Diet and Nutrition part 3: Inflammatory and Anti-Inflammatory Foods

 

As we discussed in part two, any food that your child may have an allergy  to or intolerance for (as defined by the doctor or specialist) could be a potentially inflammatory food. But if one does an Internet search for “inflammatory foods”  all kinds of things,  not related to allergy pop up. There are mentions of specific inflammatory foods to avoid and  anti-inflammatory foods to consume, and entire diets built around them. It’s difficult to know what to believe.

food

In this installment of the diet and nutrition series we will cover  the basics of inflammatory foods and anti-inflammatory foods as supported by credible scientific research. As always, it is best to refer back to the primary research to draw your own conclusions, and consult with your doctor prior to making any major dietary changes.

 

INFLAMMATORY FOODS- The big offenders

 

There are many anti-inflammatory diets floating over the Internet.  An Amazon search will uncover over 706 books on that very subject! It can be overwhelming and confusing, to say the least. Add to this, that each has its own spin or focus, and   that focus can conflict with other credible published references, it’s enough to make one want to avoid thinking about it entirely.

 

Instead of wading through all the minutia, let’s cover some of the big offenders that most everyone would agree upon:

 

*Trans fats

*Refined Sugars

*Refined Flours

*Food Additives (like MSG)

 

The same culprits that are targeted to improve the Standard American Diet (also known as SAD)  are also the “bad guys” when it comes to promoting inflammation. Let’s look at each one:

 

The Mayo clinic offers a good tutorial about trans fats here: http://www.mayoclinic.com/health/trans-fat/CL00032

In essence, a trans fat is created when oils are hydrogenated to increase their shelf lives. Trans fats are bad for a number of reasons, but there are specific effects on inflammation, as evidenced by this NIH study: http://www.ncbi.nlm.nih.gov/pubmed/15051604

Best bet is to avoid them whenever possible.

Refined sugars are another villainized food product, with good reason. Processed sugars have little to no nutritional value, yet they contribute to obesity (and its subsequent health issues) as well as to increased inflammation. A fairly recent study linked increased inflammation in healthy young men after consumption of  “low to moderate sugar sweetened beverages,” http://ajcn.nutrition.org/content/94/2/479.short, and it isn’t hard to find mainstream news sources reporting the same: http://www.cnn.com/2012/07/20/health/food-cause-pain-daniluk

If you need to use sweetener, use unrefined sources (that at least have trace nutritional value) and use them in moderation.

Similar to refined sugars, refined flours have been highly processed, stripped of many of their inherent nutrients. In addition to their reduced nutritional value, there has been a direct relationship between their consumption and an increase in inflammatory protein concentrations. In this study, cited by the NIH, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821887/ consumption of whole grains were conversely related to inflammatory markers, while refined grains had a positive relationship (that is their consumption caused an increase in inflammatory markers.) Although this study focused on diabetes, the information regarding increased inflammation is still valuable knowledge.  Decrease or avoid refined white flours (or “fake” whole wheat products that are refined flours in disguise) whenever possible.

Food Additives are often a source of debate. For individuals with food additive sensitivities, avoidance can often result in an immediate improvement in the way they feel. For others,who may not be as sensitive, it is still important to understand the different types of additives, and which ones could pose the most problems in your individual case. An excellent primer on food additives can be found here: http://www.nlm.nih.gov/medlineplus/ency/article/002435.htm

In our family, we avoid any food additive that does not add to the nutritional value or safety of the food.  If it is used for the cosmetic appearance (emulsifiers, anti-caking agents, dyes/colors, stabilizers or thickeners) we look for another, less processed option.  In the case of Monosodium Glutamate (MSG) there have been studies linking its use with chronic inflammation in the liver, noting that chronic inflammation is “a common theme for autoimmune disease.”  (see the original study here:http://www.ncbi.nlm.nih.gov/pubmed/18178378 )

Although many food additives have been studied, other FDA approved additives have not.  According to the Medline Plus article cited above:

“The U.S. Food and Drug Administration (FDA) has a list of food additives that are considered safe. Many have not been tested, but they are considered safe by most scientists. These substances are put on the “generally recognized as safe (GRAS)” list. The list contains about 700 items.”

