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Diet and Inflammation
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Diet and Inflammation

Instructor:  Tara Kulikov, L.Ac, MTOM, MA Kinesiology


Many patients seek acupuncture and Chinese medicine as a last resort to help deal with pain that they have been experiencing for many years.  Chronic arthritis, lumbago, fibromyalgia, and sports injuries are just a few conditions that patients seek treatment for.  Other ailments that acupuncturists treat on a regular basis include obesity-related complaints, symptoms of diabetes, gastrointestinal disorders, and symptoms related to heart disease.

Interesting enough, many of the above mentioned health conditions can be linked to chronic inflammation.  When we think of inflammation, redness, swelling, heat, and pain are the first things that commonly register in our minds.   Inflammation is the body’s first response to an injury or harm caused by a virus, bacteria, fungus, or by environmental toxins.  It is something we have all experienced at one time or another.

However, there is another aspect of inflammation that is gaining attention in the medical field.   Chronic internal inflammation has been linked to many major degenerative diseases including type 2 diabetes, fibromyalgia, Alzheimer’s disease, obesity, cancer, heart disease, lupus, rheumatoid arthritis, and many more.  Millions of Americans are affected by these diseases and seek relief from the symptoms in many forms including acupuncture and nutritional changes.

 


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What is Inflammation?

Most acupuncturists are accustomed to diagnosing and treating acute inflammation.  Acute inflammation is the body’s first response to injury or damage to tissues.  Acute inflammation serves to destroy, dilute, or wall off both the injurious agent and the injured tissues. The classical signs of acute inflammation are pain, heat, redness, swelling, and loss of function.  In Traditional Chinese Medicine we commonly diagnosis these types of conditions as Heat, Damp Heat, Bi Syndromes, or External Heat, and assign them as Excess.  This type of inflammation is usually quite evident.

On the other hand, chronic inflammation is typically internal and unseen.  It occurs after the body has been continuously fighting to ward off pathogens, allergens, or other forms of chronic stress.   The definition of chronic inflammation is prolonged and persistent inflammation marked chiefly by new connective tissue formation; it may be a continuation of an acute form or a prolonged low-grade form.  It is theorized that chronic inflammation can lead to many diseases as well as necrosis.  In TCM, we may diagnosis this type of inflammation as a latent heat pathogen, yin deficiency, or stagnation.

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Prostaglandins

Prostaglandins are hormone-like substances that largely control inflammation.   They also participate in the contraction and relaxation of smooth muscle, the dilation and constriction of blood vessels, the control of blood pressure, and the modulation of inflammation.  The three types of prostaglandins and their functions are described by Jessica K. Black, Author of The Anti-Inflammation Diet and Recipe Book below.  She terms the “good” prostaglandins as PGE1 & PGE3 and the “bad” prostaglandin as PGE2.

 PGE1

Helps to reduce allergies, prevent inflammation, increase mucous production in the stomach, decrease blood pressure, improve nerve function, and also promote an immune response.

 PGE2   
Stimulates the allergy response, promotes inflammation, increases platelet aggregation, increases smooth-muscle contraction, and suppresses immune function.
 PGE3

Blocks the release of pro-inflammatory prostaglandins (PGE2), promotes immune function, decreases platelet aggregation, increases HDL cholesterol, decreases triglycerides, and inhibits inflammation.

 

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C - Reactive Protein:  The Inflammatory Marker for Disease

Research has examined the association between C-reactive protein (CRP) levels and an increased risk for certain diseases.  CRP is a protein found in the blood.  Levels of CRP rise in response to inflammation.  CRP can rise 50,000-fold in acute inflammation.  CRP rises are due to a rise in the plasma concentration of Interleukin 6 (IL-6 is an interleukin that acts as both a pro-inflammatory and anti-inflammatory cytokine, which is produced predominantly by macrophages as well as adipocytes).

CRP is mainly used as a diagnostic marker of inflammation.  Normal CRP levels in healthy individuals are usually lower than 10mg/L.  These levels will slightly increase with aging.  Mild inflammation, viral infections, and late stage pregnancy will produce higher CRP serum levels (10-40mg/L), and active inflammation, mild bacterial infections can produce levels ranging from 40-200mg/L.  Severe bacterial infections and burns can produce serum levels over 200mg/L.

The normal range for C-reactive protein is 0-1.0 mg/dL or less than 10 mg/L (SI units).

