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a plant-powered
anti-inflammatory
prescription
Sharon Palmer, RD
editor of
Environmental Nutrition
author of
The Plant-Powered Diet and
Plant-Powered for Life
sharonpalmer.com
my plant-powered journey
I come from a long line of farmers
Images: Sharon Palmer, RDN
my plant-powered journey
My mother grew up on a farm, too
Images: Sharon Palmer, RDN
my plant-powered journey
Even when we lived in the city,
we had a garden
Image: Sharon Palmer, RDN
my plant-powered journey
I helped grow food, too
Image: Sharon Palmer, RDN
my plant-powered journey
I became a dietitian!
Image: Sharon Palmer, RDN
my plant-powered journey
Got my kids in on the act!
Image: Sharon Palmer, RDN
my plant-powered journey
Even now, they love
anti-inflammatory eating: tomatoes, beans,
greens, and beyond!
Image: Athens taverna, Sharon Palmer, RDN
“Fall in love with
plants and they will
love you back,”
Sharon Palmer, RDN,
Plant-Powered for Life
There are 40,000 edible species of
plants on the planet, each with the
power to nourish and help heal our
bodies; each plant has its own story.
There are 25,000 types of tomatoes
alone!
Images: Santa Rosa Heirloom Festival, Sharon Palmer, RDN
anti-inflammatory diets are hot
o 23.6 million Google hits
o 1,661 books on Amazon
o Recommended by top diet gurus,
from Dr. Weil to Dr. Sears
o Identified as a top diet trend
recommended to treat a range of
diseases
o Parkinson’s
o MS
o Arthritis
o Injuries
sources range from the credible…
Keri Glassman, RD on CBS Health Watch
speaking on anti-inflammatory foods
…to the not so credible
Juicing For Acne Cleanse: The antiinflammatory diet
consensus on inflammation and health
“Findings from
laboratory studies
have shown that
phytochemicals
have the potential
to…reduce the kind
of inflammation
that makes cancer
growth more
likely.”
“Although it is not proven
that inflammation causes
cardiovascular disease,
inflammation is common
for heart disease
and stroke
patients and
is thought to
be a sign of
atherogenic
response.”
Image: Avocados from my tree, Sharon Palmer, RDN
academy of nutrition and dietetics
“Evidence supporting the impact of specific foods on
inflammation in the body is limited. We know that
some foods have the capacity to suppress
inflammation, but it's unclear how often and how
much is needed for this benefit. Current science
advocates overall good nutrition to help enhance
the body's immune system and provide antioxidants
to reduce inflammatory stress.”
Image: Fruit at Harrods, London, Sharon Palmer, RDN
anti-inflammatory foods
Images: Farmers market in
Pasadena, Sharon Palmer, RDN
two types of inflammation:
acute inflammation is good
o The body’s natural,
pro-inflammatory
immune response in
reaction to an injury
or assault
o Cascade of events occur to fight
infection and invading foreign
substances
o Causes significant pain
o Classical inflammation
chronic inflammation is not good
More recently recognized as chronic, low-level
inflammation, below threshold of pain
o Silent inflammation
o When the inflammatory
response is triggered for no real
cause, lasts for days, weeks,
months
o Eventually causes
organ damage,
chronic disease
inflammation: root in diseases
Pulmonary
diseases
Neurological
diseases
Autoimmune
diseases
Cancer
Inflammation
Arthritis
Cardio- and Cerebrovascular
diseases
Alzheimer's
Diabetes
*Obesity is pro-inflammatory with common links with all of
these diseases
anti-inflammatory foods
Image: Pasadena farmers market, Sharon Palmer, RDN
clinical biomarkers of inflammation
Heart
Cytokines
IL-1, IL-6, TNFa
Vessel wall
Macrophages
Adipose
NEJM 2000
CRP
SAA
Fibrinogen
Measuring silent
inflammation:
(C-reactive protein)
acute-phase protein
produced by liver in
response to cytokine
production during
illness, infection,
tissue injury, general
inflammation. Not
very selective or
specific. Other
biomarkers, i.e.
fibrinogen, IL-6, TNF.
pathophysiological sequence of inflammatory
biomarkers in acute coronary syndrome
Heart Disease:
Process that leads
to eventual plaque
erosion or rupture
involves numerous
inflammatory
mechanisms.
