What is an inflammatory response?
First, a little science. Inflammation is more than something that happens to your toe when you stub it. Normally, it’s a positive thing; the process by which your immune system fights infection and repairs damage. It switches on when it’s needed, and off when it’s done. But inflammation has a murkier side, one that scientists refer to as low-grade or chronic inflammation – the kind that doesn’t switch off.
“The effects of low-grade inflammation are being linked to practically all major diseases in the Western world,” says Borelius. “So you have increased inflammatory markers connected to certain cancers, heart disease, lung disease, skin disease, joint disease and mental health.” Research has shown that lowgrade inflammation wreaks havoc in a number of ways. A recent study from Emory University School of Medicine in the US found that it reduces levels of dopamine – the chemical that drives you – with researchers believing the body switches it off when it detects inflammation, encouraging you to rest. It’s also being linked with problems such as atherosclerosis – the leading cause of heart attacks. It releases proteins called cytokines, which contribute to symptoms of depression, and it switches off genes that balance the body, turning on those that cause damage. As for where inflammation comes from, your body creates it. Fat cells excrete inflammatory substances, so the more excess weight you have, the more inflamed you’re likely to be. Stress causes it, as does lack of sleep. And it’s also triggered by external sources, such as pollutants and food. But, happily, food is also shaping up to be one of the major ways to fight it.
What is an anti-inflammatory diet?
The idea of an anti-inflammatory diet first caused a buzz in the early ’00s, when celebrity dermatologist Nicholas Perricone claimed it was the reason his clients looked so young and glowing. Genuine research followed, with various studies attempting to prove the efficacy of this way of eating. Fast forward to 2013 and Borelius came across the term ‘anti-inflammatory eating’ while on the board of Lund University in Sweden.
“One of their academics had conducted a trial on 44 people changing their diet,” she recalls. “She was getting such phenomenal results on blood pressure, cholesterol levels and cognitive ability that the doctor monitoring the patients called her and asked, ‘What kind of magic is this diet?’ When the academic told me what foods the participants in the study were eating, I nearly fell off my chair. It was a diet I’d been following under the advice of a fitness trainer for a few years, and it had totally revolutionised my health. The fat around my middle had vanished, backache gone, minor depression lifted.”
So make sure you’re seated safely while we reveal which foods make up an anti-inflammatory diet: fruit, vegetables, olive oil, whole grains, oily fish, turmeric, avocado, chia seeds, fermented foods and bone broth. Yes, they’re the kind of ingredients you read about in these pages every month, and that’s the point.
“We’ve known for years that these kinds of foods are good for us, but we haven’t always known why,” adds Borelius. Before you started ‘eating the rainbow’, it was called your five-a-day, and it was based on research that suggested this number was the minimum you needed to hit in order to reap the protective rewards. Oily fish is a mainstay of the Mediterranean diet, which a growing body of research is touting as magic for physical and mental longevity. And you can blame a collective obsession with the gut for the fact that fermented foods are enjoying a culinary revival.
“In this sense, the anti-inflammatory explanation is a way of understanding why the foods that we know to be healthy are actually healthy,” says Borelius. It’s one thing drawing a line between diet and inflammation, but trying to discern the foods that trigger it from those that temper it is another. While some studies, including one published in Biomedicine & Pharmacotherapy, have shown that eating, say, turmeric lowered levels of inflammation, they haven’t shown whether this has a knock-on effect in the body. And scientists have failed to reach a consensus on what foods are pro- and anti-inflammatory.
“Even now, opinion differs on some foods, like dairy, as it seems to show different results in different trials,” says Aisling Pigott, a registered dietitian. “It suggests there may still be something we don’t yet know about exactly how foods affect us in terms of inflammation. It may be that individuals react differently, or other elements of the diet play a role in altering the effects.” What we do know, we owe largely to two pioneers in anti-inflammatory eating: Dr James Hebert and researcher Dr Nitin Shivappa from the University of South Carolina. They examined more than 1900 articles on inflammation to create a list of about 45 foods or food components (things such as alcohol, caffeine or omega-3 fats) with either pro- or anti-inflammatory properties. They called this the Dietary Inflammatory Index (DII), and it’s now been used in more than 300 trials.
