Inflammation Causes & Effects: Acute vs. chronic inflammation, joint inflammation, fatigue and inflammation, and anti-inflammatory foods

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By Jim Black • October 15, 2018

TABLE OF CONTENTS

Introduction
1. What is Inflammation?
2. How Inflammation Affects You
3. Fighting Inflammation with Food
4. Beyond Diet: How to Fight Inflammation

 

INTRODUCTION: The Body’s Great “Defender”

Your immune system is your body’s great defender. It is efficient and effective at healing injuries and neutralizing infectious invaders, such as bacteria and viruses. You experience “the defender” at work every time you feel feverish, suffer a bug bite, cut your hand, or watch an injured joint swell up. In all of these situations and others, your immune system engages its primary defense mechanism—inflammation—to fight off microscopic intruders that breach your outer defenses, protect against further injury, and launch a healing campaign. Without inflammation, our injuries and illnesses would never heal.

So why has something so beneficial and necessary as inflammation garnered a negative reputation? After all, rarely a day goes by when you don’t hear someone extolling the virtues of an anti-inflammatory something or other, whether it’s a food, supplement, medication, or overall lifestyle.

With inflammation, as with other things in life, you can get too much of a good thing. In short, a little inflammation goes a long way to protect your body from harm. It’s when your defense network goes haywire and inflammation continues unabated that problems ensue.

If you’re reading this free guide, obviously you’re inquisitive about inflammation. In the pages ahead, you’ll learn:

• What inflammation is and what causes it
• How and why inflammation becomes chronic
• The many ways in which inflammation affects you—including the array of diseases associated with chronic inflammation
• How your diet can influence inflammation
• Other options, besides diet, for you to explore to combat chronic inflammation

We encourage you to read on and learn more about your body’s inflammatory response, what it means, and what you can do to quell the fire of chronic inflammation.

1. What Is Inflammation?

Causes of Inflammation

“The body’s immune response to infection or injury.” That’s the classic, to-the-point definition of inflammation. In short, your body creates inflammation to battle infections or recover from an injury.

Those infections may be orchestrated by germs, such as bacteria, viruses, or fungi. For instance, a fever due to a severe cold or the flu is a sign of systemwide inflammation.

Injuries—ranging from simple cuts or a splinter in your finger to ankle sprains, muscle strains, and broken bones—are another common cause of inflammation. The pain and swelling that accompany these injuries and other types of physical trauma are indicative of your body’s inflammatory immune response.

Other, less obvious factors can contribute to inflammation in varying degrees, including emotional stress and anxiety, obesity, and exposure to tobacco smoke, among others. Even strenuous exercise can cause acute inflammation, although physical activity overall has an anti-inflammatory effect.

What Is Inflammation?

After suffering a cut or scrape, we wash out and sterilize the wound, then cover it with a bandage. Simple enough. Underneath that bandage, though, your body’s immune response to the acute injury is much more complex, involving an array of immune cells.

• First responders known as sentinel cells call attention to the injury and the presence of any bacteria and other microorganisms.
• Inflammatory chemicals, such as histamine, help stimulate the blood vessels at the site of injury or infection to dilate (vasodilation) and increase blood flow to the area.
• As a result, the tissue becomes hot, swollen, and red—some of the early steps in the healing process.
• You also develop pain to prevent you from using the damaged tissue and further injuring it.
• While triggering vasodilation to increase blood flow, the inflammatory chemicals also prompt the blood vessels to grow more permeable, allowing plasma and other fluids containing disease-fighting cells and proteins to pass through and flood the affected tissues. This process impedes the microbial enemy and helps isolate it from other tissues.
• Then, a cascade of white blood cells (phagocytes) consumes the invading pathogens along with the cells they have damaged or destroyed. The white cells also release substances known as cytokines, which fight germs and eventually alert the immune system to end the inflammatory response.

When Inflammation Becomes Chronic

The scenario above characterizes acute inflammation, in which the immune system responds to a threat, neutralizes it, and then returns to normal. Ordinarily, this process lasts only a few days or weeks and has no long-lasting or permanent effect on the body.

However, if the offending agent that triggers acute inflammation cannot be removed, the immune response may continue. Sometimes, inflammation persists even after an infection has been cured or an injury heals. Essentially, your immune system fails to hit the inflammation “off switch,” and chronic inflammation develops. Chronic inflammation also may arise if you experience prolonged exposure to chemicals or other inflammatory agents.

Unlike the “shock-and-awe” nature of an acute inflammatory response, chronic inflammation is characterized by low levels of inflammatory chemicals circulating throughout the body. And, while acute inflammation is protective, chronic inflammation, over time, exacts a toll on systems throughout your body.

A major concern: chronic inflammation that arises from the wayward immune response associated with autoimmune diseases. For reasons that aren’t completely understood, the immune system goes haywire and engages in a prolonged friendly fire of sorts, damaging—over time—healthy cells and tissues throughout the body. This chronic inflammation process can have destructive effects on your blood vessels, joints, organs, and other parts of the body and has been linked to a broad array of diseases, some of them life-threatening.

Preventable Causes of Chronic Inflammation

Several modifiable factors are known to promote chronic inflammation:

• A poor diet: What you eat may increase your inflammatory burden. A number of foods have been identified as pro-inflammatory, among them high-fat red meats, full-fat dairy products, fried foods, processed foods, refined carbohydrates, and added sugars.
• Lack of exercise: Several investigations have found that people who lead sedentary lifestyles tend to have higher levels of inflammation.
• Obesity: Being overweight or obese has been linked to increases in inflammatory substances.
• Smoking: Whether you smoke or are exposed to second­hand smoke, the toxins from cigarette smoke can increase inflammation.
• Alcohol abuse: Excessive alcohol consumption can promote inflammation.
• Emotional stress: Anxiety and stress are well-known risk factors for chronic inflammation.
• Sleep disorders: Poor sleep and sleep disorders such as insomnia and obstructive sleep apnea (characterized by brief, repeated interruptions in breathing during sleep) have been linked with increased inflammation.

