What Is An Anti-Inflammatory Diet?

Can Diet Douse The Flames?

Author: Dr. Stephen Chaney

InflammationIf you have arthritis, colitis, bursitis, or any of the other “itis” diseases, you already know that inflammation is the enemy. Chronic, low level inflammation is also a contributing factor to heart disease, cancer, and many other diseases. Clearly, inflammation is a bad actor. It is something we want to avoid.

Obesity and diabetes are two of the biggest contributors to inflammation, but does diet also play a role? With all the anti-inflammation diets circulating on the internet, you would certainly think so. How good is the evidence that certain foods influence inflammation, and what does an anti-inflammatory diet look like?

The Science Behind Anti-Inflammatory Diets

ScientistLet me start by saying that the science behind anti-inflammatory diets is nowhere near as strong as it is for the effect of primarily plant-based diets on heart disease and diabetes. The studies on anti-inflammatory diets are mostly small, short duration studies. However, the biggest problem is that there is no standard way of measuring inflammation.

There are multiple markers of inflammation, and they do not change together. That means that in every study some markers of inflammation are altered, while others are not. There is no consistent pattern from one study to another.

In spite of these methodological difficulties, the studies generally point in the same direction. Let’s start with the strongest evidence and work our way down to the weakest evidence. 

Omega-3 fats are anti-inflammatory (I. Reinders et al, European Journal of Clinical Nutrition, 66: 736-741, 2011). The evidence is strongest for the long chain omega-3s found in fish and fish oil, but the shorter chain omega-3s found in foods like walnuts, flaxseeds, chia seeds and flaxseed oil, soybean oil, and canola oil also appear to be anti-inflammatory. 

Inflammation is directly correlated with glycemic index (L. Qi and F.B. Lu, Current Opinion in Lipidology, 18: 3-8, 2007). This has a couple of important implications.

The most straightforward is that refined carbohydrates and sugars (sodas, pastries, and desserts), which have a high glycemic index, increase inflammation. In contrast, complex carbohydrates (whole grains, most fruits and vegetables) decrease inflammation. No surprise there. The second implication is that it is the glycemic index, not the sugar, that is driving the inflammatory response.

That means we need to look more closely at foods than at sugars. Sodas, pastries and desserts are likely to cause inflammation, but sugar-containing foods with a low glycemic index are unlikely to be inflammatory. 

Fruits and vegetables are anti-inflammatory. This has been shown in multiple studies. At this point most of the research is centered on identifying the nutrients and phytonutrients from fruits and vegetables that are responsible for the reduction in inflammation. I suspect the investigators are hoping to design an anti-inflammatory supplement and make lots of money. I will stick with the fresh fruits and vegetables. 

Saturated fats are inflammatory. At face value, the data on saturated fats appear to be contradictory. Some Fatty Foodsstudies say that saturated fats increase inflammation, while others say they do not. However, similar to my earlier discussion on saturated fats and heart disease), the outcome of the study depends on what the saturated fats are replaced with.

When saturated fats are replaced with refined carbohydrates, sugar and highly processed foods (the standard American low-fat diet), inflammation doesn’t change. This doesn’t mean that a diet high in saturated fat is healthy. It just means that both diets are bad for you. Both are inflammatory.

However, when saturated fat is replaced with omega-3 polyunsaturated fats (J.A. Paniagua et al, Atherosclerosis, 218: 443-450, 2011) or monounsaturated fats (B. Vessby et al, Diabetologia, 44: 312-319, 2001), markers of inflammation decrease. Clearly, saturated fats are not the best fat choice if you wish to keep inflammation in check.

I would be remiss if I did not address the claims by the low-carb diet proponents that saturated fats do not increase inflammation in the context of a low-carb diet. I want to remind you of two things we have discussed previously:

  • The comparisons in those studies are generally with people consuming a diet high in simple carbohydrates and sugars.
  • These studies have mostly been done in the short-term when the participants are losing weight on the low-carb diets. Weight loss decreases inflammation, so the reduction in inflammation on the low-carb diet could be coming from the weight loss.

The one study (M. Miller et al, Journal of the American Dietetic Association, 109: 713-717, 2009) I have found that compares a low-carb diet (the Atkins diet) with a good diet (the Ornish diet, which is a low-fat, lacto-ovo vegetarian diet) during weight maintenance found that the meat based, low-carb Atkins diet caused greater inflammation than the healthy low-fat Ornish diet.