For this reason we have chosen to avoid them when we can.

Now lets talk about a less recognized and more debated group of foods that may cause inflammation: the nightshades.

If you bring up the subject of nightshades, you are bound to get a wide variety of responses. Some doctors tell you to avoid them, others say there is no difference. Patients and parents will often say the same thing. For some it seems to make a great deal of difference, while for others the effects are negligible or absent. Research tends to be inconclusive, however, there is some science to support an increase in inflammation with the consumption of some nightshades. An easy reference for the layperson can be found here: http://whfoods.com/genpage.php?tname=george&dbid=206 Although this is not a scientific citation, it is an easy to read overview with solid references.

In 1993, conclusions from a twenty-year study (Childers & Mongolis)on nightshades and  their  relation to arthritis were published.  The abstract states:

“Diet appears to be a factor in the etiology of arthritis based on surveys of over 1400 volunteers during a 20-year period. Plants in the drug family, Solanaceae (nightshades) are an important causative factor in arthritis in sensitive people. This family includes potato (Solanum tuberosum L.), tomato (Lycopersicon esculentum L.), eggplant (Solanum melongena L.), tobacco (Nicotiana tabacum L.), and peppers (Capsicum sp.) of all kinds except the black pepper (family, Piperaceae). A buildup of cholinesterase inhibiting glycoalkaloids and steroids from consumption and/or use (tobacco) of the nightshades and from other sources such as caffeine and some pesticides (organophosphates and carbamates) may cause inflammation, muscle spasms, pain, and stiffness. Osteoarthritis appears to be a result of long-term consumption and/or use of the Solanaceae which contain naturally the active metabolite, vitamin D3, which in excess causes crippling and early disability (as seen in livestock). Rigid omission of Solanaceae, with other minor diet adjustments, has resulted in positive to marked improvement in arthritis and general health.”

This shows that in both adults with arthritis and in farm animals, nightshades can cause increased pain and inflammatory issues. In the study avoidance of these foods did improve the effects of osteoarthritis, but studies have not been done on children.

In fact, it seems as though most of the research regarding nightshades has been done on animals, such as Ayad, S. K. “Effect of Solanine on Arthritis Symptoms in Postmenopausal Female Albino Rats,” while others, such as Rogers, Sherry A. “CASE HISTORIES-Solonaceae (Nightshade) Sensitivity as a Reversible Cause of Juvenile and Adult Rheumatoid Arthritis, Chronic Degenerative Disc Pain, and Osteoarthritis.” Journal of Applied Nutrition 52.1 (2002): 11-20. is the only look at nightshades and juvenile arthritis specifically that I was able to uncover ( this is not available online, but check with your local library if you would like to read the original study.)

If you and your child are willing, reducing or eliminating nightshades (only with your doctors blessing) may help alleviate some inflammation and/or decrease pain symptions.

 

ANTI-INFLAMMATORY FOODS

 

SO what should we eat?

 

In addition to a well-balanced, nutrient dense, real food diet with consideration toward the inflammatory foods, there are a few things to add to our diets that may reduce inflammation.

 

Omega 3 fatty acids, like those found in fish, have been found to have anti-inflammatory properties. Fatty saltwater fish (such as salmon, and to a lesser extent herring and tuna) tend to have higher concentrations of the beneficial fatty acids than their fresh water counterparts. Incorporating wild caught, omega 3 rich fish into the diet several times a week could help with inflammation. Although this article from the Mayo Health Clinic focuses on heart health, http://www.mayoclinic.com/health/omega-3/HB00087  much of the same information applies and it does briefly mention possible benefits for those with arthritis. For specific information on omega 3 fatty acids and arthritis, this study cited by the NIH http://www.ncbi.nlm.nih.gov/pubmed/12480795 and this article published in Rheumatology International link.springer.com/article/10.1007/s00296-002-0234-7 can provide more insight as to the applications as they relate to rheumatic conditions.