Diagnosing Inflammation

An infection or injury may manifest as pain, swelling, redness, and other symptoms, so it’s obvious when you need to see your doctor for these causes of acute inflammation. Chronic inflammation, though, can go unnoticed and unchecked for years. So, unless you exhibit signs of an inflammation-related disorder, you may never have a reason to seek an evaluation for chronic inflammation.

Generally, your physician will carefully review your medical history and symptoms and perform a thorough physical exam to gain some insight into your condition. Then, depending on the type of disorder he or she suspects you have, your doctor may order one of several types of blood tests to check for markers of inflammation.

The first test may be a complete blood count, which measures amounts of red blood cells, white blood cells, and platelets in your blood. An elevation in white blood cells and platelets gives your physician an idea that inflammation from a condition like rheumatoid arthritis, colitis, or Crohn’s disease (among others) may be present.

One of the more broadly used blood tests for inflammation measures C-reactive protein (CRP), a protein produced by the liver in response to an infection, injury, or other cause of inflammation. A CRP test affords your physician a general idea as to whether inflammation is present in your body, but it doesn’t identify a specific cause of the inflammation. A related test, the high-sensitivity CRP (hs-CRP) test, measures lower levels of CRP and is used in cardiovascular risk assessment.

Your doctor may measure your erythrocyte sedimentation rate (ESR). Inflammation triggers the production of proteins that cause red blood cells (erythrocytes) to clump. The ESR is the rate at which clumped cells fall out of solution and provides general information about the presence of inflammation.

Also, your physician may recommend testing for autoantibodies, proteins produced during an errant immune response that target your own healthy tissues and organs. One of the most widely used among these tests measures antinuclear antibody (ANA), the most common autoantibody, which may indicate autoimmune diseases such as rheumatoid arthritis, lupus, Sjogren syndrome, and others.

A wide range of other blood tests may be ordered to detect autoantibodies and other biomarkers suggestive of systemic (body-wide) inflammation or more specific to certain autoimmune diseases.

2. How Inflammation Affects You

Inflammation Symptoms

The signs of acute inflammation are relatively clear. During an injury, you’ll develop redness, warmth, swelling, and pain at the injury site. If you have an infection, you might expect a fever, chills, fatigue, and achiness.

Chronic inflammation is more insidious, often offering no warning signs. When it does, its symptoms vary depending on the area of the body affected. Essentially, you probably won’t know you have chronic inflammation until you develop symptoms of an inflammatory disease, such as the aching joints of rheumatoid arthritis or the diarrhea and other signs of ulcerative colitis.

Inflammation and Your Cardiovascular Health

Cardiovascular disease is the leading cause of death in the U.S., and inflammation appears to play a major role in diseases of the heart and blood vessels.

Several investigations have found that chronic inflammation contributes to atherosclerosis, or hardening of the arteries, and that people with elevated levels of inflammatory markers are at increased risk of cardiovascular events, such as heart attack and stroke.

Experts believe your immune system perceives fatty, cholesterol-laden plaques lining your artery walls as abnormal, and it sends white blood cells to shield them from your bloodstream. However, this inflammatory response can make the plaques vulnerable to rupture, spilling their contents out into the bloodstream and exposing parts of the vessel wall not normally in contact with blood. This process can trigger platelet activation and formation of blood clots that may cause heart attacks or ischemic strokes.

Elevated levels of myeloperoxidase (MPO)—the most abundant protein found in two major white blood cells associated with inflammation—have been linked to heart attacks, and accumulations of MPO are often found at the site of ruptured arterial plaques. When arteries become inflamed, the vulnerable plaques also produce an enzyme known as lipoprotein-associated phospholipase A2 (Lp-PLA2). High levels of this enzyme suggest that a plaque is more likely to rupture and that your risk of a heart attack or stroke is increased.

Several studies support the role of inflammation in cardiovascular disease. And a major trial, the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS), found that among patients with a history of heart attack, lowering inflammation (as measured by hs-CRP) with the drug canakinumab reduced the risk of recurrent cardiovascular events independent of reductions in LDL (“bad”) cholesterol levels (New England Journal of Medicine, Sept. 21, 2017).

So, in addition to having your blood pressure, cholesterol, blood sugar, and other cardiovascular risk factors checked, you might talk to your doctor about testing for inflammatory markers, such as hs-CRP, MPO, and Lp-PLA2 (PLAC test). Medicare and many insurance providers now cover the cost of these tests.

Having elevated levels of these inflammatory markers should prompt you to be even more vigilant in reducing your risk of heart attack and stroke through more aggressive risk-factor management.

An Inflammatory Link to Cancer

Chronic inflammation also may factor into the second-leading cause of death in the U.S.: cancer. Not only can a chronic inflammatory state weaken your immune system and make you more vulnerable to cancer, but over time, prolonged inflammation can cause DNA damage and gene alterations associated with several types of cancer.

For example, having inflammatory bowel disease (ulcerative colitis and Crohn’s disease) significantly increases the risk of colorectal cancer; chronic inflammation of the liver (hepatitis) increases the risk of liver cancer; and inflammation of the esophagus (Barrett’s esophagus) is a known risk factor for esophageal cancer.

Additionally, researchers have found pockets of inflammation in cancerous prostate cells. Research into inflammation’s role in cancer continues.

Inflammation on the Brain

Neurodegenerative Disorders

Some evidence has implicated inflammation in diseases of the brain. Inflammation is found in the brains of Alzheimer’s patients. Scientists also have found activation of inflammatory pathways in several other neurodegenerative diseases, including Parkinson’s disease.

But whether inflammation contributes to these diseases or is a byproduct of other processes occurring with these disorders remains in question. Studies examining the role of inflammation in neurodegenerative diseases—and whether reducing inflammation can treat or prevent these conditions—are ongoing.

An Inflammation-Depression Connection

High levels of inflammation also are common in people with depression, suggesting a role of chronic inflammation in the development of depressive disorders. Research suggests that certain inflammatory cytokines appear to affect the health and function of nerve cells (neurons) in the brain. Experts believe that activation of inflammatory pathways in the brain may affect neuronal health and lead to greater oxidative stress, which decreases cell function.