The American Heart Association and the Center for Disease Control recommend that "high-specificity CRP" (hs-CRP) levels should be measured to test for increased risk for heart disease.   Since levels can fluctuate, they recommend that two separate CRP levels be measured, and then the two values averaged together. Levels less than 1 mg/L are considered low, levels from 1 to 3 mg/L are considered average, and levels greater than 3 mg/L are considered high. High levels indicate an increased risk of cardiovascular events.

According to the American Heart Association, patients are at a low risk of developing cardiovascular disease if their hs-CRP level is lower than 1.0 mg/L, average risk if levels fall between 1.0 and 3.0 mg/L, and high risk if the hs-CRP level is higher than 3.0 mg/L.

In other words:

  Less than 1.0 mg/L

 Lowest Risk

  1.0 to 3.0 mg/L

 Average Risk

  More than 3.0 mg/L

 Highest Risk

 

 

 

 

It has also been found that patients with an extremely high level of CRP (over 10 mg/L)  with the absence of other risk factors for heart disease should be evaluated for other, non-cardiovascular causes such as lupus, diabetes, rheumatoid arthritis, and cancer.  Research has also shown an increase in CRP levels in the obese population.

 

 


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The Link Between Food and Inflammation

We have just learned that the body creates both inflammatory and anti-inflammatory chemicals called prostaglandins.  Nutrients from specific foods can also promote the production of certain prostaglandins.  It is thought that particular nutrients can lead to the creation of excessive amounts of inflammatory prostaglandins (PGE2), fueling the body's inflammatory response. Conversely, the consumption of particular nutrients, like omega-3 fatty acids, allows the body to produce more anti-inflammatory prostaglandins (PGE1 &3), which it uses to reduce inflammation.  Moreover, some current research has linked certain supplements (such as quercetin) with anti-inflammatory functions thus reducing risk factors for certain diseases.

It is both encouraging and discouraging to know that food can have such a profound effect on inflammation and risk factors for disease.  One advantage is that as health care providers, we can use the knowledge of anti-inflammatory foods to help create nutrition plans to better the health of our patients.  The discouraging factor is that the typical American diet is full of inflammatory foods making it a challenge to help overcome many disease epidemics seen in our country such as obesity, heart disease, and type 2 diabetes.

Learning what foods are considered anti-inflammatory and what foods are contributed to inflammation is a valuable lesson to give your patients in order to guide them towards healthier lifestyle choices. 

Inflammatory Foods

The following is a list of foods that are thought to contribute to high levels of inflammation in the body and some theories as to why.  For some of these foods, the inflammatory effect is non-specific, but nevertheless they seem to cause systemic stress on the system.  It has been found that weakened or stressed systems in the body can lead to inflammation.

 

 Food

Theorized Reason for Causing Inflammation

 Wheat Products

Conventional wheat products have been greatly genetically modified increasing the gluten content, making it very difficult for the body to recognize its structure.  This causes the immune system to react pathologically, producing inflammation. Many of the nutrients are removed during the refining process which can also cause allergic reactions and malabsorption leading to inflammation.

 Dairy Products

They tend to be high in fat which allows many toxins (coming from pesticide residues and genetically modified products in their feed) to be stored in those fat cells.  Once consumed by humans, these toxins can build up causing stress on the immune system thus leading to inflammation. Organic dairy has been recommend if a person does not react negatively (with allergic symptoms) to dairy. 

 Nightshade     Vegetables

Potatoes, tomatoes, eggplant, bell peppers, paprika, cayenne, and tobacco all contain high levels of alkaloids which can be harmful in high doses and have been shown to create inflammation in the body.

 Sugar

Has been shown to depress the immune system creating inflammation.  Can also raise glucose levels and insulin levels increasing risk factors for diabetes and heart disease.

 Citrus Fruits

It is unclear why citrus fruits trigger inflammation in many individuals.  One theory is that they cause acid to build up in the body aggravating some people with arthritis.

 Peanuts

They contain aflatoxin (a mycotoxin, commonly manifested as a fungus) on their surface, are highly allergenic to many individuals, and have been shown to increase the risk of cancer in some individuals. 

 Alcohol

Is converted into sugar in the body, depressing the immune system.

 Coffee and other   caffeinated beverages

Have been shown to tax the adrenal glands and the liver.  Overall, coffee and other caffeinated beverages cause stress on the body which can lead to inflammation.