Another food that may help decrease inflammation is the cherry. Promising studies on rats have shown a decrease in rheumatic inflammation due to the anthocyanins in cherries http://www.ncbi.nlm.nih.gov/pubmed/17062434, while researchers at the American College of Sports Medicine found a link between the consumption of tart cherry juice and reduced pain.

And although I normally take industry reports with a healthy dose of skepticism, this report generated by the Cherry Marketing Institute summarizes a very comprehensive list of primary research studies that tout the benefits of tart cherries: http://www.choosecherries.com/pdfs/cherries_FINAL_Red_Report.pdf

Finally, the last group of foods that may decrease inflammation are those containing probiotics (like yogurt with live cultures or fermented foods, such as sauerkraut.) Researchers from Montana State University have developed a therapeutic agent (patent pending) utilizing probiotics to treat autoimmune disease, (you can read about it here) while other researchers across the world are beginning to study this connection further, as referenced in this  Turkish study: http://cdn.intechopen.com/pdfs/31655/InTech-Probiotics_for_autoimmune_diseases_is_there_a_benefit_.pdf

Since increasing probiotics can strengthen the immune system, it is recommended that you discuss the use of probiotic supplements with your doctor before adding them to a treatment plan, but incorporating some naturally occurring probiotic food sources into the diet can help maintain healthy levels of the “good” bacteria that we all need.

If you are still overwhelmed and confused, I have collected a few brief “cheat sheets” for the basics on adopting an anti-inflammatory diet:

https://www.fammed.wisc.edu/sites/default/files//webfm-uploads/documents/outreach/im/handout_ai_diet_patient.pdf

http://www.webmd.com/food-recipes/features/anti-inflammatory-diet-road-to-good-health

http://www.huffingtonpost.com/2013/03/21/inflammatory-foods-worst-inflammation_n_2838643.html

http://www.researchgate.net/publication/232120497_AntiInflammatory_Diets_Science_or_Sales_Pitch (this article may need to be ordered through your library, or by subscription)

It is always helpful to do your research first, but be sure to take your findings to the doctor so that you can discuss and plan the right course of action for your individual child.

Next up, Part 4: Herbs, Spices and Supplements

The Alternatives- Diet and Nutrition Part 2

An Autoimmune Refresher

In part one we discussed the importance of a healthy diet.

Although this is an important factor for overall health, it is one that tends to be brushed aside or overlooked. I made it the first part of the series for a reason. A healthy diet (that contains nutrient dense real foods and limited amounts of refined sugars, sodium and processed food products) is the foundation for the rest of the treatments we are going to discuss. Dietary changes specific to autoimmune disease should build upon the healthy diet you should already have in place. Without taking this step first, everything else becomes much less effective.

In a way, it’s like laundry. You have dirty clothes, and you want to get them clean. You decide to put them in the wash machine, but use dirty water with extra soap. Get the picture? The water is like the healthy eating, and the soap is the “extra” boost the specific autoimmune “diet” can provide. Sure, you can do it, and your clothes will probably be cleaner than when you started, BUT if you had used both the soap and the clean water, what a difference THAT would have made! If you haven’t had a chance to review part one, please take the time to go back, read, and review the primary research cited in the links. Understanding the science of and how-to’s behind adoption of a healthy diet is the first step!

Before we delve into part two, lets take a minute to revisit the way autoimmune diseases like JA work. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases:

When an intruder invades your body—like a cold virus or bacteria on a thorn that pricks your skin—your immune system protects you. It tries to identify, kill and eliminate the invaders that might hurt you. But sometimes problems with your immune system cause it to mistake your body’s own healthy cells as invaders and then repeatedly attacks them. This is called an autoimmune disease. (“Autoimmune” means immunity against the self.)”

