Need advice on following an anti-inflammatory diet? A nutritionist explains which foods to eat and avoid, plus the conditions that might benefit from this healthier style of eating.
Nutritionist Kerry Torrens explains what inflammation is and explores whether diet might make a difference for those suffering from a chronic inflammatory condition.
This article is not intended as medical advice. If you are concerned about symptoms, speak to your GP about your treatment plan before making any changes to your diet.
An introduction to anti-inflammatory diets
We tend to think of inflammation as something to be avoided at all costs, but it’s important to remember that inflammation is a natural response actioned by our immune system. In certain circumstances, inflammation helps keep us well and protects us from infection and tissue damage following injury.
Inflammation is usually a short-term reaction to something that our body interprets as harmful, whether that’s a bacteria or virus, an injury from a cut or burn, or exposure to a toxin. A series of complex chemical reactions takes place and results in the classic signs of inflammation – swelling, redness, heat, pain and possible loss of tissue function at the wound site or injury.
But when our immune system fails to switch off the inflammatory process, problems may occur. It is then that an acute, fast-acting reaction is at risk of becoming a chronic, long-term condition with a damaging impact on our health and wellbeing.
An anti-inflammatory diet can help manage symptoms by reducing the effects of the inflammatory process. The diet restricts certain foods while encouraging others, and recommends eating at specific times to influence inflammation. An anti-inflammatory diet focuses on eating whole plant-based foods and fish – rich in healthy fats and phyto-nutrients – while stabilising blood sugar. In doing so, the diet aims to influence the control mechanisms that manage the inflammatory process.
Are anti-inflammatory diets effective?
Everyone has a unique immune system that responds to particular circumstances differently, so the effects of any dietary protocol will vary from person to person. Other factors include the level of compliance with the diet and commitment to make positive change. This, combined with the complexity of the inflammatory process, explains why many people suffering from inflammatory conditions find a multi-pronged approach is best for helping them manage their condition. An anti-inflammatory diet may form part of this approach, but may not switch off inflammation on its own. That said, evidence supports that for some people, an anti-inflammatory diet may ease symptoms or act as a valuable supplement to medical or physical interventions, making day-to-day symptoms more manageable.
Which conditions might benefit from an anti-inflammatory diet?
Inflammation is thought to be at the root of a number of chronic diseases, including auto-immune diseases such as lupus and Rheumatoid arthritis, as well as cancer, heart disease, diabetes, bowel diseases, depression and Alzheimer’s.
Lifestyle and diet may affect risk factors for some inflammatory conditions – obesity and being overweight in particular puts you at a greater risk. Obesity is a silent inflammatory condition, where excess fat tissue causes over-production of inflammatory messengers. It is referred to as 'silent' because it takes place without pain. In time, this may lead to systemic inflammation, metabolic syndrome and eventually type 2 diabetes.
Other inflammatory conditions have a hereditary connection; these atopic conditions include asthma, allergy and skin conditions such as eczema and psoriasis.
Which foods are included in an anti-inflammatory diet?
Certain foods trigger the inflammatory process while others inhibit it. Early research suggested that too many omega-6 fatty acids in the diet were linked to pro-inflammatory pathways in the body. However, more recent findings suggest this is not quite as clear-cut as was originally thought. Both omega-6 and 3 faty acids are essential in the diet, but the focus should be on foods rich in omega-3 fatty acids (such as fatty fish and nuts) while seed oils rich in omega-6 fatty acids should be limited (such as sunflower and grapeseed oils). For this reason, most fats eaten as part of an anti-inflammatory diet should be low in omega-6 fatty acids and saturates. Good choices include olive and nut oils, such as walnut. Omega-3 fatty acids in the form of fatty fish and unsalted nuts are also encouraged.
The Mediterranean diet
Most experts advocate a Mediterranean diet that includes fish, vegetables, wholegrains, nuts and quality cold-pressed olive oil. It's thought that rather than one specific food being the answer to managing inflammation, the variety of foods in a traditional Mediterranean diet actually work together to promote favourable effects on the body.
An important component of a Mediterranean diet is olive oil, a rich source of mono-unsaturated fats. Extra-virgin olive oil is less processed and retains more polyphenols, which may be effective against inflammation and pain. As a guide, you should aim to include 1-2 tbsp oil in your diet daily. Choose the best quality you can afford, buy it in small quantities and choose dark glass bottles where possible. In addition, enjoy a small handful of unsalted nuts each day.
