanoic acid (EPA) which is then broken down into a variety of substances which are anti-inflammatory.
Pro-inflammatory foods include any processed food - white bread, white pasta, bagels, crackers, white rice etc. These foods are stripped of their micro nutrients and provide a dense carbohydrate bolus which spikes insulin. Foods high in sugar such as sodas, fruit juices, candy, cookies, ice cream, potatoes, fried foods, margarine, cake, pie and others are pro-inflammatory.
As mentioned, insulin has an effect on the stimulation or inhibition of certain biochemical pathways. Too much insulin production, such as from a high carbohydrate meal, will increase inflammation in the body. As such, foods with a high glycemic index should be avoided. These often correlate with the list in the previous paragraph though there are some surprises, such as a baked white potatoe with a whopping GI of 118, instant mashed potatoes 120, home made mashed potatoe with a lower 98, and a sweet potato with a modest 70. A table of glycemic indexes can be found at any site dealing with diabetes.
In the table below a basic representation of biochemical pathways for several food types is seen.
Prostaglandin Production
As can be seen from the chart, it is the balance of PGE1 annd PGE3 (anti-inflammatory chemical
s) to PGE2 (a pro-inflammatory chemical) that correlates with a person's overall inflammatory state. It is the overall inflamatory state that can contribute to disease and pain. By direct extrapolation then, one can limit their susceptibilty to disease processes and reduce chronic pain by maintaining a positive anti-inflammatory to pro-inflammatory ratio. Looking at the chart, this can best be done by consuming fish and green leafy vegetables. The PGE3 pathway has no potential crossover to arachadonic acid, part of the pro-inflammatory pathway, whereas the PGE1 pathway allows for crossover to arachadonic acid when insulin levels are high such as when simple and processed carbohydrates are consumed and when trans fats are present. Interestingly, when one starts in the pro-inflammatory PGE2 pathway, say by consuming organ meats, crossover to the anti-inflammatory PGE1 pathway can occur when EPA or glucagon are present. This raises the issue of food combining. A side order of crab legs might not be a poor choice if the main entree is salmon. Of course, skipping the butter will be necessary.
In general, a diet high in green leafy vegetables, olive and flaxseed oils, whole grains and most types of fish which avoids simple and processed carbohydrates thus limiting insulin production will result in a lower disease and pain susceptibility. A common method of making this easy for people is to have them divide their plate into a 1/4 and a 3/4 portion. Fill the 3/4 portion with dark green leafy vegetables and the 1/4 portion with a protein. At the same tiime, the person should attempt to eat fish at least once per day. Added perks of this type of diet are weight loss for those who require it, increased energy, and more youthful skin. Water and most teas are the best choices as drinks.
When we examine societies who follow a diet similar to this, such as the Japanese and some Mediteranean cultures, we see less overall disease, less pain related disabilty, and longer lifespans. The American diet is grossly pro-inflammatory with the popularity of fast foods, supersized portions, sugary drinks, fried foods, and dense carbohydrates.
While embracing an anti-inflammatory diet is a person's best approach, some supplements can help. Fish oil pills are popular and can help but there are many enzymatic reactions that need to occur in order to get to PGE3. A better choice is directly supplementing with EPA (eicosopentanoic acid) which immediately becomes PGE3. Other anti-inflammatory supplements include grape seed extract, bioflavinoids, curcumin, boswellia, and bromelain among others. In addition, a daily 81mg aspirin is perhaps the most effective supplement a person can take.
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