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How does nutrition reduce inflammation and aid healing?

Have you ever wondered if your diet has an impact on inflammation? Inflammation shows up in our body as inflamed joints, fatigue, and achy muscles, it can also be silent, inflammation we can't feel that slowly damages blood vessels leading to cardiovascular disease. We now have evidence that what we eat has an impact on inflammation, and by changing the food you eat inflammation can be reduced.

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Nutrition and inflammation

Have you ever wondered if your diet has an impact on inflammation?

Inflammation shows up in our body as inflamed joints, fatigue, and achy muscles, it can also be silent, inflammation we can’t feel that slowly damages blood vessels leading to cardiovascular disease.

We now have evidence that what we eat has an impact on inflammation1, and by changing the food you eat inflammation can be reduced.

What is the inflammatory process?

Inflammation is a normal defense response that is triggered by damage, either by injury, infection, or toxic compounds, and plays an important role in the healing process. It can be acute or chronic. In acute inflammation, infection or injury will trigger a fast onset of inflammation and once the threat is dealt with, inflammation reduces, and we heal up. Chronic inflammation persists indefinitely, like that in osteoarthritis (joints) or autoimmune disease (where the body attacks its own tissues).

The inflammatory response consists of two phases

The first phase – onset

When tissue is damaged or infected, the damaged cells send out signals which bring white blood cells (leukocytes) to the area. These send out pro-inflammatory cytokines, chemical messengers made from proteins, and inflammatory eicosanoids, signaling molecules made from fatty acids, which increase blood flow causing redness, swelling, heat, and fluid leaking into tissues, they also stimulate nerves causing pain. White blood cells fight the infection by devouring bacteria and virus-infected cells. The role of inflammation is to eliminate whatever is causing the damage, clear out damaged cells, and initiate tissue repair. This should be a natural and temporary response and an essential part of the healing process.

The second phase – resolution

The resolution phase is the cleaning up and healing phase. It begins once the stimulus causing the damage has been removed, for example, the immune system cells have killed the germs causing infection, the inflammatory signals reduce, and inflammation begins to cease. Inflammation must be actively stopped to reduce unnecessary damage to tissues. The macrophages (a type of white blood cell) change from being in a pro-inflammatory state to an anti-inflammatory state. The immune cells exit the scene.  Beneficial anti-inflammatory cytokines and eicosanoids are produced and released, these are small molecules that send messages to cells,  in this case sending a message to cells to decrease inflammation, and start repairing and rebuilding tissues2.

Ideally, we need a short effective onset phase and then the strong anti-inflammatory resolution phase.

Chronic inflammation occurs when the trigger for inflammation continues. Certain white blood cells (macrophages) and pro-inflammatory chemicals continue to stay in an area and resolution does not occur. The tissue affected becomes thickened and scarred over time, for example, chronic liver inflammation from fatty liver causes liver sclerosis or scarring.

Common factors that promote chronic inflammation are:

  • Ongoing mechanical stress, such as repetitive stress injuries, or an infection causing tissue damage
  • A persistent irritant; diet or environmental, such as smoking, allergens, polluted air, or industrial chemicals
  • An autoimmune disorder, like rheumatoid arthritis, where the immune system mistakenly attacks healthy tissue as though it were foreign
  • A chronic infection like a virus that stays in the body

What role does diet play?

Food and nutrients counteract inflammation and facilitate healing in two different ways:

  • Reduce chronic inflammation resulting from metabolic syndrome
  • Supply the nutrients required for a healthy immune response and then switch off inflammation and promote healing.

Reduce chronic whole-body inflammation

Systemic inflammation is chronic inflammation that is generalised, inflammatory mediators or chemicals are increased throughout the body at a low level all the time. This alters our ability to turn off inflammation properly and heal when we are injured.