Red meat is probably pro-inflammatory. Most, but not all, studies suggest that red meat consumption is associated with increased inflammation. If it is pro-inflammatory, the inflammation is most likely associated with its saturated fat, its heme iron content, or the advanced glycation end products formed during cooking.

What Is An Anti-Inflammatory Diet?

Colorful fruits and vegetablesAnti-inflammatory diets have become so mainstream that they now appear on many reputable health organization websites such as Harvard Health, WebMD, the Mayo Clinic, and the Cleveland Clinic. Each have slightly different features, but there is a tremendous amount of agreement. 

Foods an anti-inflammatory diet includes: In a nutshell, an anti-inflammatory diet includes fruits and vegetables, whole grains, plant-based proteins (like beans and nuts), fatty fish, and fresh herbs and spices. Specifically, your diet should emphasize:

  • Colorful fruits and vegetables. Not only do they help fight inflammation, but they are a great source of antioxidants and other nutrients important for your health.
  • Whole grains. They have a low glycemic index. They are also a good source of fiber, and fiber helps flush inflammatory toxins out of the body.
  • Beans and other legumes. They should be your primary source of protein. They are high in fiber and contain antioxidants and other anti-inflammatory nutrients.
  • Nuts, olive oil, and avocados. They are good sources of healthy monounsaturated fats, which fight inflammation.
  • Fatty fish. Salmon, tuna, and sardines are all great sources of long chain omega-3 fatty acids, which are fish and fish oilincorporated into our cell membranes. Those long chain omega-3s in cell membranes are, in turn, used to create compounds that are powerful inflammation fighters.

Walnuts, flaxseeds, and chia seeds are good sources of short chain omega-3s. The efficiency of their conversion to long chain omega-3s that can be incorporated into cell membranes is only around 2-5%. If they fight inflammation, it is probably because they replace some of the saturated fats and omega-6 fats you might otherwise be eating.

  • Herbs and spices. They add antioxidants and other phytonutrients that fight inflammation.

Foods an anti-inflammatory diet excludes: In a nutshell, an anti-inflammatory diet should exclude highly processed, overly greasy, or super sweet foods, especially sodas and other sweet drinks. Specifically, your diet should exclude:

  • Refined carbohydrates, sodas and sugary foods. They have a high glycemic index, which is associated with inflammation. They can also lead to weight gain and high blood sugar, both of which cause inflammation.
  • Foods high in saturated fats. This includes fatty and processed meats, butter, and high fat dairy products.
  • Foods high in trans fats. This includes margarine, coffee creamers, and any processed food containing partly hydrogenated vegetable oils. Trans fats are very pro-inflammatory.
  • French fries, fried chicken, and other fried foods. They used to be fried in saturated fat and/or trans fat. Nowadays, they are generally fried in omega-6 vegetable oils. A little omega-6 in the diet is OK, but Americans get too much omega-6 fatty acids in their diet. Most studies show that a high ratio of omega-6 to omega-3 fatty acids is pro-inflammatory.
  • Foods you are allergic or sensitive to. Eating any food that you are sensitive to can cause inflammation. This comes up most often with respect to gluten and dairy because so many people are sensitive to one or both. However, if you are not sensitive to them, there is no reason to exclude whole grain gluten-containing foods or low-fat dairy foods from your diet.

Can Diet Douse The Flames?

FlamesIn case you didn’t notice, the recommendations for an anti-inflammatory diet closely match the other healthy diets I have discussed previously. It should come as no surprise then that both the Mediterranean (L. Gallard, Nutrition in Clinical Practice, 25: 634-640, 2010; L. Schwingshackl and G. Hoffmann, Nutrition Metabolism and Cardiovascular Diseases, 24: 929-939, 2014) and DASH (D.E. King et al, Archives of Internal Medicine, 167: 502-506, 2007) diets are anti-inflammatory.

Vegan and vegetarian diets also appear to be anti-inflammatory as well. The anti-inflammatory nature of these diets undoubtedly contributes to their association with a lower risk of heart disease, diabetes, and cancer.