Circulation. 2001
Diagram:
Development of an
atherosclerotic
plaque and the local
vascular events and
biomarkers that
occur.
cardiovascular disease, stroke and inflammation
 Review:
Inflammatory biomarkers predict risk
of stroke (J Stroke Cerebrovasc Dis 2008)
 In adolescents, CVD risk associated with
adiponectin, TNFα, CRP and IL-6 (Horm Res
Paediatr, 2012)
 Risk of hypertension increased with
elevated plasma CRP and IL-6 (JHH, 2010)
 Oxidative stress produces inflammation,
and inflammation enhances oxidative
stress (Oxidative Medicine and Cellular Longevity, 2013)
anti-inflammatory eating
Image: Vegetarian restaurant, Stockholm, Sharon Palmer, RDN
inflammation and cancer
 Epi evidence connects inflammation
and cancer; long-term inflammation
leads to cancer development (i.e.
HPVcervical CA, H pylorigastric CA)
 Pre-malignant tumors are wound-like
 One-fifth of worldwide cancer
incidence associated with microbial
infection (NCI, 2009)
 Chronic irritation and inflammation
predispose to cancer, such as cigarette
smoke, asbestos, and silica (Yale J Biol
Med. 2006)
inflammation and cancer
• Inflammatory mediators stimulate
tumor cell growth (Adv Exp Med Biol 2014)
• Tumors develop and progress
within inflammatory diseases
(Adv Exp Med Biol 2014)
• “Injury-inflammation-cancer"
pathway: Recurrent injuries due to
genetic susceptibility, smoking,
unhealthy diet, and alcohol abuse
induces a pro-inflammatory milieu
(Minerva Gastroenerol Dietol, 2012)
anti-inflammatory eating
Image: Santa Monica farmers market, Sharon Palmer, RDN
weight and inflammation
 BMI/adiposity linked with elevated CRP
 Related to metabolic syndrome factors (Diabetes, 2006)
 Fat cells secrete proinflammatory compounds
(Vascul Pharmacol, 2013)
 Weight loss improves systemic inflammation
(Arch Immunol Ther Exp, 2013)
diabetes and inflammation
• Type 2 diabetes: 9.3% of entire US
population (2014)
• Diabetes = inflammatory disease,
sharing many outcomes as
cardiovascular disease (J Nutr Metab, 2012)
• Insulin resistance in obesity accompanied with
inflammation (Arch Immunol Ther Exp. 2013)
• Pro-inflammatory compounds increased in
adipose tissue, linked to
systemic inflammation, insulin resistance.
(Arch Immunol Ther Exp. 2013)
anti-inflammatory foods
Images: Pasadena farmers market, Sharon Palmer, RDN
alzheimer’s and inflammation
 Inflammation in vulnerable regions
of AD brain
 Damaged neurons, neurites, amyloid beta peptide,
neurofibrillary tangles stimulate inflammation
 Present from early preclinical to terminal stages
 Over many years, inflammation exacerbates the
very pathogenic processes that gave rise to it
 Several avenues linking AD inflammation to
pathogenesis : autopsy; in vivo (PD imaging), epi
data, and biochemical/histologic testing of patients
(Clin Neurosci Res, 2006)
enter diet
Diets high in
refined starches,
sugars, saturated
fats, and trans fats
and low in fruits,
vegetables, whole
grains, and omega3 fatty acids appear
to turn on the
inflammatory
response. (JACC, 2006)
enter diet
But a diet rich in whole foods, including
healthful carbohydrates and fat and protein
sources, along with regular exercise and not
smoking, seems to cool down inflammation.
(JACC, 2006)
Image: Bok Choy Edamame Bowl, Sharon Palmer, RDN
why is anti-inflammatory eating important?
