Download Anti-Inflammatory Menu

The Anti-Inflammatory Menu - Lifestyle & Nutritional Approach (advanced handout)
HEALTHY OILS:
↑ Omega-3 Fatty Acids – reduces proinflammatory prostaglandin & leukotriene synthesis, alters inflammatory gene expression (to suppress
pro-inflammatory cytokines and adhesion molecules) by activating transcription factors including PPAR-γ, AND produces a family of antiinflammatory mediators (resolvins). Serum levels also predict the response of proinflammatory cytokines to both psychological stress 1 and
stress reduction.
FISH OR FISH OIL especially cold water fish: salmon, mackerel, sardines, herrings, and albacore tuna
If as supplements, Eskimo-3 or Nordic Naturals Ultimate 2 - 7 gm/day, by EPA + DHA content
Probably NOT cod liver oil, which at anti-inflammatory doses provides excessive Vitamin A.
vegetarian? use Alpha Lipoic Acid as substitute, max 10% conversion, but still impressive results.
flax seed, walnuts, hazelnuts, pecans, and almonds, purslane or other dark green leafy vegetables
with either, also include antioxidant supplementation, which keep the oils healthy even after they’ve been eaten.
↑ Monounsaturated FAs – Olive & Canola Oils, avocado, tree nuts, tree nut butter (best to limit peanuts)
↓ Omega 6 Fatty Acids – Avoid most vegetable and animal fats, all hydrogenated or saturated fats.
No Trans-fats
No “Partially hydrogenated vegetable oil”, margarine, shortening, commercial deep frying oils, and commercial
baked goodsm or snacks like cookies, crackers, and chips. NO TWINKIES! Movie and sporting event popcorn,
doughnuts and fried fast food, like french fries, are also rich in Trans-fats.
PROTEIN CHOICES with anti-inflammatory effects and little arachadonic acid:
Fish
salmon, sardines, tuna, mackerel. (See www.seafoodwatch.org and www.ewg.org/node/15436 for safe choices)
Vegetables
soy products, walnuts, flax seeds, nuts.
Soy (contains the isoflavones Genistein & Daidzein) antioxidants, phytoestrogens, anti-cancer effects in most studies
low fat or non fat dairy
↓ poultry
↓↓ (minimize) beef, pork, and most dairy. especially avoid grain fed beef, which is loaded with omega-6’s.
CARBOHYDRATE CHOICES:
aim at a Low glycemic load. ↓ or ↓↓ flour and sugar. The glycemic load reflects how rapidly the carb is absorbed into the bloodstream.
Whole Grains - but LIMIT WHOLE WHEAT FLOUR as well as white flour!
↑occassional dark chocolate – antioxidant polyphenols.
SPICE CHOICES which enhance the anti-inflammatory pathway:
Spice
active agent enzyme inhibited
dose if used as a supplement
Turmeric
Curcumin
lipoxygenase & COX-3 enzymes, TNF-α, & IL-1 β. 400-600 mg three times daily
Red Pepper Capsaicin
COX enzymes
Ginger
PGE2 and lipoxygenase
500 mg twice daily
Rosemary
Carnosol
lipoxygenase
HYDRATION CHOICES:
At least 64 oz of non-caffienated fluids per day, but ↓ juices (high glycemic load)
Green Tea – Polyphenols, esp the catechin EGCG (epigallocatechin gallate), antioxidant
Red Wine – Reservatrol, antioxidant
SUPPLEMENT APPROACH - Botanicals, vitamins, and minerals with direct anti-inflammatory effects:
Vitamin D – 1000 IU Vitamin D2 daily in summer, 2000 IU Vitamin D2 daily in winter. To reduce inflammation, vitamin D (D3 form)
is locally converted to active form, which binds nuclear Vit D Receptor, producing an activating transcription-regulating
complex, shutting down further inflammation.2
Boswellia
boswellic acid inhibits complement systems & lipoxygenase, LTB4
1-2 capsules twice daily
GLA/EPO/Borage Oil if also taking mod to high dose of EPA – somewhat controversial.
MIND BODY APPROACH: aka Psychoneuroimmunology - how we feel affects our bodies!
Stress reduction techniques ↓circulating neuropeptides, ↓prostaglandins, ↓cortisol, ↓adrenaline, ↓interleukin-6.
Meditation, breath work, bioenergetic exercises such as qi gong or tai chi, guided visualization, biofeedback, progressive muscle
relation, self-hypnosis, yoga, and others are all options.
Anger reduction
Forgiveness training (Fred Luskin, Stanford)
Social Connectedness vs Social Isolation
Sense of Coherence (Aaron Antonovsky, 1980) Life as comprehensible, manageable, and meaningful – predicts better health and longer survival3
ALTERNATIVE SYSTEMS / ENERGY MODALITIES:
Acupuncture – reduces and moves excessive heat in organ systems.
Reiki
Healing Touch
Homeopathy
Arnica for local & systemic use
constitutional remedies
DIET:
To make the diet easy, start off with the high points summarized by Michael Pollan4:
 Eat food,
 not very much, and
 mostly vegetables.