In a study of 14,276 people, researchers found that those with depression had, on average, 46 percent higher levels of C-reactive protein, adding to the body of evidence connecting inflammation with depression (Journal of Clinical Psychiatry, December 2016). And, in other research, 12 weeks of therapy with the anti-inflammatory drug ixekizumab produced remission of depression symptoms in 40 percent of people with psoriasis, an inflammatory skin disease (Psychotherapy and Psychosomatics, October 2017).

Scientists are studying the potential of other anti-inflammatory strategies, such as the use of omega-3 fatty acid supplements, against depression. Since chronic inflammation may be at the root of depression in some patients, targeting inflammation may play a significant role in depression treatment, especially among depressed patients with increased levels of inflammatory biomarkers.

Joint Damage from Inflammation

There are more than 100 types of arthritis, according to the Arthritis Foundation, and many of them have a strong inflammatory component. The most common type of inflammatory arthritis, rheumatoid arthritis (RA), is an autoimmune disease in which the joint lining (synovium) becomes inflamed and swollen, releasing enzymes into the joint capsule that gradually eat away at the bone and cartilage. Once the cartilage is eroded, bones rub against bone, causing pain.

Another common inflammatory joint disease is gout, which occurs when deposits of uric acid settle in the joints and cause inflammation and painful gout flareups. Chronic inflammation, pain, and joint damage also characterize ankylosing spondylitis (a type of inflammatory arthritis that affects primarily the spinal joints) and psoriatic arthritis, which affects the joints, connective tissues, and the skin (psoriasis). Furthermore, inflammation from another autoimmune disorder, systemic lupus erythematosus (lupus), can harm the joints as well as the heart, lungs, blood vessels, kidneys, skin, and brain.

And, although the most common form of arthritis, osteoarthritis (OA), traditionally has not been considered to be an inflammatory condition, research has uncovered elevated levels of inflammatory markers in the joints of OA patients. Research into the role of inflammation in OA continues.

Digestive Diseases

In the Stomach and Intestines

Inflammation is at the root of several digestive diseases, including inflammatory bowel disease, which encompasses ulcerative colitis and Crohn’s disease. In Crohn’s disease, a wayward immune response produces inflammation that damages the intestinal lining. That same process also can occur in the colon, resulting in ulcerative colitis.

An abnormal immune sensitivity to gluten (a protein found in wheat, rye, and barley) triggers inflammation that causes celiac disease. The intestinal wall contains tiny structures known as villi that help absorb nutrients from food. When a person with celiac disease consumes gluten, his immune system responds by damaging the villi, preventing him or her from obtaining essential vitamins, minerals, and other nutrients.

Another digestive disease, gastritis, occurs when inflammation strikes the lining of the stomach. This disorder may result from prolonged use of nonsteroidal anti-inflammatory drugs (Advil, Motrin, and Aleve are examples), infection with Helicobacter pylori (H pylori) bacteria, or alcohol abuse, among other causes.

In Your Mouth: Problems with Periodontal Disease

And, in the mouth, where the digestive system begins, inflammation from periodontal disease can wreak havoc on your gums. Periodontal disease is particularly worrisome because the toxic mix of bacteria and inflammatory products that accumulate below the gum line can access the bloodstream and may contribute to problems elsewhere in the body. Studies suggest an association between periodontal disease and cardiovascular disease and its risk factors, certain cancers, kidney disease, lung infections, rheumatoid arthritis, cognitive decline, and other maladies.

Inflammation in Your Respiratory Tract

Asthma is characterized by chronic inflammation of the bronchial tubes, while an abnormal immune response is to blame for seasonal allergies, such as hay fever. Prolonged inflammation in the sinuses leads to the pain of chronic sinusitis. Chronic bronchitis—a component of chronic obstructive pulmonary disease, or COPD—occurs when the mucous membranes lining the lungs’ bronchial tubes become chronically inflamed.

Inflammation also can contribute to interstitial lung disease, a group of diseases affecting the interstitium, the tissue surrounding the tiny air sacs (alveoli) in the lungs.

Another disease, sarcoidosis, occurs when clumps of inflammatory cells known as granulomas develop in the lungs and other parts of the body, such as the skin, eyes, and lymph nodes.

The Diabetes-Inflammation Connection

Type 1 diabetes is an autoimmune disorder that damages insulin-producing cells in the pancreas. In one study, as reported in the Journal of Clinical Endocrinology & Metabolism (January 2017), researchers identified chronic inflammation of the digestive tract and unique changes in gut bacteria in people with type 1 diabetes.

“Our findings indicate that individuals with type 1 diabetes have an inflammatory signature and microbiome that differ from what we see in people who do not have diabetes or even in those with other autoimmune conditions, such as celiac disease,” the study’s senior author, Lorenzo Piemonti, MD, of San Raffaele Hospital in Milan, Italy, said in a statement.

Scientists also have found higher levels of inflammation in people with type 2 diabetes, the most common form of diabetes. Obesity is a major contributor to type 2 diabetes—nearly nine out of 10 people with type 2 diabetes are overweight or obese, according to the Obesity Society. And, a leading risk factor for obesity is a sedentary lifestyle, which also is significantly linked with an increased risk of type 2 diabetes.

Skin Disorders

Inflammation is at the root of several skin diseases, such as the following:

• Psoriasis, a chronic inflammatory condition that occurs when immune T cells, which normally protect the body against infection, rise to the skin’s surface at an accelerated rate and accumulate on the top layer before they can mature. The result: patches of thick, scaly, inflamed skin that itch and burn. These patches form most commonly on the elbows, knees, legs, lower back, face, palms, soles of the feet, and scalp.
• Allergic contact dermatitis, characterized by a rash that occurs when your skin comes into contact with allergens, substances like poison ivy, poison oak, or poison sumac, certain dyes, or cosmetics that cause your immune system to overreact.
• Rosacea, a chronic inflammatory condition of the face that causes facial redness, bumps and pimples, eye irritation and swelling, burning or stinging skin, swelling/thickening of the skin, and the appearance of tiny blood vessels. Symptoms also can develop in the neck, chest, scalp, or ears. Several factors may trigger flareups: sun or wind exposure, extreme heat or cold, exertion, emotional stress, and consumption of hot beverages, alcohol, or spicy foods.