• Reducing inflammation
critical to disease risk
reduction
• Diet plays a significant
role in reducing
inflammation
• Plant foods linked with a
number of health
benefits; antiinflammation may be
one reason
Image: Pasadena farmers market, Sharon Palmer, RDN
anti-inflammatory eating
Images: Calabasas farmers market, Sharon Palmer, RDN
diet patterns and inflammation
 Recent study comparing
three breakfasts: Western,
Med Diet (olive oil or
walnuts); Western highest
inflammatory response
(Atherosclerosis, 2009)
 Review: Mediterranean
and DASH diets
associated with lower
inflammation
(J Nutr Metab, 2012)
 Vegetarian diets linked with
lower CRP levels (Nutrition, 2004)
Image: Farmers market, Crete, Sharon Palmer, RDN
Anti-Inflammatory Foods
Images: Farmers market, Crete, Sharon Palmer, RDN
Phytochemicals: Protective Plant Compounds
Phytochemicals
phytochemicals in plants
Benefits to plants:
Benefits to humans:
• Antioxidants
• Act as natural defense
system: UV protection, anti- • Anti-inflammatory agents
• Enhance cell-to-cell
bacterial, -fungal, natural
communication
pesticide
• Alter estrogen metabolism
• Attract pollinating or other
• Cause cancer cells to die
seed dispersing insects
• Repair DNA damage
• Detoxify carcinogens
• Tufts review: regular
consumption may reduce risk of
several chronic conditions, i.e.,
neurodegenerative diseases,
atherosclerosis, and cancer.
Image: Raspberry farm tour, Bellingham, WA, Sharon Palmer, RDN
antioxidant-rich foods
• Antioxidants are like
sponges, which mop up
free radicals in the
bloodstream and help
quiet the immune system.
• Eat the rainbow
(including white):
– Fruits & vegetables with rich hues,
such as berries, broccoli, and dark leafy
greens
– less-than-colorful garlic and onions,
too!
• Whole grains, legumes, nuts
Image: Heirloom tomatoes from my garden, Sharon Palmer, RDN
Not Just the Antioxidants
A Portrait of an Anti-Inflammatory Diet
Variety of foods
Healthful fats
Low in refined, low-nutrient
Includes omega-3 fatty acids
foods
High in fruits and vegetables
Rich in antioxidant spices
and herbs
Balanced in calories to
promote optimal weight
Tea consumption
Healthful carbohydrates
Moderate consumption of
red wine (if alcohol is
consumed)
Low in animal proteins
Small amounts of dark
chocolate (at least 70%
cocoa) as a treat
Includes plant proteins such
as legumes, soy foods, and
nuts
Anti-inflammatory foods
Images: Nashville farmers market, Sharon Palmer, RDN
plant foods linked to lower inflammation
 Fruit and vegetable intake linked
with lower CRP (J Nutr, 2004)
 Whole grains lower inflammation
(Curr Opin Lipidol, 2007)
 Soy foods linked to lower
inflammation (J Acad Nutr Diet, 2012)
 Effects seen even at one meal;
Strawberry reduces inflammatory
response after high-fat meal (JACN,
2010)
Images: Hollywood farmers market, Sharon Palmer, RDN
Powerful plants: soy and CVD
•Epi data: soy intake and lower CVD rate
•FDA: Health claim 25 g/d soy protein
may reduce risk of heart disease.
•Isoflavones anti-inflammatory effects:
•Act as antioxidant
•Possible estrogen-like effects
inhibit pro-inflammatory cytokines
•Study: European women, isoflavone-enriched
bars for 8 wks, beneficial effects on CRP. (AJCN, 2005)
powerful plants: soy and cancer
•Soy Story: Populations with high soy intake, low
breast and prostate cancer rates
•Soy contains several anticarcinogenic compounds:
isoflavones (genistein), saponins and protease
inhibitors
•Soy protein and isoflavones:
•Acts as antioxidant
•Regulates immune function
•Cancer suppressive activity
•Whole food approach:
•Very high levels had stimulatory
effect on tumors
•Soy better results than soy
isoflavones (Exp Biol Med 2010)
Image: edamame, Sharon Palmer, RDN
anti-inflammatory eating
Images: Charleston farmers market, Sharon Palmer, RDN
slow-digesting carbs
• Low-glycemic foods
may reduce
inflammation; i.e.,
legumes, berries
• Overweight men &
women who ate a lowglycemic diet for 1
month reduced CRP by
22% compared to those
on a high-glycemic diet
(Journal of Nutrition, 2012)
Images: Nashville farmers market, Sharon Palmer, RDN