We can include nearly all the points we’ve discussed if we add:
 mostly organic, including dairy, eggs, and meat if you can afford it,
 lots of fish,
 healthy oils,
 eat the rainbow,
 limit white foods.
 include protein, carbs, and healthy oils in every meal.
EATING THE RAINBOW – Foods with the best dietary antioxidants, based on antioxidant content,
can be identified by the color of that phytonutrient.5
BLUE
Blueberries, blackberries
anthocyanins
↓BP, ↓liver injury to toxins,
Cherries, red grapes, beets, pom.
↓Ca risk, antimicrobial6
RED/PURPLE
Pomegranate, grapes, berries,
Ellagic acid
↓risk prostate cancer
red apples
RED
Tomatoes, watermelon,
carotenoid,
↓risk prostate & GI Ca
pink grapefruit
Lycopene
ORANGE
Carrots, mangos, winter
α & βcarotenes
↑transcription of hepatic
squash, sweet potato
conjug. enzymes (to detoxify)
ORANGE/YELLOW
Oranges, peaches, papaya,
β-cryptothanxin
antioxidant carotenoid
YELLOW/GRN
Spinach, greens, corn, peas,
carotenoids
ocular health
avocado, honeydew
lutein & zeaxanthin ↓cataracts & macular degen
GREEN
Broccoli, brussels sprouts,
sulforaphane, indoles, ↓cancer risk
cabbage, kale, bok choi
isothiocyanate
WHITE/GREEN
Garlic, onions, celery, pears,
allicin, quercetin
inhibit phospholipase A2,
endive
COX 1 & 2, lipoxygenase
For FISH OIL, Nordic Naturals and Carlson’s have the best data and the best quality
control. Dose is the sum of EPA and DHA found on the back of the bottle. I recommend
daily doses of 1 gm for everyone, 2-3 gms for modest anti-inflammatory effect, and up to
90 mg/kg body wt for robust anti-inflammatory effects. Most farmed fish has very little
omega-3 FA, because very little is in their feed, while wild sockeye salmon has the most!
For PRODUCE, go to www.foodnews.org for a listing of pesticide residues in nonorganic produce. If you do mostly eat organically, use this while ordering at restaurants
that may serve non-organic foods to guide your choices. If the prices of organic produce
are a problem, use this to guide your choices at the grocery, to determine which are worth
the extra money.
The Mediterranean style diet is anti-inflammatory, immune stimulating, and possibly cancer
preventing. Aim at 8-10 servings of vegetables and fruits daily, 4-6 servings of whole grains,
regular use of nuts and seeds, low to moderate amounts of fish, poultry, and dairy products and
very little red meat. Use olive oil as the principal source of fat.
Lyon Study of an ALA enhanced Mediterranean diet (1999) – 76% reduction in
secondary prevention of heart attacks in experimental group without change in lipids, but
with ↑ALA, EPA, and ↓ LA and AA. Experimental group’s butter & cream replaced
with 5% ALA margarines, control group on the prudent American Heart Association diet.
605 patients. At 27 months the experimental group with 3 cardiac deaths and 5 non fatal
MIs, control group had 16 cardiac deaths and 17 non-fatal MIs. The study was
terminated early because it was deemed unethical to continue the control group.7
The effects continued on four year followup.8 (Statin studies show a max 37% reduction
for the best of the agents.)
Enzyme cofactors: Ca, Mg, Zn, B3, B6
ANTIOXIDANTS
A – ideally β carotene rather than preformed vitamin A
C – ideally 200 – 400 mg twice daily
E - 400 – 800 IU/day, depending on dose of fish oil, taken as mixed tocopherols,
tocotrienols, +/- γ-tocopherols.
AVOID d,l-α-tocopherol (l-α-tocopherol is OK, mixed are better)
Selenium – 100 to 200 μgm daily, >400 may be excessive.
CoQ 10
Proanthrocyanidins/pycnogenols
Reservatrol
1 Simopolous, A. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll of Nutrit.,
21.6, 495-505, 2002.
2 Holick, M. How Vitamin D Modulates Immune and Inflammatory Processes, presented at Univ of Az
Nutrition and Health conference, Phoenix, Az in 4/2008.
3 Eriksson, J Epidemiol Community Health. 2006
4 Pollan, M. The Omnivore’s Dilemma: a Natural History of Four Meals. Penguin Press, 2006.
5 Heber, David. What Color is your Diet?: the Seven Colors of Health. HarperCollins Books, 2001.
6 Weil, A. Healthy Aging: A lifelong guide to your physical and spiritual well being. Knopf, 2005, 156.
7 Leaf A. Dietary prevention of coronary heart disease: the Lyon Diet Heart Study. Circulation.
1999;99(6):733-35.
8 deLorgeril M, Lalen P, Martn JL, et al. Mediterranean diet, traditional risk factors, and the rate of
cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study.
Circulation. 1999 Feb 16;99(6):779-85.