Does Inflammation Add to Your Fatigue?

If you feel overly tired all the time, inflammation might be to blame—at least in part. Some evidence has connected chronic inflammation with chronic fatigue syndrome and general fatigue. Plus, as mentioned earlier, inflammation is associated with depression, which also contributes to feelings of fatigue.

Several studies have found that people with chronic fatigue have significantly higher levels of C-reactive protein and other pro-inflammatory cytokines. Some research suggests that inflammation may contribute to fatigue by affecting certain areas of the brain and through several biological pathways.

Inflammation and Frailty

Physical frailty is a major concern among elderly adults. Some evidence suggests that chronic, systemic inflammation in your midlife years may increase the likelihood of becoming frail later in life.

In one study, researchers measured levels of several inflammatory markers in 5,760 people starting when they were in their 40s and 50s and continuing through their midlife years. They then assessed the participants for frailty when they were in their 70s. Each increase in inflammatory markers was associated with a significantly greater risk of frailty, as reported by the Journal of Gerontology in an online article on March 9, 2018.

“There are studies underway to see if dropping levels of inflammation, mostly in older age groups, can prevent the progression of declines in mobility and in the muscles that contribute to frailty,” study author Jeremy Walston, MD, of Johns Hopkins Medicine, said in a statement. “Stay tuned. Hopefully, we’ll be able to say with more accuracy in the not-too-distant future that treating chronic inflammation will reduce your risk of muscle decline and related frailty.”

Sepsis: Life-Threatening Inflammation

One of the most dangerous complications associated with inflammation is sepsis, an extreme response by your immune system to an infection, most often originating in the lungs (pneumonia), skin, gut, kidneys, or blood.

The infection triggers an inflammatory chain reaction that can damage several organ systems. Without prompt treatment, sepsis can cause organ failure and death. Older adults and people with weakened immune systems are more susceptible to sepsis.

3. Fighting Inflammation with Food

Your Diet Can Make a Difference

You can take one medication to reduce your blood pressure, another to trim your cholesterol, and yet another to ease your joint pain. You also can find medications to help quell inflammation (see Chapter 4).

However, over the long term, the best instrument against inflammation might not be what you pour out of a pill bottle, but what you put on your dinner plate. You are what you eat, and what you eat may contribute to inflammation. While a number of foods promote inflammation, others are anti-inflammatory and form the cornerstone of a healthful diet that can help you combat inflammation and potentially ward off its ill effects.

Adopt an Anti-Inflammatory Diet

In general, an anti-inflammatory diet is one rich in fruits, vegetables, whole grains, legumes, and healthful fat sources. A good example of an anti-inflammatory eating pattern is a Mediterranean-style diet, which is rich in fruits, vegetables, fish, whole grains, and healthy oils and is widely recommended to promote cardiovascular health.

Vegetables

Leafy green vegetables, such as kale, spinach, romaine lettuce, and collards, are rich in antioxidants, including beta-carotene, lutein, and zeaxanthin, which have anti-inflammatory properties. Some studies suggest that consumption of leafy green vegetables is good for your heart and may protect against age-related macular degeneration (an eye disease), cancer, cognitive decline, and osteoporosis.

Broccoli, in providing ample amounts of vitamins A, C, and K along with other nutrients, is another potent anti-inflammatory vegetable. Carrots and tomatoes also offer up a bounty of antioxidant vitamins A and C as well as vitamins B6 and K, fiber, and potassium. And, tomatoes are rich in the antioxidant lycopene.

Try to eat 5 to 9 cups/servings of vegetables each day—two of those servings should be raw leafy green vegetables. As a general rule of thumb, the U.S. Department of Agriculture recommends filling half your plate with vegetables and fruit at every meal and snack.

A Note about Nightshades

Nightshade vegetables, such as tomatoes, eggplant, red bell peppers, and potatoes, offer nutritional and anti-inflammatory benefits with little effect on your daily calorie count. Still, some people are intolerant to nightshades and may experience inflammation related to conditions such as rheumatoid arthritis.

Fruits

Fruits are rich in fiber and antioxidants, making them inflammation-fighting powerhouses. Among the most potent are blueberries, raspberries, and other berries, all of which contain antioxidants known as anthocyanins that give them their color. Similarly, cherries (especially tart cherries) are rich in anthocyanins as well as antioxidant vitamin C, fiber, and potassium. Vitamin C-rich oranges and other citrus fruits also are anti-inflammatory.

In general, you’ll gain the most benefits from fruit by consuminug whole fruits rather than juices. That’s because whole fruits contain high amounts of beneficial fiber that are lacking in juices. However, some inflammation-fighting fruits, such as antioxidant-rich pomegranates, are more readily available in juice form. Given that many people fail to consume enough fruit, pomegranate juice generally is a healthful choice. Just be sure to choose products containing 100 percent pomegranate juice, not a cocktail of juices containing added sugar.

Fish

Fish, especially fatty, cold-water fish like salmon, mackerel, herring, tuna, and anchovies, are rich in protein and contain the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These healthful fats are inflammation fighters, and studies have found that diets rich in EPA and DHA can benefit cardiovascular health. Note that studies examining the effects of fish oil supplements on various health conditions have produced mixed results.

For people without cardiovascular disease, the American Heart Association (AHA) recommends getting omega-3s by eating two to three 3½-ounce servings (about the size of a checkbook) of fish a week. Substitute fish for red meat or other unhealthful fat sources, like processed meats, which are pro-inflammatory. People with heart disease should consume about 1 gram (1,000 mg) of EPA and DHA a day, preferably from fatty fish, the
AHA advises.