The passing of time helps, too. Cause and effect is notoriously difficult to prove in nutrition research, since the workings of your body are more complicated than the assembly instructions for an IKEA bookcase, but now researchers are investigating the long-term effects of the whole diet on actual people, with fascinating results. One 2018 study from Manchester Metropolitan University found that those with an inflammatory diet had a 40 per cent greater risk of depression. And a 2018 study published in Journal of Internal Medicine looking at 70,000 people over the course of 16 years found that those who followed an anti-inflammatory diet had a 20 per cent lower risk of dying of heart disease and a 13 per cent reduced risk of cancer. In fact, their overall risk of dying by any cause during the study was 18 per cent lower than those who were chowing down on a more inflammatory diet.
How can you reduce inflammation?
Before you go grande on a turmeric latte, know that nutrition science is complicated. Simply adding one food to your diet – served by a barista with a beard or otherwise – is not anti-inflammatory eating. Experts liken inflammation to a fire, and adding one yellow drink to your daily menu is like trying to put it out with sprinkles of water while dousing the other side with petrol.
“Fighting inflammation is holistic – your whole diet and lifestyle play a role,” adds Borelius. In Health Revolution, she outlines five inflammation-fighting principles, of which food is involved in just two (the others are exercise, calmness and finding awe). Pigott agrees. “It’s not as simple as this food is ‘good’ and this food is ‘bad’. For example, carbs with a low-glycaemic index are generally anti-inflammatory, but eat enough of them to produce excess kilojoules and that puts you in a pro-inflammatory state. You need to look at your diet as a whole.”
First, get rid of the petrol. “Foods that appear to be most relevant here are white or colourless, lack flavour and aroma [even if they have a strong taste, ie, sweetness], are nutrient-sparse and kilojoule dense,” says Hebert. That means refined sugars; white carbohydrates, such as white rice or bread; foods high in saturated or trans fats and vegetable oils, such as sunflower oil (high in omega-6 fatty acids, which, when eaten in too high a ratio to healthier omega-3 fatty acids, have a pro-inflammatory effect). Next, you can turn on the water hose (well, this analogy has legs) by adding more anti-inflammatory eats into your diet.
“These are foods that are colourful, aromatic, nutrient dense and kilojoule-sparse,” says Hebert. Yes, salads that would give Lola Berry a run for her money, but also whole grains, oily fish and spices, such as turmeric and ginger. Fermented foods can also play a role in fighting inflammation via your gut bacteria. And it isn’t just about what you’re eating, but when.
“The gut bacteria do their best work at fighting inflammation when they have nothing else to focus on,” adds Borelius. “If you can give them a break from digestion by leaving around 14 to 16 hours between your last meal of the day and your first one the next morning, it helps.”
Indeed, a study by Yale University found that when the body is in a fasted state, it produces a substance called BHB, which directly interferes with the process of inflammation. Fasting, fermented foods, fruit and vegetables – nothing you don’t already know. But, understanding the mechanism by which something works is generally a good thing. Anti-inflammatory eating may not be changing the game, but it’ll help you understand why you play.
What foods do you eat on an anti-inflammatory diet?
Dietitian Aisling Pigott gives you a starting point.
“This is only an example for one day,” she explains. “If you ate this way every day, you probably wouldn’t get the desired results. Anti-inflammatory eating is all about diversity, so it’s important to include a variety of anti-inflammatory foods in your diet.”
- Overnight oats
- Greek yoghurt
- Berries and banana
- Cup of tea
- apple or orange
- Fet salad
- Wholegrain cous cous or rice
- Olive oil based dressing
- Piece of fruit
- Piece of dark chocolate
- Cup of tea
- Salmon fillet
- Leafy veg
- Jacket potato