As for the low-carb diets, the jury is out. There are no long-term studies to support the claims of low-carb proponents that their diets reduce inflammation. The few long-term studies that are available suggest that low-carb diets are only likely to be anti-inflammatory if vegetable proteins and oils replace the animal proteins and fats that are currently recommended.

What does this mean for you if you have severe arthritis or other inflammatory diseases? An anti-inflammatory diet is unlikely to “cure” your symptoms by itself. However, it should definitely be a companion to everything else you are doing to reduce inflammation.

The Bottom Line 

If you have arthritis, colitis, bursitis, or any of the other “itis” diseases, you already know that inflammation is the enemy. Chronic, low level inflammation is also a contributing factor to heart disease, cancer, and many other diseases. Clearly, inflammation is a bad actor. It’s something we want to avoid.

Obesity and diabetes are two of the biggest contributors to inflammation, but does diet also play a role? With all the anti-inflammation diets circulating on the internet, you would certainly think so. In this article I review the evidence that certain foods influence inflammation and describe what an anti-inflammatory diet looks like.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

What’s Worse Saturated Fat or Sugar?

What Causes Fatty Liver Disease?

Author: Dr. Stephen Chaney

 

what is worse saturated fats or sugarThe great American food fight continues. The low fat enthusiasts tell you saturated fat is going to kill you. The low carb enthusiasts tell you saturated fat is fine. It’s sugar that’s going to kill you.

You can find studies that support either viewpoint. And the story keeps changing. One day the headlines proclaim: “The latest study shows…” A few weeks later you see a headline saying: “Wait. That’s wrong. Science now shows…” It’s no wonder you are confused and perhaps a bit cynical.

So, what’s worse saturated fat or sugar?

Perhaps we should step back and ask how we got to this point.

 

Why Is the Saturated Fats and Sugar Dilemma So Confusing?

saturated fats or sugar dilemmaTo understand why the literature around saturated fats and sugar is so confusing, we need to go back to the 1950s. The first studies implicating saturated fats as a risk factor for heart disease replaced saturated fats with unsaturated fats. Everything else in the diet was kept the same. When you do that, the answer is clear-cut. Saturated fats increase heart disease risk and unsaturated fats decrease heart disease risk.

When the American Heart Association first recommended a low-fat diet, they had in mind replacing saturated fats with fresh fruits, vegetables, whole grains, and beans. The remaining fat would be mostly unsaturated. Today, we would call that a Mediterranean diet, which, by the way, has been shown to reduce both diabetes and heart disease risk.

Big Food Inc. took one look at that and panicked. They make their money from processed foods, not from fresh fruits and vegetables. If the American people made the changes the American Heart Association recommended, Big Food Inc. would go bankrupt.

They sprang into action. They had their laboratories whip up processed foods that replaced fat with sugar, white flour, and a witch’s brew of chemicals. Then they told the American people: “Never fear. You don’t have to give up your favorite foods. We have created low fat versions of the foods you love.”

That became the diet that most Americans adopted. Even worse, most Americans continued eating foods high in saturated fats. We ended up with the worst of all possible worlds – a diet high in saturated fat and high in sugar. This became the Standard American Diet (SAD).

This shift has corrupted most of the recent research studies on saturated fat and sugar. Most of the studies on saturated fat or sugar have compared them with the Standard American Diet, not with a healthy diet. When you do that, your results are going to be skewed. Almost anything is better that the Standard American Diet.

Why Was This Study Done?

fatty liver disease causesWhen we think of obesity, we think of the excess fat we can see. But what we have learned in recent years is that the fat you can’t see is far more damaging to our health. I am talking about fat stores in the liver, something called fatty liver disease.

Fatty liver disease has serious consequences. It causes insulin resistance and inflammation, and that increases the risk of diabetes and heart disease. Even worse, it can lead to cirrhosis and liver failure.

Excess sugar is converted to saturated fat in the liver. Therefore, the popular literature attributes the epidemic of fatty liver disease to increased intake of simple sugars. But is it true? Saturated fats require no conversion. They can simply be deposited in the liver as is. Shouldn’t they be at least as damaging to the liver as sugar?

It turns out that no studies have actually compared the effect of excess calories in the form of saturated fat, unsaturated fat, and simple sugars on fat accumulation in the liver. This study (PK Luukkonen et al, Diabetes Care, 41: 1732-1739, 2018) was designed to fill that gap.