You also can get omega-3s from plant sources. Flaxseed, chia, walnuts, canola, and soybeans (and their oils) contain alpha-linolenic acid (ALA), which your body can convert into EPA and DHA. Unfortunately, only a small amount of ALA is converted, and your body uses EPA and DHA from fish and fish oils much more rapidly. Nevertheless, these ALA foods are generally healthy options and are easy to incorporate into your diet. Simply munch on some walnuts as a snack, or sprinkle flaxseed or chia seeds on your cereal or low-fat yogurt.

Fats and Oils

As omega-3 fatty acids demonstrate, not all fats are bad for you. Still, it’s important to distinguish between the good and the bad. Categorized as polyunsaturated fatty acids (PUFAs), omega-3 and omega-6 fatty acids are essential fatty acids that your body can’t produce but needs for good heart and brain function, as well as for healthy skin and cholesterol metabolism.

Omega-6s are found in beneficial foods like nuts, seeds, grains, and vegetable oils, but they’re also prevalent in an array of unhealthful products, such as refined baked goods. The problem is that linoleic acid, the primary omega-6 in foods, is synthesized by your body into arachidonic acid, which is involved in the early stages of inflammation.

Some evidence suggests that excessive omega-6 consumption, especially at the expense of reduced omega-3 intake, may contribute to inflammation and certain chronic diseases. However, investigations into the role of omega-6s in chronic inflammation have produced conflicting results. The AHA notes that, when used to replace unhealthful, pro-inflammatory saturated and trans fats in your diet, omega-6 PUFAs are considered to be heart healthy.

Monounsaturated fatty acids, or MUFAs, are another healthful fat source. MUFAs, found in olive and canola oils, avocados, and nuts, fight inflammation and also help maintain a healthy cholesterol balance that’s important to heart health. So, replace butter with olive oil, and eat a handful of nuts and seeds each day.

Face the Facts about Fats

MUFAs and PUFAs are perhaps most beneficial when used to replace saturated or trans fats. However, even healthful fats should be consumed in moderation. All fats are high in calories, and even too much of the “good” fats will add to your daily calorie intake and promote weight gain.

The AHA recommends that no more than 20 to 35 percent of your daily calories should come from dietary fat, mostly unsaturated fat. If you follow a 2,000-calorie-per-day diet, that adds up to 400 to 700 calories a day from fat; each gram of fat contains 9 calories, meaning that you should consume no more than 44 to 78 grams of fat per day.

Beans

Beans such as chickpeas, black beans, red kidney beans, and lentils are high in fiber and anti-inflammatory phytonutrients. Some people have dubbed beans a “superfood” because of their nutritional value. Plus, they’re inexpensive and provide a bounty of protein. Try to eat at least 1 cup of beans twice a week.

Whole Grains

Whole grains are high in fiber and rich in antioxidants and other nutrients. That’s why most nutrition experts recommend replacing refined grains (which are pro-inflammatory) with more healthful whole grains.

Some diet proponents have raised concerns that proteins (lectins) found in grains can interact with certain immune cells and trigger inflammation, leading to theories that removing grains and other lectin-containing foods from the diet might help some people with inflammatory conditions like rheumatoid arthritis. However, multiple studies have found that eating whole grains is associated with lower levels of certain inflammatory markers, such as C-reactive protein, suggesting an overall anti-inflammatory benefit to whole-grain consumption. (Keep in mind that grains such as wheat, rye, and barley contain gluten, which can cause the intestinal inflammation of celiac disease.)

The Dietary Guidelines for Americans recommend that everyone consume at least half their grains as whole grains, which equates to six ounce-equivalents of whole grains for a 2,000-calorie-per-day diet. An ounce-equivalent contains 16 grams of whole grains, equating to one slice of 100 percent whole-grain bread, a small muffin, a half-cup of cooked rice or pasta, or one cup of ready-to-eat cereal.

“What’s in a (Grain) Name?”

As you shop for whole-grain products, understand that some whole grains are better than others. You’ll come across items bearing such marketing lingo as “multigrain,” “7-grain,” “9-grain” and even “12-grain” that sound like good choices, but don’t be fooled. Those terms simply mean that multiple grains were used to make the product, but they may be refined or processed grains with little or no nutritional value over white bread.

To be given the whole-grain tag, a product must contain all three essential parts and nutrients of the entire grain kernel—the germ, bran, and endosperm—in their original proportions, according to the Whole Grains Council. Also, if the grain has been cooked, ground into flour, or processed in any way, it should retain the same balance of nutrients found in the original kernel.

That’s why it’s best to read the product label closely to make sure you’re making the best choice. Select products that specifically state on the label “100 percent whole grain” or “100 percent whole wheat.” This percentage indicates that all parts of the grain have been used.

Spice Up Your Anti-Inflammatory Diet

Spices not only add flavor to your food, but some can help fight inflammation. Cinnamon, cayenne pepper, garlic, ginger, and turmeric (among other types of spices) are anti-inflammatory and can easily be incorporated into your diet. Simply add some extra garlic to your pasta sauce, sprinkle a little cinnamon on sweet potatoes, or add some turmeric to your eggs, soups, or vegetables. Many of these spices also are found in supplement form.

Brew Up Some Anti-Inflammatory Benefits

Your morning tea or coffee can fight inflammation while helping to jump-start your day. True teas—black, green, oolong, and white—are derived from the Camellia sinensis tea plant. Typically, the more processed a tea is, the lower its content of healthful antioxidants, such as flavonoids. White and green teas are the least processed and generally contain the highest amounts of flavonoids. Black tea is the most processed, while oolong falls somewhere in the middle.

Regardless of these differences, all true teas have beneficial antioxidants. Most teas are steeped in hot water for three to five minutes, but brewing them longer may be more beneficial. Brewing tea for five minutes releases 85 percent of the antioxidant potential. Brewing for an additional five minutes releases the other 15 percent.

Herbal teas are not true teas because they do not originate from tea plants. Rather, they’re infusions made from parts of other plants, such as chamomile, hibiscus, or echinacea. They have lower concentrations of the antioxidants found in true teas.