 Commercial eggs  (non-organic)

Similar to dairy, they contain a high level of toxins due to toxins in the chicken feed.   The yolk also has a high amount of arachidonic acid which initiates inflammation in the body.  Organic eggs, however, are tolerated by many individuals.

 Pork

Has been shown to stimulate an autoimmune reaction due to its similar protein structure with humans causing a cross-reaction in the immune system and inflammation.  Its high fat content also makes it high in arachidonic acid creating inflammation in the body. Other forms of high-fat meat can have the same effect.

 Shellfish

Many people are allergic to shellfish.  Shellfish contain a high amount of arachidonic acid creating inflammation in the body.

 Hydrogenated Oils/Trans Fats

Are manmade fats that are hard for the body to recognize and breakdown, thus stimulating inflammatory-generating prostaglandins.

 Fried Foods

Oils and fats cooked at very high temperatures turn into trans fat.  (See above.)

 Processed Foods

Are typically man-made and difficult for the body to recognize and breakdown stimulating inflammatory-generating prostaglandins.

 Corn

Is highly allergenic in many individuals and conventional corn has been grossly genetically modified making it difficult to digest.  Corn is also heavily sprayed with pesticides which can also cause stress and inflammation in the body.  Small amounts of organic corn is tolerated by most people.

 

Other foods that frequently contribute to inflammation due to a sensitivity in the body include: food dyes, chocolate (due to its dairy content and or caffeine content), monosodium glutamate, meat preservatives (nitrates), some vinegars (due to its high acid content), artificial sweeteners, and dried fruit with sulfur. 

For NCCAOM students, follow this link to your third worksheet question.



For the acupuncture and Chinese medicine community:  If you would like California or NCCAOM continuing education credit for this course, click on the green button on the top right hand corner of the screen that says "Go to Quiz" after completing the course.
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Anti-Inflammatory Foods

Now that you are familiar with food that can increase inflammation in the body thus increasing the risk for certain diseases,  let's learn about the best food for preventing inflammation in the body.

Fruit (pineapple, berries, melons, apples, bananas, kiwi, cherries, mango and any other fruit except citrus)

Fruit is full of phytochemicals and antioxidants that can help prevent disease.  Abundant in fiber, fruit can improve the digestive tract by helping to eliminate toxins that can contribute to inflammation, and help to absorb and utilize beneficial nutrients. Certain fruits, such as pineapple, contain bromelain, an enzyme that is naturally anti-inflammatory.  Phytochemicals (plant chemicals) are complex chemicals that vary from plant to plant.  They include thousands of compounds, pigments, and natural antioxidants, many of which have been associated with protecting against heart disease, hypertension, cancer and diabetes.

Vegetables (spinach, asparagus, cauliflower, pumpkin, lettuce greens, Brussels sprouts, and any other vegetables except nightshade vegetables and corn) & Sea Vegetables (Nori, Kombu, Kelp, Wakame, Arame, Dulse)

Similar to fruit, vegetables contain a high amount of fiber and many phytochemicals and antioxidants shown to be beneficial to the body.  The cruciferous vegetables — broccoli, Brussels sprouts, bok choy, kale, cabbage, and cauliflower contain powerful plant compounds such as sulforaphane which has been shown to have an anti-inflammatory action in the body.  Sea vegetables contain fucoidans (starch-like polysaccharide molecules), which have been shown to have anti-inflammatory properties as well.

Legumes (garbanzo beans, pinto beans, split peas, black beans, lentils, and other beans)

Legumes can be utilized in the body as a carbohydrate or as a protein when properly combined.  They are known as incomplete proteins as they lack essential amino acids that the body needs to form a protein.  Legumes also contain a high amount of fiber.  Studies have shown that diets that are high in legumes are inversely related to levels of CRP found in the blood.

Meat (organic chicken without the skin, organic turkey without the skin, organic buffalo, organic lamb, wild game, organic, grass-fed beef in small amounts)

Meat helps to regulate blood sugar levels and provide stable energy throughout the day lessening stress on the body.

Seafood (wild salmon, halibut, tuna, sardines, cod, trout, haddock, mackerel, flounder) 

Seafood contains a high amount of omega-3 fatty acids which help to improve immune function, improve brain function (mood, memory, nerve conduction) and other nerve systems, improve lipid profile, improve the skin, and lessen stress on the body.  Omega-3 fatty acids have been shown to diminish the production and effectiveness of various prostaglandins that cause inflammation.