How Was The Study Done?

saturated fats or sugar studyThe authors enrolled 38 middle aged (average age = 48), overweight (average BMI = 31) adults for the study. The participants were divided into three groups and were fed an extra 1,000 calories per day of saturated fat (SAT group), unsaturated fat (UNSAT group), or sugar (SUGAR group) for 3 weeks. The composition of those extra 1,000 calories was as follows:

  • The SAT group ate an extra 30 g coconut oil, 40 g butter, and 100 g blue cheese
    • Macronutrient composition = 1% carbohydrate, 86% fat, 13% protein, 0% simple sugars.
    • Fat composition = 76% saturated fats, 21% monounsaturated fats, 3% polyunsaturated fats
  • The UNSAT group ate an extra 36 g olive oil, 26 g pesto, 54 g pecans, and 20 g butter
    • Macronutrient composition = 2% carbohydrate, 91% fat, 7% protein, 0% simple sugars.
    • Fat composition = 21% saturated fats, 57% monounsaturated fats, 22% polyunsaturated fats
  • The SUGAR group ate an extra 9.5 ounces of orange juice, 16 ounces of sugar-sweetened beverages, and 200 g of candy.
    • Macronutrient composition = 100% simple sugars.

Compliance to these dietary additions was confirmed by measuring the fat composition of serum triglycerides. As expected, the triglycerides were primarily composed of saturated fat in the SAT and SUGAR groups and unsaturated fats in the UNSAT group.

None of the participants had diabetes or other diseases, pre-existing liver disease, excessive consumption of alcohol (which can also lead to fatty liver disease). They were also not taking any drugs that could influence glucose or lipid metabolism.

Upon entry into the study, the three groups were comparable with respect to age, sex, BMI (a measure of obesity), amount and type of fat stores in the liver, and insulin sensitivity.

The baseline diet to which the extra calories were added was also comparable between the three groups and did not change during the study. That meant that the only difference between groups was the composition of the extra calories they consumed.

 

What Causes Fatty Liver Disease?

fatty liver disease dietsAt the end of three weeks:

  • All 3 groups gained weight, but the weight gain was slightly larger (0.6 pounds) for the SAT and SUGAR groups than for the UNSAT group (0.4 pounds).
  • Fat stores in the liver increased by 55% in the SAT group, 33% in the SUGAR group, and 15% in the UNSAT group.
  • The fat stores were primarily saturated fat in the SAT and SUGAR groups and primarily unsaturated fat in the UNSAT group.
  • Insulin resistance was increased in the SAT group, but not in the SUGAR and UNSAT groups.

Previous studies have suggested that the effect of liver fat stores on insulin resistance might be mediated by fat metabolites called ceramides. Therefore, they also measured plasma ceramide levels.

  • Plasma ceramides were increased in the SAT group, but not in the SUGAR and UNSAT groups.

Previous studies have also suggested that the effect of saturated fat on insulin resistance might be mediated by a change in gut bacteria that produce endotoxins which end up in the bloodstream.

  • A change in gut bacteria and an increase in plasma endotoxins was observed in the SAT group, but not in the SUGAR and UNSAT groups.

 

What is Worse Saturated Fat Or Sugar?

sugar cubesThe authors of this study concluded: “Saturated fat induced the greatest increase in fat stores in the liver, insulin resistance, and harmful ceramides. Decreased intakes of saturated fat could be beneficial in reducing fat stores in the liver and the associated risk of diabetes.”

Is that statement true? This study was well designed. However, this is a very small study. It needs to be replicated by larger studies. In the meantime, we can ask if the findings are consistent with previous studies.

You may have noticed, the authors included three variables in their study (saturated fats, unsaturated fats, and simple sugars), but I focused only on the comparison between saturated fats and simple sugars in this article. That is because the damage caused by saturated fats versus simple sugars is controversial in the popular literature. In contrast, most (but not all) experts agree that saturated fats are worse for you than unsaturated fats.

Let’s start with the relatively non-controversial comparison (saturated fats versus unsaturated fats) before turning to the comparison between saturated fats and simple sugars. When comparing saturated fats and unsaturated fats, the author’s conclusion that saturated fats are worse for you is probably true.