Like tea, coffee is a good source of antioxidants. Coffee also contains several vitamins and minerals, including magnesium, niacin, vitamin B5 (pantothenic acid), phosphorus, potassium, and riboflavin.

Just keep these tips in mind when you make your morning tea or coffee:

• While syrups, heavy creams, and sugar may add some jive to your java and extra taste to your tea, they also add calories, so stick to low-fat or fat-free creamers, and minimize your use of sweeteners.
• The caffeine in coffee and tea can cause jitteriness and temporary spikes in blood pressure and heart rate. So, drink it in moderation, or try decaffeinated brands. Note that black tea contains the highest amount of caffeine of any tea—47 milligrams (mg) per 8-ounce cup—about half the 95 mg of caffeine in an 8-ounce cup of brewed coffee.
• Since coffee and tea increase insomnia, don’t drink either of them close to bedtime.
• Caffeine from coffee and tea can increase urine production, which may pose a problem if you have an overactive bladder or an enlarged prostate.

Pro-Inflammatory Foods to Avoid

Just as certain foods can help you combat inflammation, others tend to promote inflammation. The inflammatory response can vary from person to person. Many foods cause inflammation only in certain people, but some foods are known to be pro-inflammatory for the majority of individuals. Here’s a look at some of the more common pro-inflammatory elements in the average diet.

Sugar

Evidence continues to accumulate regarding the harmful effects of added sugars in the typical American diet. Excessive sugar consumption can lead to weight gain, diabetes, metabolic syndrome, and increases in triglycerides, among other health problems.

Research also suggests that sugar consumption promotes inflammation. In fact, in one study, even low to moderate consumption of sugar-sweetened beverages led to significant increases in high-sensitivity C-reactive protein in just three weeks among healthy younger men, as reported in American Journal of Clinical Nutrition (August 2011).

The American Heart Association (AHA) recommends getting no more than half your daily discretionary calorie allowance from added sugars. (This allowance refers to the number of calories you can consume to obtain adequate nutrients while maintaining your weight. Added sugars, fats, and alcohol account for most discretionary calories.) For most people, that adds up to no more than 150 calories a day (about 9 teaspoons or 36 grams of added sugar) for men and no more than 100 calories (about 6 teaspoons or 25 grams of added sugar) for women.

Soft drinks and other sugar-sweetened beverages are the leading source of added sugars in the American diet, according to the AHA; a 12-ounce can of regular soda contains about eight teaspoons of sugar and 130 calories. Other major contributors include candy, baked goods, fruit drinks, and sweetened dairy desserts.

Read the Nutrition Facts panel to find out how much total sugar and added sugars a product contains. Also, check the ingredients list. Ingredients are listed in descending order based on the amount that is in the product, so if a sugar is listed near the top, chances are that product is high in added sugars.

Sugar, By Any Other Name…

To borrow from Shakespeare, sugar, by any other name, would taste as sweet. When reading the ingredients list on a product, look for these names for added sugars:

• Fructose
• Glucose
• Sucrose
• Dextrose
• Lactose
• Maltose
• Maltodextrin
• Brown sugar
• Beet sugar
• Date sugar
• Raw sugar
• Turbinado sugar
• Evaporated cane juice
• Molasses

Bad Fats

Scientists have found that trans fats and saturated fats contribute to or create inflammation. Most trans fat is manufactured through a process called hydrogenation, which makes liquid fats (oils) more solid and increases their shelf life. By order of the U.S. Food and Drug Administration (FDA), food makers had until 2018 to remove trans fats from their products or to petition the FDA to permit specific uses of trans fats. Carefully review the Nutrition Facts label on processed foods, and choose those with zero trans fat. And, avoid products with the words “partially hydrogenated” in the ingredients list.

Like trans fats, saturated fats promote inflammation, increase LDL (“bad”) cholesterol levels, and contribute to cardiovascular disease. The AHA and other experts recommend limiting your saturated fat intake to less than 7 percent of your daily calories. To cut down on saturated fat, replace fatty meats like beef, lamb, and pork with skinless poultry, avoid processed meats (sausage, pepperoni, salami, etc.) and fried foods, and substitute low-fat or fat-free dairy products for full-fat versions.

Refined Carbohydrates

Whole grains contain the entire grain kernel, including the germ, bran, and endosperm. The germ and bran contain the bulk of the fiber, B vitamins, and other beneficial nutrients in the grain. However, with refined grains, such as white bread, these nutrient cornerstones are removed, leaving only the less nutritious endosperm.

Refined grains not only lack the nutritional value of whole grains, but they’ve also been associated with higher levels of inflammation in your body. That’s because your body breaks down these simple carbohydrates into sugar more rapidly, and, as noted earlier, sugar is a known inflammation booster.

In addition to white bread and other products made from refined white flour, examples of refined grains include white rice, cookies, and cakes. So, when you get your grains, choose brown rice over white rice, and select whole-grain breads, buns, muffins, tortillas, and other similar products over those made with refined white flour.

Excessive Alcohol Consumption

Studies suggest that moderate alcohol intake can reduce certain markers of inflammation. However, drinking alcohol in excess can promote inflammation. And, if you have gout, an inflammatory type of arthritis, consuming alcohol (especially beer) can contribute to painful gout flareups.

Moderate alcohol consumption is defined as no more than two standard drinks a day for men and no more than one standard drink daily for women. The National Institutes of Health define a standard drink as one 12-ounce beer (about 5 percent alcohol content), 8 to 9 ounces of malt liquor (about 7 percent alcohol content) 5 ounces of table wine (about 12 percent alcohol content), and 1.5 ounces of 80-proof liquor.

Individual Triggers

Celiac disease is a well-known example of how your body can overreact to a particular food—in this case the gluten found in wheat, rye, and barley. Some people have one or more specific foods that trigger an abnormal immune response and inflammation. They may suffer from a food allergy—an immune system reaction that can cause potentially life-threatening symptoms, sometimes affecting multiple organ systems—or a food intolerance, an abnormal response to a particular food that is usually less serious and limited to the digestive system.