Sweeteners (honey, pure maple syrup, agave syrup, brown rice syrup, barley malt, stevia, rice malt)

Certain sweeteners contain a good percentage of complex sugars which can smooth out blood sugar levels.  They help regulate blood sugar levels when combined with other foods as well. Honey contains important minerals and enzymes for the body.  Raw, unheated, unprocessed honey allows it to retain all the nutrients and can be anti-bacterial and anti-fungal helping to improve the immune system decreasing risk for inflammation.  Stevia is a small plant with sweet leaves & flower buds used as a natural non-caloric sweetener.  It has been shown to help regulate blood sugar levels decreasing stress on the body.

Nuts and Seeds (almonds, cashews, sunflower seeds, chia seeds, flax seeds, pumpkin seeds, sesame seeds, and nut butters)

Nuts and seeds can be utilized in the body as an essential fat and as a protein.  Nuts and seeds are one of the best sources of vitamin E, which acts as a nerve protector and immune-enhancing antioxidant.  Common nuts and seeds also contain the greatest quality of fats of all unprocessed foods-much of in the form of an essential fatty acid.  They are high in antioxidants, promote a healthy liver, high in Vitamin E, high in Omega 3 fatty acids, high in folic acid, high in niacin, and high in minerals.

Oils and Butter (olive oil, coconut oil, nut or seed oil, small amounts of organic butter)

A naturally occurring chemical found in extra-virgin olive oil, Oleocanthol, is a non-steroidal anti-inflammatory agent.  The health benefits of coconut oil can be attributed to the presence of lauric acid, containing antimicrobial, antioxidant, antifungal, antibacterial, and antiprotozoal properties, all which can improve the immune system.  Coconut oil has also been found to aid in the management of inflammatory disease by increasing production of the anti-inflammatory compound, interleukin-10.  Nut oils contain a high amount of omega 3 essential fatty acids, shown to reduce inflammation.

Organic Eggs

Eggs are a good source of protein aiding to regulate blood sugar levels and their yolks contain choline which has been shown to reduce inflammation in the body.

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Omega 3 & 6 Fatty Acids

Research has found that the most optimal diet for reducing inflammation contains a balance of omega-3 and omega-6 fatty acids.  It has been found that omega-3 fatty acids can help to reduce inflammation, and some omega-6 fatty acids can promote inflammation.  Not all omega-6 fatty acids promote inflammation, but many sources, such as high-fat red meat, do.

When excessive amounts of omega-6 fatty acids are consumed, the body has a hard time metabolizing omega-3's, reducing their anti-inflammatory role in the body. Research shows that the typical American diet tends to contain 14 - 25 times more omega-6 fatty acids than omega-3 fatty acids.

Recent studies suggests that most American diets are at a ratio of 20:1 for omega 6's to 3's.  A suggested healthy ratio is 4:1 and many health experts recommend 1:1 for optimal health.  It is recommend that adults consume 1,000 mg of Omega-3's per day to reap the most benefit.
*http://www.omega3summit.org/ 

Dietary sources Omega-6 fatty acids

Oils:  Blackcurrent seed oil, flax/linseed oil, rapeseed or canola oil, hemp oil, soybean oil, cottonseed oil, sunflower seed oil, corn oil, safflower oil, borage oil, most vegetable oils, evening primrose oil

Meat and Dairy:  poultry, eggs, red meat 

Nuts & Seeds:  Many nuts have a high Omega 6 content, in particular cashews.  Pumpkin seeds are a particulary good source of Omega 6's a well.

Whole Grains:  Whole grain breads, cereals         

Other:  Acai berry, avocado

Concentration of Omega 3 Fatty Acids in Foods

The following chart illustrates the Omega-3 concentration in certain foods.  Some people are surprised to see that flax seeds have almost three times the Omega-3 content as salmon.