Metabolic syndrome is a state in which there is increased chronic inflammation. How do you know if you have metabolic syndrome? You will be suffering from high blood pressure, abnormal lipids (cholesterol), insulin resistance, high blood glucose (pre-diabetes and type 2 diabetes), and obesity, especially internal abdominal fat3,4. Fat cells in visceral (internal fat) contain immune cells that secrete inflammatory cytokines, chemicals that increase inflammation5,6. In diabetes or prediabetes blood glucose levels are higher than ideal all the time, and the glucose binds to proteins in the body. This changes the proteins’ structure and function. Inflammatory chemicals are increased as HbA1c (average blood glucose) levels increase7. You might have seen this on a blood test if you have been tested for diabetes. Over time high blood glucose damages small blood vessels that supply organs like the eyes, kidneys, and nerves. High blood glucose also increases the damage in osteoarthritis (inflamed joints)8.

Reducing body fat, and managing blood glucose will reduce chronic inflammation

Simple diet changes to lose weight, and manage your blood glucose

Fat and carbohydrates are the macronutrients that, when eaten in excess increase blood glucose and fat storage. This is exactly the combination of foods that has increased in the last 50 years of the obesity epidemic; highly refined starches and fats9,10. Think about all the snack food and easy meals we grab; muffins, cake, cereal bars, savoury snacks, bakery products, pasta with creamy sauces, donuts, deep-fried foods, pizza, chocolate, and ice-cream. Fat in these foods is often invisible, for example, a donut can contain around 4 teaspoons of oil, a small packet of French fries 3 teaspoons of fat.

A simple switch to unprocessed whole-food carbohydrates primarily from colourful vegetables, fruit, and fibre-rich starches like root vegetables, true whole grains, and legumes will fill you up, digest slowly, thereby controlling blood glucose, as well as increase the nutrients in your diet. For some eating fewer carbohydrates overall is necessary to decrease blood glucose.

Dietary fat does not increase blood glucose, however, in excess, it gets tucked away in our fat cells. Fat eaten in whole food forms like nuts, seeds, egg yolks, and avocado are preferable as they are nutrient-rich and less easily overeaten.

To reduce hunger while cutting calories, protein is your friend. Protein increases satiety more than fat or carbohydrates, by sending chemical signals to your brain where appetite is regulated. Protein is difficult to turn into fat, as well it does not increase blood glucose. Eat a portion of protein at every meal, around a palm size; lean meat, poultry, fish, eggs, seafood, tofu, tempeh, are good choices11.

Protein is also essential for the healing process as all the cells in our body, including those in your bones, joints, and muscles are made from amino acids, the building blocks of protein12.

Nutrients that quell inflammation

The active process of switching off inflammation is done by anti-inflammatory mediators or signaling molecules; cytokines and eicosanoids. Anti-inflammatory eicosanoids are made from the long-chain omega 3 fatty acids EPA and DHA13,14.  Long-chain Omega 3 is found mainly in seafood, particularly oily fish like salmon, sardines, mackerel, and tuna.

Australian studies show that 80% of us do not consume enough Omega 3 in our diet15. To make sure we get adequate omega 3 we need to eat oily fish at least 3 times a week or take Omega 3 supplements. If you do not eat seafood or animal products, there are algae-based Omega 3 supplements available. Quality is paramount when choosing an omega 3 supplement, as many off the shelf in New Zealand have high levels of oxidation and are poor quality16. For people with high levels of inflammation, a daily high dose supplement is recommended 17, the upper limit is 3000mg of EPA plus DHA.

You may be aware that some plant sources, like flax oil, contain omega 3. However, this is in a short-chain form and is not able to be used to make the anti-inflammatory mediators until our body converts it to the active long-chain forms of EPA and DHA. Humans do not convert this well, which is why it is best to use EPA and DHA forms.

Polyphenols and antioxidants

Polyphenols are found in abundance in plant foods, and a number have been studied for their anti-inflammatory properties. Polyphenols reduce proinflammatory mediators and oxidative stress, and slow joint damage in arthritis18. Increase the polyphenols in your diet by eating a rainbow of plant foods, all the different colours are associated with different polyphenols. Specific foods to include are turmeric, garlic, green tea, olive oil, cocoa, and berries19. Aim for at least 6 fists or cups of colourful fruit and vegetables per day.

