The Anti-Inflammatory Diet ( Krause’s Book 14th Edition)

THE ANTI- INFLAMMATORY
DIET
Krause’s Book 14th Edition
Tehran University of Medical
Sciences (TUMS)
Batoul Ghosn

DIETARY APPROACHES TO
REDUCE
INFLAMMATION
Inflammation is thought to underlie most chronic health conditions
including metabolic syndrome, type 2 diabetes, cancer, cardiovascular
disease, arthritis, autoimmune diseases, atopic conditions, inflammatory
bowel disease, and there is now evidence linking it to cognitive decline.
Various nutrients, foods and dietary patterns have been shown to reduce
inflammatory markers as well as subjective and objective measures of
inflammation.
Multiple iterations of an anti-inflammatory diet exist: DASH (Dietary
Approaches to Stop Hypertension), Mediterranean, MIND (Mediterranean-
DASH Intervention for Neurodegenerative Delay), vegetarian, food allergy
elimination, calorie restriction, and low histamine.

In most cases, overall dietary and lifestyle habits are more important to
consider rather than any single change.
Which diet is right for any individual often depends on trial and error .
The Dietary Inflammatory Index (DII) has been developed and validated as
a tool to evaluate the overall inflammatory potential of the diet based on
evaluation of over 6500 peer reviewed research articles.
The DII consists of 45 foods, spices, nutrients and bioactive compounds
in relation to six inflammatory biomarkers IL-1b, IL-4, IL-6, IL-10, TNF-a
and C-reactive protein.
Dietary components with the most anti-inflammatory effect are included
as negative numbers in the Overall Inflammatory Effect Score as shown in
the table below.

THE FOLLOWING RECOMMENDATIONS REFLECT AN
EFFORT TO CONSOLIDATE SIMILARITIES AMONG THE
VARIOUS ANTI-INFLAMMATORY DIETS.
1. CONSUME AN ABUNDANCE OF FRUITS, VEGETABLES, HERBS AND
SPICES Colorful fruits and vegetables contain a myriad of anti-inflammatory phytochemicals
and fiber and are thought to be the cornerstone of an anti-inflammatory diet due to
their ability to down-regulate markers such as C-reactive protein (CRP), Nuclear
Factor-kappa Beta (NFkB), histamine and other inflammatory cytokines in vivo and
in vitro.
 Although most plant based foods contain anti-inflammatory properties, the
following fruits and vegetables appear to be the most anti-inflammatory based on
their mention in research:
 cruciferous vegetables, onions, berries, purple grapes, cherries, citrus fruits,
tomatoes, and pomegranates.
 Anti-inflammatory herbs and spices include:
 green and black tea, turmeric, garlic, ginger, rosemary, oregano, fenugreek,
caraway, anise, cocoa, mint, clove, coriander, cinnamon, nutmeg, red chili powder,

2. EAT A LOW GLYCEMIC DIET
Excessive amounts of refined carbohydrates and sugars may be pro-
inflammatory. Regular consumption of these high glycemic foods can
increase blood glucose and insulin levels which, when chronically
elevated, can trigger an inflammatory response.
Choosing low glycemic foods has been shown to reduce post prandial
glucose and insulin levels and “modestly lower” concentrations of the
insulin-like growth factor and improve the inflammatory and
adipokine (inflammatory proteins secreted by adipose tissue) profiles.
It’s important to look at the glycemic load of a food versus the
glycemic index because the load is a better indicator of the actual
portion of food.
For example, beets have a high glycemic index: 64, but a low
glycemic load: 5.

3. HAVE NUTS AND SEEDS
Nuts and seeds not only provide anti-inflammatory and valuable
phenolic compounds, but they provide a beneficial ratio of
polyunsaturated fats (omega-6 and omega-3) that helps to support a
healthy inflammatory response in the body.
Consume a variety of nuts in order to gain the spectrum of nutrients
that each has to offer.
Especially beneficial are pumpkin seeds, sunflower seeds, almonds,
cashews, Brazil nuts, flaxseed, sesame seeds, and walnuts.

4. ADJUST THE QUALITY AND QUANTITY OF DIETARY FAT AND OILS
Increase:
Unsaturated fats high in omega-3 fatty acids (alphalinolenic acid) which
are anti-inflammatory. Best sources include cold water fish, flax, chia
and hemp seeds, and walnuts.
Flaxseed and walnut oil are excellent plant sources of omega-3 fatty
acids, and are great for salad dressings, but should not be heated.
Canola is also a price-friendly option for obtaining more omega 3’s in
the diet, but is considered by some to be more processed.
Monounsaturated fats: Use extra virgin olive oil as the main ingredient
for sauces, salad dressings, and marinades. Unrefined coconut oil can
be used for sautéing.
Avocados can replace cheese or mayonnaise on sandwiches, and can be
added to dips, smoothies and salads.

