Many chronic conditions, such as asthma, lupus, irritable bowel syndrome, Crohn’s disease, glomerulonephritis and allergies are characterized by inflammation.
Normally, inflammation is a bodily response to trauma, toxins, heat, or infection from foreign organisms such as bacteria and viruses. The damaged cells release various chemicals including bradykinin (causes blood vessel dilation), histamine (causes contraction of smooth muscle and dilation of capillaries), and prostaglandins (cause inflammation, pain and fever as part of the healing process).
The swelling caused by the dilation of blood vessels and capillaries is part of the immune system’s ability to sequester the foreign matter, thereby isolating it from further contact with other tissues. The chemicals released during an inflammatory response signal and attract phagocytes (white blood cells) to the site of damaged cells to start the healing process.
Acute inflammation is short term and beneficial to the body; however, chronic inflammation can be destructive. Chronic inflammation occurs when a malfunctioning immune system doesn’t “turn off” when it should. Chronic inflammation destroys healthy tissues and is associated with the development of various diseases.
Chronic inflammation can occur anywhere in the body and is damaging because it acts like a slow-burning fire that continues to stimulate pro-inflammatory immune cells.1 Excess immune cells and their signaling molecules circulating in the body can damage blood vessel linings (in atherosclerosis), pancreatic tissue (diabetes), and joint tissue (in arthritis).2 Chronic inflammation also occurs in autoimmune diseases such as lupus, asthma, inflammatory bowel disease and allergies.
Over time, chronic inflammation can cause changes in DNA and can lead to cancer, as in the case of people with chronic inflammatory bowel diseases.3 People who are overweight or obese also experience chronic inflammation, which lends itself to water retention and weight gain.
Inflammation can cause people to feel pain, stiffness, distress, discomfort and even agony depending on the severity. Inflammation primarily causes pain because the swelling pushes against nerve endings that send pain signals to the brain. Living with chronic inflammation and pain can be debilitating and cause depression.
There are many treatment modalities for addressing and reducing chronic inflammation:
Non-steroidal anti-inflammatory drugs (NSAIDs). These drugs (such as naproxen, ibuprofen, aspirin, etc.) counteract an enzyme that contributes to inflammation.
Corticosteroids. There are two types of corticosteroids used to treat inflammation. Glucocorticoids (e.g., cortisone, prednisone, triamcinolone, and budesonide) treat conditions such as systemic lupus, arthritis, dermatitis, allergic reactions, and inflammatory bowel disease (IBS). Glucocorticoids are offered in both oral and topical forms. Mineralcorticoids are used to treat salt imbalances in the body that contribute to inflammation.
Disease-modifying antirheumatic drugs (DMARDs). This class of drugs inhibits T cells and B cells and suppresses the body’s immune and inflammatory responses. Common drugs in this category include methotrexate, sulfasalazine and azathioprine.
Biologic drugs. In this category are drugs such as Enbrel, Stelara and Humira, which all work by targeting chemicals and cytokines such as necrotic tumor factor (TNF), interleukin 1 (IL-1) and interleukin 6 (IL-6) that cause inflammation.
Many of these pharmacotherapy agents work well in controlling inflammation; however, many people experience side effects and these treatments can be expensive. Most common side effects include nausea, headache, dizziness, diarrhea, extreme weakness or fatigue and dry mouth. And some medications can create severe side effects such as hepatic problems, blood disorders and even fetal harm in pregnant women.
Nutrition therapy. The one treatment modality that has few to no side effects is diet. The typical American diet is rich in pro-inflammatory fried and processed foods. The unhealthy food that people are eating affects the body in many ways and chronic inflammation is just one of them.
We commonly hear about hypercholesterolemia, hypertension and atherosclerosis being associated with dietary intake; however, more recently diet has been linked to chronic inflammation.4 Moreover, research pertaining to chronic inflammation is proving that the body reacts to the types of foods a person eats, whether healthy or not.
Foods that are pro-inflammatory include fried foods, red meat, processed meats (e.g. sausage, bacon and deli meats), snack foods, sugar-sweetened beverages (e.g., sodas, energy drinks and juices), baked goods, vegetable-oil-laden products and refined carbohydrates. Omega-6 fatty acids are pro-inflammatory and are found in all kinds of fried foods.
These products as well as highly processed foods contain high levels of AGEs (advanced glycation end products). AGEs are compounds produced in the body through an array of chemical reactions. These reactions occur in response to elevated blood sugar levels. The danger of AGEs is that they can clog the microvascular system of the eyes, heart, kidneys and brain, thus contributing to higher risks of complications of disease states like diabetes mellitus and heart disease.
Foods high in saturated fat are also pro-inflammatory. Although a moderate intake of yogurt with active cultures can be beneficial to the GI tract, dairy foods high in saturated fat can decrease levels of good gut bacteria, which are crucial participants of the immune system in reducing inflammation.
Saturated fats also inflame white adipose tissue; this type of tissue stores energy while brown adipose tissue is catabolic and burns energy. If fat cells increase in size, through the intake of excess calories of processed foods, they release pro-inflammatory mediators that provoke a systemic inflammation response as well. Therefore, staying at a healthy body weight (or losing weight if overweight or obese) also helps in managing chronic inflammation.
Although there is no set “anti-inflammatory diet,” combatting chronic inflammation with nutrition is as easy as getting back to the basics. Patients should consume more fresh fruits and vegetables, and choose whole grains, nuts, omega-3-rich fish and healthy oils such as olive oil. Anti-inflammatory foods contain phytochemicals that carry out healthy biochemical and biological activity at the cellular level, which is beneficial for the body.5 But processing foods can damage and destroy phytochemicals; therefore, whole foods are recommended to ensure the best nutritional benefit. (See Table 1.)
Table 2 lists anti-inflammatory foods that can help you start the conversation with your clients about healthy foods and chronic inflammation. By choosing more of these foods daily, and stopping the intake of highly processed foods, your patients will be feeling better soon.
Tammy Hutchisen, RD, LDN, is the director of clinical and commercial services at Nutritional Resources, Inc. (d/b/a HealthWise). She is a member of the Academy of Nutrition & Dietetics, (AND), the AND Weight Management DPG, and the Georgia Academy of Nutrition and Dietetics (GAND). She can be contacted through healthwisenri.com.
1 Nordqvst C. “Everything You Need to Know About Inflammation.” Medical News Today. Nov. 24, 2017. 2 Want X, et al. Inflammation Markers and Risk of Type 2 Diabetes. Diabetes Care. 2013;36(1):166-175. 3 Calder P. Long Chain Fatty Acids and Gene Expression in Inflammation and Immunity. Current Opinion in Clinical Nutrition & Metabolic Care. 2013;16(4):425-33.
4 Minihane A., et al. Low-Grade Inflammation, Diet Composition and Health: Current Research Evidence and Its Translation. Br J Nutr. 2015;14;114(7):999-1012.
5 “Foods That Fight Inflammation.” Harvard Health Publishing. https://www.health.harvard. edu/staying-healthy/foods-that-fight-inflammation. Updated August 2017. Accessed August 2018.