Micronutrients

All micronutrients (vitamins and minerals) are important for health, and we cannot build and repair our body’s tissues without the entire range of building blocks. Nutrient deficiencies impair a proper immune response to infection and slow our ability to heal. For example, magnesium deficiency20 is associated with chronic inflammation, and deficiencies of vitamin K and D are associated with more severe osteoarthritis 21. A poor diet is associated with greater inflammation in rheumatoid arthritis, an autoimmune disease22.

New Zealander’s diets are often deficient, with 25% of us deficient in zinc, 30% have insufficient vitamin D levels, and in those with darker skin, up to 60% have inadequate vitamin D. Over one-third of males and half of females are deficient in selenium, and for vitamin A, 23% of males and 12% of females are deficient 23

How to increase nutrients in your diet

To get an entire spectrum of nutrients in your diet, ditch or decrease the highly processed foods (as these displace nutrient dense foods) and include:

Protein-rich foods; lean meats, poultry, eggs, and dairy, tofu, tempeh, plus a variety with seafood and shellfish at least 3 times a week. Aim for a palm-size or more at each meal. Bone broth or collagen hydrolysate is rich in certain amino acids that may help rebuild cartilage24.

Eat a large range of fibre-rich plant foods; legumes, lentils, true whole grains, colourful fruit and vegetables, mushrooms, and seaweed. Aim for 6 fists or more of colour each day. Add plenty of herbs and spices, like ginger, garlic, and turmeric.

Whole food fats; seeds, nuts, avocado, virgin olive oil, fish oil and egg yolks. Eat 1 -2 small handfuls of fat rich food each day depending on your calorie needs.

Foods to ditch when fighting inflammation

Certain foods increase inflammation by either displacing nutrient-dense foods or supplying the building blocks of pro-inflammatory mediators.

As mentioned above – limit consumption of sugars and starches, you may need to be especially strict if you have prediabetes or diabetes. Think of removing white and beige foods – sugar, white grains, finely ground and processed flours, and foods made from these. Certain foods contribute to inflammation in autoimmune diseases for example gluten, nightshade fruit and vegetables, and dairy. (See previous articles on rheumatoid athritis and diet). In these cases, an elimination/reintroduction diet can pinpoint the problem foods.

Certain fats in excess increase inflammation.  Seed oils are high in the polyunsaturated fat Omega 6, which is the building block of pro-inflammatory eicosanoids. The current western diet includes large amounts of omega 6 rich fat, as it is used widely in the food industry and in margarine. Seed oils high in omega 6 are safflower, sunflower, and soybean oil. The imbalance of high omega 6 and low omega 3 tips our body towards inflammation. Using oils high in monounsaturated fats; olive oil, nuts and nut oils, avocado, and limiting processed foods will ensure you do not over-consume omega 6 25.

Fats used in deep frying vats, which are reheated many times, are especially damaging as they have high levels of oxidised and damaged fats, which increase inflammation 26. Avoid deep-fried foods in general.

Meats that are charred produce chemicals that are inflammatory, slow-cooked, or low heat cooking is preferable27.

Supplements that may help:

For those suffering from high levels of inflammation, supplementation can be useful adjunct to diet, for example certain plant extracts like curcumin reduce inflammation28, as do higher levels of micronutrients like magnesium 20.

If you would like more guidance on your diet and supplements to reduce inflammation contact me (Julianne) for an appointment