Decrease:
Excessive amounts of animal protein contain arachidonic acid, which can
increase inflammation in excess.
Processed foods and oils are high in omega-6 fatty acids (linoleic acid) such
as soybean, corn, safflower, and sunflower oils. Omega-6 fatty acids can
increase pro-inflammatory markers in the body if eaten in excess. Many of
these oils are widely used in processed foods.
Avoid hydrogenated fats and trans fats that are found in many baked and
prepackaged foods and are in hydrogenated vegetable shortening and many
margarines.
Trans fat consumption has been shown to increase markers of systemic
inflammation and is particularly associated with coronary artery disease.
Trans fats were banned in processed foods in the US in July of 2015, but
manufacturers have 3 years to completely remove it.

5. GET ADEQUATE SOURCES OF PROBIOTICS
Supporting the gut ecology helps to keep the digestive tract healthy
and balance the immune system, which may reduce inflammation.
Fermented and cultured foods are an excellent source of probiotic
bacteria. Sources include miso, sauerkraut, yogurt, kefir, and kimchi,
tempeh and kombucha (a fermented beverage).
Getting sufficient pre-biotics to feed the good bacteria is also
important.
Inulin and fructooligosaccharides are examples of prebiotics and can
be found in bananas, asparagus, maple syrup, onions, garlic, chicory,
artichoke and many other plant foods

6. CONSIDER FOOD ALLERGY OR SENSITIVITY ELIMINATION
A food allergy is a systemic immune mediated response that involves both the
innate (macrophages, mast cells) and adaptive immune system (antibodies).
A food intolerance or sensitivity happens within the gut and can be the result
of an enzyme deficiency or a reaction to a food additive or to naturally
occurring chemicals in foods.
These adverse reactions to food can induce the production of a variety of
inflammatory mediators including immunoglobulins, cytokines and histamine.
Reactions can be either immediate or delayed, and their intensity may depend
on dose and individual tolerance.
Risk may depend on timing and composition of food exposure in early life,
diet quality and gastrointestinal microflora balance. The 8 common food
allergens that must be listed on food labels are: milk, eggs, fish, wheat, tree
nuts, peanuts, soybeans and shellfish.
Common food intolerances are non-celiac gluten, lactose, soy, histamine and
salicylate intolerances.
Common food additive intolerances are to sulfites, tartrazine (Yellow 5),
benzoic acid, and monosodium glutamate (MSG).

7. AVOID CHEMICALS
Many industrial chemicals and pesticides can irritate or disrupt the
immune system and cause inflammation.
Choose organic or low pesticide foods and “green” personal care and
cleaning products to reduce exposure.
Many canned foods contain bisphenol A in their linings.
Bisphenol A (aka “BPA”), which is also found in many plastic bottles
and food containers, is an endocrine disruptor, impairs the action of
insulin in the body, and up-regulates inflammatory pathways.
Seek out “BPA-Free” cans, and use glass containers and bottles as
often as possible.

8. ALCOHOL CONSUMPTION
Alcohol can have the effect of both increasing and decreasing
markers of inflammation, depending on the individual person and the
amount consumed.
High intake, especially for prolonged periods, can increase
inflammatory cytokines.

9. STRESS AND SLEEP
High stress levels and lack of adequate sleep are both associated
with inflammation.
Elevated circulating cortisol levels found under conditions of
psychological stress are associated with elevated inflammatory
cytokines.
Sustained sleep restriction has also been associated with an
inflammatory state and an elevation of TNF- a, IL -1b, IL-2, IL-4 and
monocyte chemo-attractant protein-1 (MCP-1).
Intentionally practicing stress reduction techniques such as
meditation has been shown to reduce the inflammatory response in
human experimental models.

EXAMPLE OF AN ANTI-INFLAMMATORY 1 DAY DIET BASED ON THE DASH*,
MIND AND
MEDITERRANEAN MEAL PATTERNS*
Breakfast: Vegetable frittata with onions, garlic, basil, spinach,
artichoke hearts and tomato. Baked sweet potato wedges. Herbal tea.
Lunch: Lentil vegetable soup and a green salad with arugula, purple
cabbage, red onion, cucumber, carrot, walnuts and a mustard
vinaigrette. Whole grain bread or crackers. Iced black tea with lemon
Snack: Greek yogurt with berries and green tea
Dinner: Lemon dill baked fish over brown rice with garlic sautéed kale
and a glass of red wine
Dessert: Dark chocolate and cherries

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