While no one knows exactly what causes this response, the result is inflammation, in whatever part of the body that has been targeted. NAIMS goes on to say:

 “The acquired (or adaptive) immune system develops as a person grows. It “remembers” invaders so that it can fight them if they come back. When the immune system is working properly, foreign invaders provoke the body to activate immune cells against the invaders and to produce proteins called antibodies that attach to the invaders so that they can be recognized and destroyed. The more primitive innate (or inborn) immune system activates white blood cells to destroy invaders, without using antibodies.

Autoimmune diseases refer to problems with the acquired immune system’s reactions. In an autoimmune reaction, antibodies and immune cells target the body’s own healthy tissues by mistake, signaling the body to attack them.”

The Role of Allergies and Elimination Diets

In a similar manner, when the body is allergic to something, the body attacks the ingested substance (either inhaled, consumed or otherwise absorbed into the body) with a vengeance. This chain of events can cause a hyper-reaction of the immune system, resulting in anything from mild discomfort to total failure (like anaphylaxis or death in the most severe cases)

Many hospitals combine allergy, immunology and rheumatology in the same department, as all of these areas deal with immune system response. Recent research are finding more links between allergy and rheumatology, therefore, it would stand to reason that food allergies should be something that parents should give a bit more attention.

Understanding that all autoimmune diseases are an over-reaction of the body’s immune system means that anything we can do (with the doctor’s blessing, of course) to calm the immune system would be of some benefit. Avoiding an allergic response (even mild ones like seasonal allergies or those caused from issues with food) can help to keep the system a bit calmer. After my own children were tested for food allergies, we found a few surprises. I believe avoiding these foods have kept them more comfortable on several levels, although many were so mild that we were unaware of them prior to testing! Knowing that ingesting these foods could stimulate an autoimmune response was enough four our family to make adjustments in their diet.

Avoiding “allergic” foods (unique to each case) is another small way that food choices can positively impact JA and overall health. Ask your pediatrician (or allergist if you have one) if testing for food allergies would be beneficial for your child. Don’t forget to advocate, and back up your request with objective, scientific reasoning. They will be more apt to consider it when you have an evidence-based reason versus a hunch!

Speaking of food allergies, you may have heard of or been tempted to try an elimination diet for the very reasons I stated above. Unless it has been recommended by your child’s doctor, I would discourage taking that path. According to the Mayo clinic, the top 8 allergic foods are:

* Milk

* Eggs

*Peanuts

*Tree Nuts (almonds, cashews, walnuts)

*Fish

* Shellfish

*Soy

*Wheat

A true elimination diet takes a long time (a minimum of 3 weeks to three months with no cheating) and as you can see, truly eliminating all these could be extremely difficult, and possibly unnecessary with a simple allergy test. Children especially need a good nutritional balance to grow properly, and eliminating entire groups of foods could make this balance difficult to obtain, as well difficult to enforce (not to mention the logistical hardship it could cause.)

Focusing on a healthy nutrient dense diet, free of potential allergens in your child’s unique case is the first big step in creating the optimal eating plan for Juvenile Arthritis. Stay tuned for the next step in part 3 where we will cover inflammatory foods and anti-inflammatory diets.

 

The Alternatives- Diet and Nutrition, Part 1

  *Since this is a politically charged topic, I have included many hyperlinks throughout the text that refer to original articles and scientific support for the statements that are made. Please take a moment to review the primary research for yourself! The links will open in a new window, so you won’t lose your place. […]

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“The Alternatives,” An Introduction

Lets have a little chat.   We have talked about the rollercoaster that is juvenile arthritis. It seems as though your child can be doing so well, and then with very little warning things can change at the drop of a hat. It is an emotionally draining situation, and we all seek out our solutions […]

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