  • In this study saturated fats caused greater fat accumulation in the liver than unsaturated fats, and these differences were statistically significant.
  • The fat stores in the liver mirrored the fat composition of the diet. Saturated fat caused saturated fat stores. Unsaturated fat caused unsaturated fat stores.
  • Saturated fats increased insulin resistance while unsaturated fats did not.
  • This is consistent with several previous studies that have shown:
  • Saturated fats cause greater fat accumulation in the liver than polyunsaturated fats in younger, normal weight individuals.
  • High saturated fat intake is associated with fatty liver disease and insulin resistance.
  • Saturated fat increases heart disease risk, while unsaturated fat decreases heart disease risk.

However, the differences between saturated fats and sugar were less clear.

  • In this study saturated fats caused greater fat accumulation in the liver and more insulin resistance than simple sugars.
  • The conclusion that saturated fats are worse for you than simple sugars was strengthened by the following:
  • Saturated fat caused insulin resistance, while simple sugars did not.
  • Saturated fat caused a change to gut bacteria which resulted in increased endotoxin levels in the bloodstream, while simple sugars did not.
  • The conclusion that saturated fats are worse for you than simple sugars was weakened by the following:
  • The difference in fat accumulation in the liver was not statistically significant. A larger study may have provided a more definitive answer.
  • Previous studies have suggested that saturated fats and simple sugars may be equally bad for you. They both increase the risk of diabetes and heart disease.

Clearly, this study does not end the debate about whether saturated fats or simple sugars are worse for you. However, it does provide a new perspective.

Previous studies have not compared the effects of saturated fat and sugar on fatty liver disease when all other aspects of the diet were identical. If the observations of this study are confirmed in subsequent studies, it could influence how we evaluate the relative risks of saturated fats and sugars in the future.

What Does This Study Mean For You?

When you strip away all the noise, there are three obvious conclusions from this and most previous studies:

  • Excess calories in any form are bad for us. We don’t just store fat in the liver, and fat stores in other parts of our body have bad effects on our health as well.
  • Unsaturated fats are better for us than saturated fats. They reduce the risk of heart disease. This study suggests they also reduce the risk of fatty liver disease, insulin resistance, and possibly diabetes.
  • The jury is still out on the health consequences of saturated fats versus simple sugars. This study suggests that simple sugars may be less likely to cause fatty liver disease. While fatty liver disease can lead to diabetes and heart disease, so can fat stores anywhere else in the body. Other studies suggest that excess calories as saturated fats and simple sugars are equally likely to lead to obesity, diabetes and heart disease.

My recommendation is to avoid both saturated fats and simple sugars. Don’t focus on low fat diets or low carb diets. Instead focus on whole food diets with healthy fats and healthy carbs.

 

The Bottom Line

 

Fatty liver disease has serious consequences. It causes insulin resistance and inflammation, and that increases the risk of diabetes and heart disease. Even worse, it can lead to cirrhosis and liver failure.

Excess sugar is converted to saturated fat in the liver. Therefore, the popular literature attributes the epidemic of fatty liver disease to increased intake of simple sugars. But is it true? Saturated fats require no conversion. They can simply be deposited in the liver as is. Shouldn’t they be at least as damaging to the liver as sugar?

A recent study compared the effect of diets high in saturated fats (SAT group), unsaturated fats (UNSAT group), or simple sugars (SUGAR group) on fat accumulation in the liver. The results were:

  • Fat stores in the liver increased by 55% in the SAT group, 33% in the SUGAR group, and 15% in the UNSAT group.
  • The fat stores were primarily saturated fat in the SAT and SUGAR groups and primarily unsaturated fat in the UNSAT group.
  • Insulin resistance was increased in the SAT group, but not in the SUGAR and UNSAT groups.

The authors of this study concluded: “Saturated fat induced the greatest increase in fat stores in the liver and insulin resistance. Decreased intakes of saturated fat could be beneficial in reducing fat stores in the liver and the associated risk of diabetes.”

My recommendation is to avoid both saturated fats and simple sugars. Don’t focus on low fat diets or low carb diets. Instead focus on whole food diets with healthy fats and healthy carbs.

For more details on the study and what it means for you, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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