Food Serving Omega-3 fatty acids

 

Flax seeds

 

 0.25 cup

 

 7.0 g

 

 Walnuts

 

 0.25 cup

 

 2.3 g

 

 Chinook salmon, baked/broiled

 

 4.0 oz-wt

 

 2.1 g

 

 Scallops, baked/broiled

 

 4.0 oz-wt

 

 1.1 g

 

 Soybeans, cooked

 

1 cup

 

 1.0 g

 

 Halibut, baked/broiled

 

 4.0 oz-wt

 

 0.6 g

 

 Shrimp, steamed/boiled

 

 4.0 oz-wt

 

 0.4 g

 

 Snapper, baked

 

 4.0 oz-wt

 

 0.4 g

 

 Tofu, raw

 

 4.0 oz-wt

 

 0.4 g

 

 Winter squash

 

 1 cup

 

 0.3 g

 

 Tuna, yellowfin

 

 4.0 oz-wt

 

 0.3 g

 

 Cod, baked

 

 4.0 oz-wt

 

 0.3 g

 

 Kidney beans

 

 1 cup

 

 0.3 g

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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Inflammatory Rating System

A beneficial tool for acupuncturist and patients to utilize is the Inflammation Factor Rating System (IF Rating System) which was created by a nutritional researcher that dedicated many years to studying systemic inflammation and nutrition. The formula used to calculate the IF Ratings measures the effects of more than 20 different factors that determine a food’s inflammatory or anti-inflammatory potential, including: amount and type of fat, essential fatty acids, vitamins, minerals, antioxidants, glycemic index, and anti-inflammatory compounds.

The IF Rating System estimates how various foods and combinations of foods are likely to affect inflammation in the body.  According to the website dedicated to this subject, www.inflammationfactor.com, foods with negative ratings can contribute to inflammation, especially when consumed in excessive quantities. Foods with positive IF Ratings aid in supporting the body's anti-inflammatory functions.  A higher number indicates a stronger anti-inflammatory effect.  A sample list can be found below.  For the serving size of each food, please reference the Web site.

The IF rating system is designed in the following way:  Foods with an IF rating of 1-100 are considered to have mild anti-inflammatory effects, foods with an IF rating of 101-500 show increasingly potent anti-inflammatory effects, and foods with an IF rating of over 500 are strongly anti-inflammatory.  Foods that are rated -1 to -100 are considered mildly inflammatory, -101 to -500 are considered increasingly inflammatory, and -500 and below are considered highly inflammatory. A zero score is neutral.

 Food  IF Rating Factor

 

  Almonds, dry roasted

 

 56

 

  Apple

 

 -30

 

  Bagel, Plain

 

 -180

 

  Bread, Multi-Grain

 

 -33

 

  Broccoli, boiled

 

 60

 

  Butter

 

 -40

 

  Cantaloupe

 

 75

 

  Carrot, raw

 

 99

 

  Chicken breast, roasted (no skin)

 

 -18

 

  Cottage Cheese (1% fat)

 

 -17

 

  Corn Flakes

 

 -95

 

  Egg, Whole

 

 -43

 

  French Fries

 

 -181

 

  Green Beans, boiled

 

 1

 

  Ground Turkey

 

 -60

 

  Ice Cream, Chocolate

 

 -127

 

  Milk (1% fat)

 

 -60

 

  Oatmeal Cookie

 

 -39

 

  Olive Oil

 

 73

 

  Pasta shells, cooked

 

 -55

 

  Peanuts, dry roasted

 

 25

 

  Salmon, Atlantic (wild)

 

 493

 

  Spinach, raw

 

 80

 

  Strawberries

 

 28

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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Creating an Anti-Inflammatory Nutrition Plan for Patients

The first step in assisting a patient with a nutrition plan is to determine their goals such as weight gain or loss, ease of pain and discomfort, etc.  A proper diagnosis (both TCM and Western) for the condition they are seeking treatment for is the second step in creating a nutrition plan.  After these two steps have been determined, an overall caloric intake and macronutrient breakdown according to their individual profile should be determined.  If you are unfamiliar with how to do this, please reference the free course:  Nutritional Basics for the Acupuncturist also featured on Grasshopper Education.

Once you have established a patient’s caloric needs, you can now suggest an anti-inflammatory food plan.  It is also helpful to give them a list of anti-inflammatory foods or “food to eat” and a list of inflammatory food or “foods to avoid.”

