Diet and Inflammation

Worldwide various civilizations have experimented diets with the aim to achieve homeostasis in the body which in turn will lead to anti inflammatory response, wellness and increase in life expectancy. Here we aim to highlight varied diets which are considered anti-inflammatory in various parts of the world. However it is unclear whether the diet followed is suitable for one race/ regional group may have the same effect over the other race/ region.

The search for a simple equation for diet is undergoing massive research which can be applicable to whole of mankind for overall wellness and longevity. The role of supplements are still undefined.

The advances in medicine over the years has led to the increase in life expectancy. Diseases once considered lethalhave become treatable or have been eradicated, thus moving away the prevalence from communicable and acute processes to chronic inflammatory states. For survival inflammatory response plays a pivotal role as it is a critical response of the body towards external or internal injuries, which helps to eradicate the intruder, repair and regenerate the affected tissues, further helping the body to return back to homeostasis.

Inflammations can be acute or chronic. Acute inflammations occur within minutes, hours to days and if this process does not resolve chronic inflammation ensues. A continuous proinflammatory process when being unchecked by anti inflammatory processes continuously leads to chronicity of a disease. Free radicals, oxidative stress etc  in abundance contribute to chronicity. Atherosclerosis, cancer, neurocognitive diseases are all caused because of dysfunctional and dysregulated chronic inflammatory processes.

Clinicians have thus shifted their focus for treatment and management of such chronic inflammatory conditions along with incorporating anti inflammatory diets.

One of the mainstay of reduction of systemic inflammation are dietary modifications and lifestyle changes. Since ancient times dietary modifications and regimes have been mentioned, even in age old science – Ayurveda there is a mention of aahara (diet) and vihara(activities/ exercises) and a further classification of Sada pathya and apathya ( always conducive and not conducive) diet and activities have been mentioned in detail. The concept of anti- inflammatory diet is thus not new, but the use of such diets in treatment and prevention of inflammatory conditions are relatively new entity in modern science. The examples include traditional Mediterranean diet, Dietary approach to stop hypertension (DASH), Nordic or Mexican diets.

These diets are basically a holistic lifestyle approach. Incorporating physical activity, adequate rest, socialization, biodiverse diet consumption which includes whole grains, fruits and vegetables, unsaturated fats like olive oil, protein sourced from legumes, lean protein like fish and chicken are considered to have an anti inflammatory properties. On the contrary diets comprising high amount of processed meats, saturated animal fats, high fat dairy products, artificial sweeteners and refined sugars are considered proinflammatory, which stimulate inflammatory cascadeproducing heightened levels of cytokines, chemokines, PGE2 etc.

Pro-inflammatory Diet

Anti-inflammatory Diet

Western Diet – Refined grains and sugar

Red and processed meat

High fat dairy products

High salt consumption

Artificially sweetened drinks

Mediterranean Diet – Olive oil

Whole grain products-Rye,oat,barley

Fruits( berries, apple, pear) and vegetables

Legumes and nuts

Low fat meat- chicken

Fish and sea food – shellfish, mackerel, herring, salmon

Salt restriction

Low intake of sugar- sweetened products

Moderate consumption of alcohol

Nordic Diet – Canola Oil

Whole grain products

Local Fruits and Vegetables( root vegetables, cabbage, peas, potatoes)

Local Fruits

Jiangnan Diet -Soy derived foods

Rapeseed oil

Fruits and vegetables

Fish

Legumes

Washoku Diet – Soy derived products

Fish

Fruits and Vegetables

Umami

Miso soup

Mushrooms

Seaweed

Anti-inflammatory diet as mentioned in Ayurveda

Fruits and Vegetables: Berries, green leafy and cruciferous vegetables

Spices and herbs: Turmeric, ginger, garlic, cinnamon, gooseberry

Most wholesome diet: Red rice, green gram, rock salt, cow’s ghee, sesame oil, fat of chicken meat, fat of goat’s meat, raisin

Olive oil because of its phenolic compounds has the ability to reduce reactive oxygen species and prevent diseases related to inflammation, this was studied in PREDIMED study(multicentre, randomized, primary prevention study).In another multicentric trial conducted in Spain in people with high cardiovascular disease risk, 3 diets were allotted; Mediterranean diet with extra virgin oil, Mediterranean diet with nuts and low fat control diet, 1.7-2.1% reduction in cardiovascular events were seen in the group consuming Mediterranean diet. In another similar study a significant reduction in IL6, CRP, monocyte attractant protein 1 was noted in plasma by > 16%.

In a randomized trial it was found that Japanese diet rich in consumption of tea, vegetable and seafood was associated with lower levels of IL6, CRP, HbA1c and VFA significantly, possibly due to glucose dependent insulinotropic polypeptide suppression.

A clear association with a healthy Nordic diet and IL1 receptor agonist and CRP was established in SYSDIET study. In a Randomized cross over trial it was found that with whole grain diet a significant lowering of IL6 and CRP in 8 weeks in Danish adults with metabolic syndrome risk. In another substudy, patient’s with metabolic syndrome were given Nordic diet or low fiber, milk fat, berries and small amount of fish ; after 18-24 weeks there was downregulation of TNF receptor 1A, but an up regulation of NFkB subunit and RELA protooncogene was seen. Downregulation of Toll – like receptor 4,CD 36 , and IL18  and upregulated expression of peroxisome proliferator- activated receptor delta significantly,was seen in Nordic diet group.

The whole scientific and research world is currently highly invigorated with the thought of search of a holy grail in diet and supplements which is in sync with constitution and composition of human body, which can naturally assimilate in the body without causing any inflammatory response or evenanti inflammation.

The above mentioned diet is a very comprehensive list of food that are considered anti-inflammatory in all around the world and also in our ancient science – Ayurveda

Dr.Amit Bhasin

Gastroenterologist