If you suspect you have a food allergy, see a doctor for tests to determine how you react to allergy-causing foods (allergens). Also, the doctor may suggest a food challenge, during which you’re given a placebo or a potential food allergen to identify a cause of your symptoms. Common food allergens include milk, eggs, fish and shellfish, peanuts, soy products, tree nuts, and wheat.

Keeping a food journal and documenting your specific symptoms can help your allergist. If you have a food allergy, avoid the problem food, check food labels carefully, and ask about the ingredients in the meals you order at restaurants.

4. Beyond Diet: How to Fight Inflammation

Improve Your Lifestyle

In addition to your diet, several modifiable lifestyle factors are known to promote chronic inflammation. By avoiding or optimizing these risk factors, you might minimize the damaging effects of chronic inflammation.

Lack of Exercise

People who lead a sedentary lifestyle tend to have higher levels of inflammation. Conversely, increasing your physical activity may help reduce inflammation. In one study, reported in Circulation (Aug. 21, 2012), researchers discovered that people who regularly adhered to guidelines recommending at least 150 minutes of moderate-to-vigorous physical activity a week had significantly lower levels of two inflammatory markers—C-reactive protein and interleukin 6—over a 10-year period compared with those who did not adhere to the guidelines.

Indeed, most health experts recommend that adults get at least 150 minutes of moderate-intensity physical activity a week (e.g., 30 minutes a day, five days a week). An alternative for more fit adults is a goal of 75 minutes of vigorous exercise a week.

For most adults, brisk walking, biking, and swimming are examples of moderate-intensity exercise, while vigorous activities include jogging, running, or brisk walking on hilly terrain. However, what constitutes moderate or vigorous intensity will vary from person to person, depending on your fitness level.

A simple way to measure your level of exertion is the “talk-sing” test. During your exercise, you should be able to talk with some effort. If you can sing during your workout, or if you can converse without much effort, the exercise is not vigorous enough. If you can’t carry on a conversation at all while exercising, you’re probably pushing too hard and need to slow down.

Obesity

Fat cells aren’t just inactive storage centers, but rather tiny factories that produce inflammatory chemicals called cytokines. The inflammation resulting from an overabundance of fat cells may explain, in part, obesity’s connection to several chronic diseases, including cardiovascular disease, type 2 diabetes, and certain cancers. If you’re overweight or obese, work with your health-care team to lose weight via a healthy diet, regular exercise, and, if necessary, medical weight-loss therapy.

Smoking

Cigarette smoking and exposure to secondhand smoke can increase inflammation. If you smoke, ask your physician about nicotine replacement therapy, medications, counseling, and other strategies to help you kick the habit. Also, take advantage of telephone support programs, such as the U.S. Department of Health and Human Services’ 1-800-QUIT-NOW.

Emotional Stress

Anxiety and stress are well-known risk contributors to chronic inflammation. After one study, as reported in Proceedings of the National Academy of Sciences (April 2, 2012), researchers wrote that stress can inhibit the body’s ability to use the hormone cortisol to manage inflammation. “Inflammation is partly regulated by the hormone cortisol, and when cortisol is not allowed to serve this function, inflammation can get out of control,” study author Sheldon Cohen, PhD, of Carnegie Mellon University, said in a statement.

You can’t remove all stress from your life, but you can learn to manage it. Find a guide, coach, or therapist who can help you develop coping strategies. Tell your doctor if you chronically feel anxious, and work on ways to manage the stress in your life.

Also, consider stress-relieving techniques such as mindfulness meditation. Or simply find a hobby you enjoy that can take your mind off your worries. One well-established stress reliever that also combats inflammation is exercise.

Sleep Disorders

Sleep problems—insomnia or sleep apnea, for example—have been linked with increased inflammation. The National Sleep Foundation recommends that adults ages 26 to 64 get seven to nine hours of sleep each night, while people over age 65 should aim for seven to eight hours nightly. However, many people fail to get the restorative sleep they need.

Prescription and over-the-counter sleep aids may help you get a better night’s rest in the short term. For more long-term results, consider these strategies to improve your sleep hygiene—lifestyle practices that promote good sleep:

• Get exposure to bright light in the morning, and avoid bright lights at night.
• Find ways to unwind—reading, taking a warm bath, listening to soft music—before you go to bed.
• Keep your bedroom dark, and remove pets or any sources of noise that could disrupt your sleep.
• Use your bedroom only for sleep or sex. Leave the bedroom if you can’t fall asleep within 15 to 20 minutes.
• Minimize your caffeine intake, and avoid caffeinated beverages or alcohol at night.
• Limit daytime napping to an hour or less.
• Put your clock out of sight. Fixating on the clock will only promote insomnia.
• Ask your doctor if the medications you take are making you sleepy or keeping you awake.
• Turn off the television and computer at least two hours before bedtime, and don’t eat or exercise at least four hours before bedtime.

Another common sleep disorder linked to increased inflammation is obstructive sleep apnea, characterized by repeated interruptions in breathing during sleep. Tell your doctor about any signs of obstructive sleep apnea, such as excessive daytime sleepiness, loud snoring, or interruptions in breathing during sleep (as reported by your bed partner).

Medications

Various medications can reduce inflammation, depending on the type of inflammatory condition you have.

NSAIDs

For acute pain and inflammation resulting from a musculoskeletal injury, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs)—aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve), for example—may suffice. They also can help you get through the pain and inflammation of an acute gout flareup, tendinitis, and bursitis.

For more severe inflammatory musculoskeletal problems—rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis, for example—stronger, prescription-strength doses of these and other NSAIDs—diclofenac (Voltaren), indomethacin (Indocin), meloxicam (Mobic), and others—may be necessary.

NSAID Concerns

NSAIDs may cause stomach irritation and increase the risk for gastrointestinal bleeding. Celecoxib (Celebrex), a member of a class of NSAIDs known as COX-2 inhibitors, is less likely to affect your gastrointestinal (GI) tract.