Below is a sample diet plan that a patient can follow to optimize anti-inflammatory nutrition:

 

Day 1 Day 2 Day 3
  Breakfast 
1 cup cooked gluten-free oatmeal with 2 tbs. organic canned pumpkin, 1 tbs. flax seed meal, ½ cup organic blueberries, ½ cup almond milk, 1 tbs. raw almonds, 1 tsp. raw honey 2 organic poached eggs, 1 slice of gluten free bread, 1 cup of organic steamed spinach (with eggs), 1 small piece of organic fruit Smoothie with 1 cup rice milk (more if necessary), ½ banana, ½ cup frozen, organic blueberries, ½ cup frozen, organic pineapple, 1 cup organic spinach, 1 scoop rice protein powder, 1 tbs. cashew butter, 1 tbs. ground flax seeds, ice
Snack 1 organic green apple sliced with 2 tbs. almond butter 4 oz. almond milk yogurt mixed with 1 tbs. raw walnuts and a 1/3 cup organic raspberries 1 cashew cookie Lara bar
Lunch 1 can of wild caught salmon over fresh organic greens, 1 tbs. avocado, and other organic veggies, 1 tsb. olive oil, fresh lemon, 4 whole grain rice crackers 1 brown rice tortilla filled with ¼ c. black beans, ¼ c. quinoa, chopped onions, 2 tbs. avocado, chopped mango, chopped organic lettuce, 1 cup chopped organic pineapple White bean and kale soup, with 1 cup rice chips, and 1 organic peach.
Snack Organic raw nut and seed mix, ¼ cup, 1 small plum ½ cup hummus with organic celery and carrot stick 1 hard boiled organic egg, ½ cup organic grapes
Dinner Baked, organic chicken breasts  with fresh herbs and spices of your choice baked in olive oil and lemon, with ½ cup brown rice with 1 tsp. flax seed meal, 1 cup steamed organic broccoli, 1 tsb. olive oil, lemon 6 oz. wild caught grilled salmon with fresh lemon and herbs, 1 small baked organic sweet potato, organic mixed green salad with 1 tbs. olive oil and apple cider vinegar with fresh lemon. 1 salmon and avocado sushi roll, 1 cup edamame, 1 cup cucumber salad mixed with 1 cup seaweed salad.
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Main Herbs and Supplements for Inflammation

A few main herbs and supplements that I would like to briefly cover in regards to their anti-inflammatory properties are quercetin (a plant-derived flavonoid found in fruits, vegetables, leaves and grains), curcumin (jiang huang or yu jin), and ginger (gan-jiang dried ginger, and sheng-jiang, fresh ginger).

Research has shown that quercetin acts like an antihistamine and an anti-inflammatory, and may help protect against heart disease and cancer.

The anti-inflammatory effect of curcumin is most likely mediated through its ability to inhibit cyclooxygenase-2 (COX-2), lipoxygenase (LOX), and inducible nitric oxide synthase (iNOS). COX-2, LOX, and iNOS are important enzymes that mediate inflammatory processes.

The anti-inflammatory properties of ginger have been known and valued for centuries.  Ginger has an inhibitory effect on prostaglandin biosynthesis and shares pharmacological properties with non-steroidal anti-inflammatory drugs.

Ginger and curcumin are two herbs that are easy to add to everyday cooking.  Soups, stews, rice dishes, meat and egg dishes, fish, and many vegetable dishes can be greatly enhanced in flavor with the addition of ginger and curcumin.  Quercetin can be found in a powdered form and can be added to smoothies or taken in a pill form as a supplement.

In addition to a healthy diet, quercetin, curcumin and ginger are simple for patients to add to their meals and are safe to recommend to everyone.

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18.  Olaf Adam et. al., “Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis.’ Rheumatology International  23( 1): 27-36, DOI: 10.1007/s00296-002-0234-7.

19.  Patterson, G., Larsen, L., Moore, R., “Bioactive natural products from blue-green algae.”  Journal of Applied Psychology,  pages 151-157.

20.  Pitchford, P. Healing with Whole Foods, 3rd Edition. 2002. North Atlantic Books. Berkley, Ca.

21.  Thomas DE, Elliott EJ, Baur L., “Low glycaemic index or low glycaemic load diets for overweight and obesity.” Cochrane Database Syst Rev. 2007;(3):CD005105. (PubMed).

22.  Verhaggen PW, de Maat MP, Cats VM, et al., “Inflammatory status as a main determinant of outcome in patients with unstable angina, independent of coagulation activation and endothelial cell function.” Eur Heart J. 1999; 20:567-574.

23.  Weil, A., “Anti-Inflammatory Diet Tips.”  available online at: http://www.drweil.com/drw/u/ART02012/anti-inflammatory-diet. (last visited July 8, 2011).
 



 

 
 
 
 
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