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Anti-Inflammatory Diets

Many patients visit their healthcare provider with complaints of chronic pain that have an underlying inflammatory etiology as is seen with autoimmune diseases, osteoarthritis, and other chronic musculoskeletal conditions. There is an increasing recognition of the relationship of diet to the development of a pro-inflammatory state and the role it plays in the perpetuation of pain and ill health . Inflammation, especially when chronic, is, in part, determined by the circulatory balance of specific prostaglandin levels. These prostaglandins are synthesized from fatty acids, making these precursors an integral part in understanding how to influence the inflammatory process with diet.

In particular, there are two classes of fatty acids, omega-3 and omega- 6, that can affect the inflammatory cascade and can provide an important window
for therapeutic intervention with the dietary habits of patients. Both classes of fat are metabolized competitively by oxygenase enzymes via the arachidonic acid pathway to form eicosanoids that include prostaglandins, thromboxanes, leukotrienes, and protacyclins. Omega-3 polyunsaturated fatty acids, abundant in cold-water fish such as salmon and mackerel and also found in flaxseed and walnuts, provide eicosapentanoic acid (EPA), docosahexanoic Acid (DHA), and alpha-linoleic acid (ALA), which can reduce the synthesis of inflammatory prostaglandins . In contrast, omega-6 fatty acids tend to increase the synthesis of these inflammatory prostaglandins. Cellular membranes’ lipid composition and inflammatory balance is therefore influenced by the ratio of omega-3 and 6 fatty acids in our diets.

Avoidance of fats rich in omega-6 fatty acids such as those derived from safflower oil, sunflower oil, corn oil, vegetable shortening, margarine, and processed foods with partially dehydrogenated oils can favor the synthesis of anti-inflammatory eicosanoids. Dietary inclusion of oils contained in olives, walnuts, flax/hemp, salmon, sardines, and herring will create a favorable ratio to produce more of the anti-inflammatory metabolic pathways and regulators.

The traditional Mediterranean diet seen in countries like Spain, Italy, and Greece offers food choices that naturally support many of these anti-inflammatory principles mentioned. In addition, there is evidence that this diet can lower the incidence of cardiovascular disease, cancer, and obesity .
When observed in the cultural context of these countries, with their strong family and social bonds, noticeable pleasure in eating, varied cuisine, and daily physical activity, the traditional Mediterranean diet offers important health advantages. Unfortunately Western-style dietary habits with fast food, processed food, and high saturated fat content are rapidly becoming a part of these traditional cultures. Walter Willet, Ph.D., chairman of the department of nutrition at the Harvard School of Public Health and co-investigator of the Harvard Nurses Study, supports the advantages of this diet. The benefits of following such a diet include the following as mentioned by Dr. Weil in his book, Eating Well for Optimal Health :

• Great variety of tastes that appeal to people of many different cultures
• Emphasis on whole-grain products as opposed to refined carbohydrates in the Western diet, hence a reduced glycemic load
• Mostly monounsaturated fat and plenty of omega-3 fatty acids from fish, nuts, seeds, and vegetables
• Little meat and poultry compared to the Western diet and more fish and legumes
• Inclusion of some cheese and yogurt
• Wide variety of fruits and vegetables, including low-glycemic index fruits and vegetables, providing fiber and protective phytochemicals
• Emphasis on fresh foods
• Little processed food
• Use of familiar ingredients and good adaptability to locally available ingredients
• Relative ease of preparation
Drawbacks can include—
• May not provide enough iron for growing children and pregnant women, unless iron-rich foods are emphasized
• May not provide enough calcium unless calcium-rich foods are emphasized or supplemental calcium is added

Therefore a traditional Mediterranean diet can and should be an important strategy to consider when creating an integrative treatment plan for chronic inflammation and pain.


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