Fatty fish including salmon, trout and sardines
Fatty varieties of fish, such as salmon, trout and sardines, supply long-chain omega-3 fatty acids that have potent anti-inflammatory properties. Aim for at least two portions (140g cooked weight) weekly.
Colourful fruit and vegetables
Colourful plants, like leafy greens and berries, contribute plant compounds called phyto-nutrients, which help lessen the effects of inflammation. Although mainly found in plant foods, they're also present in foods such as salmon (astaxanthin). Phytonutrients help to reduce the effects of inflammation, improve the gut barrier and strengthen our immune defences. Include at least five portions of different fruit and vegetables in your diet daily, and choose from a variety of colours like dark green, orange, yellow, red and purple.
Non-starchy vegetables and wholegrains
Stabilising blood sugar and insulin response is important for managing inflammation, so the carbohydrate content of an anti-inflammatory diet should focus on colourful, non-starchy vegetables, a moderate amount of fruits and some wholegrains for fibre. Combining these with healthy fats and lean protein reduces the glycaemic load of a meal.
Other foods and factors
It’s worth remembering that the ideal composition of your diet may vary depending on the inflammatory process involved. For example, an obese person may benefit from more protein, as it promotes a process called thermogenesis which helps with weight management and hormonal control. Similarly, a food that would work to reduce inflammatory symptoms for most people may have the opposite effect if an individual has an intolerance or allergy to it.
An anti-inflammatory diet needs to take account of the likes and preferences of the individual as well as their lifestyle because to be effective long-term, they will need to be compliant for life.
Finally, there is the question of meal timing. The very action of eating is pro-inflammatory, so allowing the gut time to rest by adopting an eating window may prove beneficial.
Which foods should be avoided in an anti-inflammatory diet?
The main foods to avoid are highly processed or refined foods. These are easily broken down by the body and rapidly absorbed, which means they cause spikes in insulin production, promoting inflammation. They are also typically of low nutritional value and easy to overeat. Sugary foods and drinks disrupt blood sugar control and promote the release of inflammatory messengers called cytokines, which may trigger an inflammatory response. Eating a high proportion of refined carbohydrates is proven to be pro-inflammatory – white rice, bread, pasta, processed foods and potatoes all impact the glycaemic load and insulin release.
In addition to this, the combination of high levels of fat and sugar are associated with reduced gut integrity and disruption of the beneficial bacteria that live there. This can lead to compounds known as endotoxins passing into the bloodstream and triggering an inflammatory response. Deep-fried foods and foods rich in trans fats should be minimised or, at best, avoided. Saturated fats increase inflammation, especially in those who are overweight or obese.
Can inflammatory conditions be managed through diet?
An anti-inflammatory diet is beneficial for all, regardless of whether or not you suffer from an inflammatory condition. Significant dietary influences have been established for adopting a diet that promotes blood sugar control, includes adequate dietary fibre and a beneficial fatty acid composition, and supplies phytonutrients such as carotenoids and flavonoids – the latter being found in colourful fruit and vegetables.
Although beneficial, diet alone is unlikely to be the answer for all people, and in such cases, it is worth considering other influences on the immune system. One factor to consider is light exposure – 80% of our immune system is under the influence of the circadian rhythm, and with modern lifestyles exposing us to more artificial light, it may be worth reviewing daily habits. Aspects to consider include access to the outdoors during daylight hours, especially in the morning, as well as screen use during the evening. Stress, insufficient physical activity, smoking, excess alcohol and lack of sleep could also promote inflammation.
Although diet may be effective in easing symptoms and aiding day-to-day management, it is important for anyone with a chronic inflammatory condition to follow a comprehensive treatment plan that's been approved and is overseen by their GP or health practitioner.
This article was published on 31st October 2019.
Kerry Torrens is a qualified Nutritionist (MBANT) with a post graduate diploma in Personalised Nutrition & Nutritional Therapy. She is a member of the British Association for Nutrition and Lifestyle Medicine (BANT) and a member of the Guild of Food Writers. Over the last 15 years she has been a contributing author to a number of nutritional and cookery publications including BBC Good Food.
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