 Image credit

References

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  2. Chen L, Deng H, Cui H, et al. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget. 2018;9(6):7204-7218. doi:10.18632/oncotarget.23208
  3. Monteiro R, Azevedo I. Chronic Inflammation in Obesity and the Metabolic Syndrome. Mediators Inflamm. 2010. doi:28964510.1155/2010/289645
  4. Ellulu MS, Patimah I, Khaza H, Rahmat A, Abed Y, Sci AM. Obesity and Inflammation : The Linking Mechanism and the Complications. Arch Med Sci. 2016:851-863.
  5. Hanauer SB. Obesity and visceral fat: A growing inflammatory disease. Nat Clin Pract Gastroenterol Hepatol. 2005;2(6):245. doi:10.1038/ncpgasthep0197
  6. Thijssen E, Van Caam A, Van Der Kraan PM. Obesity and osteoarthritis, more than just wear and tear: Pivotal roles for inflamed adipose tissue and dyslipidaemia in obesity-induced osteoarthritis. Rheumatol (United Kingdom). 2014;54(4):588-600. doi:10.1093/rheumatology/keu464
  7. Tessaro FHG, Ayala TS, Martins JO. Lipid Mediators Are Critical in Resolving Inflammation: A Review of the Emerging Roles of Eicosanoids in Diabetes Mellitus. Sorgi CA, ed. Biomed Res Int. 2015;2015:568408. doi:10.1155/2015/568408
  8. Mendes AF, Rosa SC, Rufino AT, Ribeiro M, Judas F. Diabetes-induced osteoarthritis: role of hyperglycemia in joint destruction. BMC Musculoskelet Disord. 2015;16(S1):4-5. doi:10.1186/1471-2474-16-s1-s1
  9. Kiecolt-Glaser JK. Stress, food, and inflammation: Psychoneuroimmunology and nutrition at the cutting edge. Psychosom Med. 2010;72(4):365-369. doi:10.1097/PSY.0b013e3181dbf489
  10. Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B. Ultra-processed products are becoming dominant in the global food system. Obes Rev. 2013;14(S2):21-28. doi:10.1111/obr.12107
  11. Stentz FB, Brewer A, Wan J, et al. Remission of pre-diabetes to normal glucose tolerance in obese adults with high protein versus high carbohydrate diet: Randomized control trial. BMJ Open Diabetes Res Care. 2016;4(1). doi:10.1136/bmjdrc-2016-000258
  12. Quintero KJ, Resende A de S, Leite GSF, Lancha Junior AH. An overview of nutritional strategies for recovery process in sports-related muscle injuries. Nutrire. 2018;43(1):27. doi:10.1186/s41110-018-0084-z
  13. Kohli P, Levy BD. Resolvins and protectins: Mediating solutions to inflammation. Br J Pharmacol. 2009;158(4):960-971. doi:10.1111/j.1476-5381.2009.00290.x
  14. Uauy R, Valenzuela A. Marine oils: The health benefits of n-3 fatty acids. Nutrition. 2000;16(7-8):680-684. doi:10.1016/S0899-9007(00)00326-9
  15. Meyer BJ. Australians are not meeting the recommended intakes for omega-3 long chain polyunsaturated fatty acids: Results of an analysis from the 2011–2012 national nutrition and physical activity survey. Nutrients. 2016;8(3). doi:10.3390/nu8030111
  16. Albert BB, Derraik JGB, Cameron-Smith D, et al. Fish oil supplements in New Zealand are highly oxidised and do not meet label content of n-3 PUFA. Sci Rep. 2015;5(1):7928. doi:10.1038/srep07928
  17. Kremer JM, Lawrence DA, Petrillo GF, et al. Effects of high‐dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs clinical and immune correlates. Arthritis Rheum. 1995;38(8):1107-1114. doi:10.1002/art.1780380813
  18. Shen CL, Smith BJ, Lo DF, et al. Dietary polyphenols and mechanisms of osteoarthritis. J Nutr Biochem. 2012;23(11):1367-1377. doi:10.1016/j.jnutbio.2012.04.001
  19. Oliviero F, Scanu A, Zamudio-Cuevas Y, Punzi L, Spinella P. Anti-inflammatory effects of polyphenols in arthritis. J Sci Food Agric. 2018;98(5):1653-1659. doi:10.1002/jsfa.8664
  20. Nielsen FH. Magnesium deficiency and increased inflammation: Current perspectives. J Inflamm Res. 2018;11:25-34. doi:10.2147/JIR.S136742
  21. Thomas S, Browne H, Mobasheri A, Rayman MP. What is the evidence for a role for diet and nutrition in osteoarthritis? Rheumatol (United Kingdom). 2018;57:iv61-iv74. doi:10.1093/rheumatology/key011
  22. Bärebring L, Winkvist A, Gjertsson I, Lindqvist HM. Poor dietary quality is associated with increased inflammation in Swedish patients with rheumatoid arthritis. Nutrients. 2018;10(10):6-13. doi:10.3390/nu10101535
  23. Ministry_of_Health U of O and. A Focus on Nutrition: Key findings of the 2008/09 New Zealand Adult Nutrition Survey. 2011;Wellington.
  24. Porfírio E, Fanaro GB. Collagen supplementation as a complementary therapy for the prevention and treatment of osteoporosis and osteoarthritis: a systematic review. Rev Bras Geriatr e Gerontol. 2016;19(1):153-164. doi:10.1590/1809-9823.2016.14145
  25. Simopoulos AP. The omega-6/omega-3 fatty acid ratio: health implications. OCL – Ol Corps Gras, Lipides. 2010;17(5):267-275.
  26. Perumalla Venkata R, Subramanyam R. Evaluation of the deleterious health effects of consumption of repeatedly heated vegetable oil. Toxicol Reports. 2016;3:636-643. doi:10.1016/j.toxrep.2016.08.003
  27. Hoffman R, Gerber M. Food processing and the mediterranean diet. Nutrients. 2015;7(9):7925-7964. doi:10.3390/nu7095371
  28. Ravalli S, Szychlinska MA, Leonardi RM, Musumeci G. Recently highlighted nutraceuticals for preventive management of osteoarthritis. World J Orthop. 2018;9(11):255-261. doi:10.5312/wjo.v9.i11.255