anti-inflammatory foods
Images: Produce market, Paris, Sharon Palmer, RDN
plant-powered star: legumes
• “ideal protein
package”
• American Diabetes
Association, the
American Heart
Association and the
American Cancer
Society all
recommend
legumes as one of
the most important
food groups for
disease prevention
and optimal health
Images: Stockholm vegetarian restaurant, I love bean dietitian t-shirt, Sharon Palmer, RDN
plant-powered star: whole grains
• Designed as natured intended, with bran
outer covering and inner germ intact
• Hundreds of studies: diet rich in whole
grains reduce risk of stroke, type 2 diabetes,
heart disease, asthma, colorectal cancer,
obesity and gum disease
• Whole grain linked to lower
inflammation; refined grains
linked to higher inflammation
(Journal of Nutrition, 2010)
Images: Food market, Stockholm, Sharon Palmer, RDN
plant-powered stars: fruits & vegetables
• Anthocyanin-rich purple
sweet potatoes appear to
protect against colorectal
cancer (Molecular Nutrition 2013)
• Eating tomato products
with a high-fat meal
significantly reduces LDL
(“bad cholesterol”)
oxidation and
inflammatory markers in
the blood (Molecular Nutrition 2013)
Images: Pikes Place Market, Seattle, Sharon Palmer, RDN
anthocyanin-rich plant foods
Plant Color
Black
Plant Foods
Blackberries, black beans, carrots
(black), currants (black), Mission figs
Blue/Purple
Blueberries, eggplant, grapes
(purple), plums, potato (purple),
sweet potato (purple), raisins
Red
Apples (red), beets, blood oranges,
cabbage (red), cherries, cranberries,
grapes (red), kidney beans, peaches,
pears (red), onions (red) radicchio,
raspberries (red), rhubarb,
strawberries, pomegranates,
potatoes (red), radishes
Images: Farmers market, Helsinki, Sharon Palmer, RDN
anthocyanin-rich plant foods
Image: Heirloom Festival, Santa Rosa, Sharon Palmer, RDN
omega-3 fats
• Fats produce
prostaglandins  these
increase or decrease
inflammation; omega-3s
produce anti-inflammatory
prostaglandins
• Plant sources: Walnuts,
flaxseeds, chia seeds, soy
Images: Food market, Stockholm, Sharon Palmer, RDN
probiotic foods & supplements
• Probiotics can reduce
inflammation in the gut, and
other parts of the body (Gut
Microbes, 2013)
• Can help with inflammatory
diseases, including psoriasis,
chronic fatigue syndrome,
and ulcerative colitis
• Fermented foods: i.e.,
yogurt, pickles, kefir,
kombucha
Images: Whole Foods, Pasadena, Sharon Palmer, RDN
• Prebiotics, i.e. garlic, onions,
asparagus
Spices & Herbs
• Rosemary, sage, thyme
retain antiinflammatory activity
after heating &
digestion (Oxidative Medicine, 2012)
• Cayenne pepper,
cinnamon, clove,
ginger, nutmeg,
oregano, tumeric, and
others
Images: Whole Foods, Pasadena, Sharon Palmer, RDN
Anti-Inflammatory Foods
bonus foods
• Drink tea
• Drink moderate
amounts of red
wine (if alcohol is
consumed)
• Allow for small
amounts of
antioxidant-rich
dark chocolate
(at least 70%
cocoa) as a treat
Image: Indio Date Dark Chocolate
Walnut Cookies, The PlantPowered Diet, Sharon Palmer,
RDN
Image: Pasadena Farmers
Market, Sharon Palmer, RDN
Eat food.
Not too much.
Mostly plants.
Michael Pollan
In Defense of Food
2015 dietary guidelines
Focused on plant-based diet patterns:
• Mediterranean
• US Healthy Diet
Pattern
• Vegetarian
Limit Saturated Fat
Limit Salt
Limit Added Sugars
Images: Farmers market, Bordeaux, Sharon Palmer, RDN
MyPlate
3/4 plate
filled
with
plant
foods
MyPlate—An Anti-Inflammatory Diet
Flickr MyPlate Tool
Physicians should consider recommending a plantbased diet to all their patients, especially those with
high blood pressure, diabetes, cardiovascular
disease, or obesity.”
Special Report, Nutritional Update for Physicians: Plant-Based Diets
Perm J 2013 Spring;17(2):61-66
Image: Outdoor market Belize, Sharon Palmer, RDN
"Nothing will benefit human health and increase
the chances for survival of life on
earth as much as the evolution to a vegetarian diet."
—Albert Einstein
Thank You
The Plant-Powered Dietitian™
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