If you take NSAIDs, especially over the long term, your doctor may recommend medications known as proton pump inhibitors, such as esomeprazole (Nexium) and omeprazole (Prilosec), or histamine 2 blockers, like cimetidine (Tagamet) and ranitidine (Zantac), to decrease stomach acid production and reduce GI irritation.

All NSAIDs (except aspirin) carry warnings about increased cardiovascular risks associated with the use of the drugs, especially among those with a history of heart attack or who take high doses or use the drugs frequently and over an extended period of time. If you need an NSAID, experts recommend taking the lowest effective dose for the shortest duration possible.

Corticosteroids

Corticosteroids, commonly known as steroids, are potent anti-inflammatory medications used in a variety forms for an array of medical conditions:

• Oral corticosteroids—dexamethasone (Baycadron), methylprednisolone (Medrol), prednisone (Deltasone), prednisolone (Prelone), and others—may be prescribed to quell inflammation associated with certain joint diseases, lupus, skin conditions, inflammatory bowel disease, and other disorders. Although effective, long-term use of oral corticosteroids may increase the risk of infection, weight gain, diabetes, osteoporosis, glaucoma, cataracts, mood changes, high blood pressure, and other adverse effects. Consequently, they are administered in the lowest dose possible to control symptoms.
• Corticosteroid injections, or cortisone shots, can provide rapid relief of localized inflammation from arthritis, gout, bursitis, tendinitis, and other conditions. Overuse of the injections may damage or weaken cartilage, tendons, and other tissues near a joint, so many experts recommend limiting the injections to no more than three times a year and no more than 10 times per joint in a patient’s lifetime. Note that this recommendation depends on the joint being treated and each patient’s individual characteristics.
• Inhaled corticosteroids—budesonide (Pulmicort), fluticasone (Flovent), and triamcinolone (Azmacort) are examples—are mainstays of asthma treatment. They also may be prescribed with other inhaled medications to treat chronic obstructive pulmonary disease, or COPD.
• Nasal steroids, such as budesonide (Rhinocort), mometasone (Nasonex), triamcinolone (Nasacort), and others, are used to relieve nasal allergy symptoms.

Aminosalicylates

These anti-inflammatory drugs, such as balsalazide (Colazal), mesalamine (Asacol, Delzicol), and sulfasalazine (Azulfidine), are prescribed to treat inflammatory bowel disease. Sulfasalazine doubles as a disease-modifying antirheumatic drug and also is used to treat rheumatoid arthritis.

Immunomodulators

Immunosuppressive drugs slow the reproduction of immune cells, thus reducing the production of enzymes and other chemicals that these cells produce and hindering the inflammatory response. One of these drugs, methotrexate (Rheumatrex, Otrexup), is among the most widely used medications to treat rheumatoid arthritis and other types of inflammatory arthritis.
Other immunomodulators, such as azathioprine (Azasan, Imuran) and 6-mercaptopurine (Purinethol, Purixan), are used to treat inflammatory bowel disease.

Biologic Drugs

Biological response modifiers, or biologics, also target the immune response. They are powerful medications genetically engineered to reduce inflammation by interfering with certain immune cytokines, such as tumor necrosis factor (TNF) and interleukins:

• TNF inhibitors—such as adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), and infliximab (Remicade)—are prescribed for inflammatory joint diseases like rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, as well as psoriasis and inflammatory bowel disease.
• Interleukin inhibitors block a number of proteins involved in inflammation. Drugs in this class—including anakinra (Kineret), canakinumab (Ilaris), sarilumab (Kevzara), secukinumab (Cosentyx), ustekinumab (Stelara) and others—can be used to treat several types of inflammatory arthritis and inflammatory bowel disease.

Immunomodulator Side Effects

Biologic drugs and other immunomodulators can cause an array of side effects. And, since they suppress the immune system, they can increase the risk of certain infections, especially in the upper respiratory tract. Your physician must carefully weigh the risks and benefits of using these medications.

Supplements

A number of herbal and dietary supplements have been studied for their anti-inflammatory effects. Keep in mind that, in many cases, evidence supporting the use of these supplements is mixed or insufficient.

Dietary Supplements

Some dietary supplements contain spices like turmeric, ginger, and cinnamon, as well as garlic, all of which have anti-inflammatory properties and might be beneficial, particularly if you can’t incorporate them into your daily diet.

Likewise, supplements of antioxidants—beta-carotene, vitamin C, and vitamin E, as well as selenium and zinc—can provide some anti-inflammatory benefits. However, the use of these supplements in high doses among certain people has been associated with adverse health outcomes, so it’s probably best to obtain these vitamins from foods (see “Adopt an Anti-Inflammatory Diet,” in Chapter 3).

Power from Pineapple Juice?

Supplements of bromelain, an enzyme in pineapple juice, may help relieve symptoms of acute nasal and sinus inflammation.

However, evidence to support the use of bromelain for other conditions, such as gastrointestinal disorders and cancer, is inconclusive, according to the National Institutes of Health (NIH). The NIH is funding studies investigating bromelain for inflammatory diseases and asthma.

Herbal Supplements

Supplements of resveratrol, a powerful antioxidant found in red wine, grapes, and certain berries, may combat inflammation. Some evidence supports the use of herbal supplements such as willow bark extract and devil’s claw to reduce pain and inflammation. Also, some studies suggest that evening primrose oil (gamma linolenic acid) and thunder god vine (used in traditional Chinese medicine) may help treat symptoms of rheumatoid arthritis.

Use Supplements with Caution

Tell your doctor about any herbal supplements you take. If a supplement is potent enough to elicit a therapeutic response, it also can cause side effects. Plus, some supplements may interact adversely with one or more of your prescription medications.

And, since supplements aren’t subjected to the same regulatory standards as conventional medications, there is no guarantee about the quality, purity, dosage, and effectiveness of a given product. For instance, some investigations have found that certain herbal products contain little or none of the desired herbs, and some contain fillers or contaminants.

So, if you choose a supplement, it’s probably best to go with one made by a large national manufacturer. And, look for products tested for quality and purity by independent organizations such as the U.S. Pharmacopoeia or Consumerlab.com.