Anti-inflammatory diets for pain have been extensively studied both clinically and anecdotally. Diet has widespread appeal for patients but needs the presence of scientific evidence that demonstrates substantial benefits to reduce symptoms such as pain, stiffness, swelling, tenderness and associated disability. There does not seem to be a one size diet, however, there is evidence which we can explore to look at different diets and their possible molecular mechanism of action with possible therapeutic benefits for management. There also appear to be some foods with potential aggravating factors and some offering symptomatic relief.
Many people complain of gastrointestinal problems particularly acidity, bloating, fullness, belching, nausea, altered bowel movements and ulceration of the lining. Changed microbiota has been implicated to support the “gut-joint axis” hypothesis and bacteria found in some foods such as milk were often blamed for causing some inflammatory responses. (2)
Various dietary plans for inflammation have been trialled and the following showed clinical and statistical significance and long-term beneficial effect. Dietary features are assessed for their influence to reduce pro-inflammatory cytokines such as TNF-α, and IL-12 and IL-1β and subjective patient assessment using VAS and other scores which measure a characteristic or attitude that is believed to range across a continuum of values and cannot easily be directly measured.
7-10 day fasting followed by a vegan diet
The 7-10 days of fasting included some supplementation plus intake of vegetable broth, vegetable juice (carrots, beets and celery), herbal teas, parsley, garlic and a decoction of potatoes to get the juice. Considerable reduction in swelling, joint tenderness, pain as well as ESR and CRP were observed.
A diet including only fruits, vegetables, legumes, nuts and seeds and excluding all animal products is vegan. It has repeatedly reported being clinically beneficial for the disease. The improvements may be due to the reduction in immune-reactivity to certain food antigens and improved gastrointestinal health. Blood tests showed a reduction in acute-phase reactants known to cause inflammation and joint destruction and pro-inflammatory cytokines which lead to tissue damage. (1)
A Mediterranean diet stands apart from other diets by the high consumption of olive oil and more frequent intake of fish and vegetables. Olive oil has been rigorously studied for its health benefits and the fatty acids that differentiate it from seed oils such as oleic acid metabolized to eicosatrienoic acid which has anti-inflammatory effects similar to omega 3 fatty acids from fish oil. (3)
Elimination diets strip back foods from the evidence that shows them as a potential antigen for humans and could aggravate inflammatory symptoms. The intestinal epithelium is an interface between the mucosal immune system and the external environment and determines the resultant immune response to various food antigens. It has been shown that the intestinal mucosa is more permeable to allergens under some disease conditions and when on non-steroidal anti-inflammatory drugs.
Treatment of Rheumatoid arthritis, for instance, includes inhibition of TNF-αand IL-1, both of these inflammatory mediators are observed to be increased with the intake of allergenic foods. (4) Food allergens, additives, preservatives, corn and lactoproteins were studies by Van der Laar and Van der Korst and concluded to be potential triggers of the immune system leading to inflammation.
Vegetables and fruits are key players in the diet and shown to diminish symptoms of several chronic diseases. They can be categorized into groups as nitrogen-containing compounds, phenolics, organosulfur compounds, alkaloids, phytosterols and carotenoids. (5) Anthocyanins from black soybean, black rice and eggplant to reduce oxidative stress and inflammation and fresh fruits are rich in important phytochemicals are potent anti-oxidants. In addition, tea, cocoa, red wine, ginger, curcumin and cinnamon are known for their therapeutic properties due to the presence of pungent phenolic compounds that reduce oxidation and inflammation
Omega-3 (ALA) from plant oils, and fish oil, as well as omega-6 fatty acids containing gammalinoleic acid (GLA), have shown their value as antioxidants and a significant decrease in pain, stiffness and tenderness, VAS scores and CRP levels.
Probiotics are known for their health benefits and reports have confirmed they play a part in reducing oxidative stress to reduce peroxidase activity and allergenic properties of some food components. (6)
Growing clinical support of the impact of diet therapy on decreasing disease through anti-inflammatory and anti-oxidative mechanisms is of interest to those seeking alternative therapies with no side effects. Patients with debilitating conditions or concern due to a family history should be motivated to change their eating habits and we should work to educate and capacitate them with the benefits of eating more vegetarian/vegan diets, eliminate potential allergic food components and introduce more polyunsaturated fatty acids such as oleic and omega 3 along with probiotic and prebiotic foods. It may be difficult to see the immediate effects of dietary manipulation but the long-term benefits are reported.
Recommended anti-inflammatory food chart. (1)
Fruits: dried plums, grapefruits, grapes, blueberries, pomegranate, mango, banana, peaches, apples
Cereals: whole oatmeal, whole wheat bread, whole flattened rice
Legumes: black soybean, black gram
Wholegrains: wheat, rice, oats, rye, barley, millets, sorghum
Spices: ginger, turmeric
Oils: olive oil, fish oil, borage seed oil
Other: cultured yoghurt, tea, cocoa