 

3 COMMENTS

  1. Thanks for another excellent article Julianne. I have a question that is relevant for many seniors. As we reach retirement age many of us experience a surprisingly large reduction in appetite, even with an active lifestyle. Consuming polyphenols and antioxidants from “at least 6 fists or cups of colourful fruit and vegetables per day” just is not doable. My question is how well are polyphenols and antioxidants preserved when fruit and vegetables are dehydrated (not freeze dried as those are extremely expensive). The highly concentrated dehydrated fruits, and especially the vegetables (which are much lower in natural sugars), are easy to consume in soups, sauces, blender drinks, baked goods, etc. in small quantities that are equivalent to 6+ servings of fresh vegetables and fruit. Many thanks in advance for your reply.

    • It looks like it depends on the fruit or vegetable – some retain phenolic compunds better than others. In this paper they looked at various drying techniques. In some foods drying made the polyphenols more bioavailable https://pubmed.ncbi.nlm.nih.gov/24915359/
      Any way that people get their vegetables and fruits is fine if it increases the amount. If appetite is reduced pick the fruit and vegetables with higher polyphenols for example frozen berries – which can be used thawed for desserts or in smoothies. Frozen vegetables tend to retain nutrients better than fresh, as they are snap frozen shortly after being picked.

      • Thanks Juliane. I also found this article which might serve as a rough guide to optimal drying methods for leafy vegetables.

        Published: 17 September 2015

        Evaluation of seven different drying treatments in respect to total flavonoid, phenolic, vitamin C content, chlorophyll, antioxidant activity and color of green tea (Camellia sinensis or C. assamica) leaves
        Sahar Roshanak, Mehdi Rahimmalek & Sayed Amir Hossein Goli
        Journal of Food Science and Technology volume 53, pages721–729(2016)

        Abstract

        The effect of seven drying treatments (sun, shade, oven 60 °C, oven 80 °C, oven 100 °C, microwave and freeze-drying) were evaluated with respect total flavonoid (TFC), phenolic (TPC), antioxidant activity, vitamin C and color characteristics of green tea.

        In general, drying increased antioxidant activity, TPC, TFC and chlorophyll content, while it led to a decrease in vitamin C.

        The highest TPC (209.17 mg Gallic acid/gdw) and TFC (38.18 mg Quercitin/gdw) were obtained in oven drying at 60 and 100 °C, respectively.

        Among methods, oven drying at 60 °C revealed the highest radical scavenging activity (IC50 = 167.166 μg/ml), while microwave showed the lowest one (IC50 = 505.5 μg/ml).

        Similar trend was also observed in reducing power assay. The highest vitamin C (16.36 mg/100gDM) and Chlorophyll a (17.35 mg/l) were obtained in freeze drying.

        Finally, sun and freeze drying methods were considered as the least and the most desirable drying methods, respectively the final color of green tea leaves.

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