The Anti-Inflammatory Diet: Cooling

the “Fires” Within

Richard E. Collins, MD
THE COOKING
CARDIOLOGIST®
Susan Buckley, RDN, CDE

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The Anti-Inflammatory Diet

 Most people associate inflammation with conditions

such as arthritis and IBS, but we are increasingly
coming to understand that it is also connected to
diabetes, obesity, heart disease, Alzheimer’s,
cancer and even depression and mood disorders
 Americans are living more and more disconnected
from their natural food sources, and our diets are
increasingly made up of processed foods, excess
sugars and bad fats, and genetically modified
foods.

The Anti-Inflammatory Diet

 This is a recipe for chronic inflammation.

 An anti-inflammatory diet can quiet
symptoms, and turn back the tide on many
health issues, with the added benefits of
increased energy and, in many cases,
weight loss

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What is Inflammation?
 Part of a healthy immune system response
 Low-level, chronic inflammation is an excessive,
inappropriate inflammatory response
 Can be measured with lab test: C-reactive protein
 C-reactive protein (CRP) is a substance produced by
the liver in response to inflammation.
 High CRP levels may put people at increased risk for
coronary artery disease, which can cause a heart
attack

The Anti-Inflammatory Diet

 One of the most

powerful tools to
combat inflammation
comes not from the
pharmacy, but from
the grocery store
 Many studies have
shown that components
of foods and beverages
can have anti-
inflammatory effects

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Cooking Methods/Inflammation

 Also, HOW we cook our food may be as

important as WHAT we cook as far as health
and nourishment are concerned
 Food cooked at high heat in our modern,
fast-paced, processed-food culture, creates
potentially cancer-causing chemicals called
heterocyclic amines (HCAs) and
polycyclic aromatic hydrocarbons (PAHs)

AGEs, HCAs

 Heterocyclic amines (HCAs) are created when

meat, poultry and fish are cooked at high
temperatures –seafood has less, plant foods little
to none
 Foods cooked at high temperature also contain
greater levels of advanced glycation end products
(AGEs) that cause more tissue damage and
inflammation than foods cooked at lower
temperatures.
 AGEs irritate cells in the body, damaging tissues
and increasing risk of complications from diseases
like diabetes and heart disease.

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HCAs

 Grilling, barbecuing, broiling and pan-frying

are more likely to produce HCAs than baking
or roasting – due to high temp
 Propane gas grill can reach 640 degrees F
while a typical roasting temp is 350 degrees
 Liquid cooking – boiling, steaming, poaching,
stewing generates no HCAs because temp
never tops boiling point of water.
 Microwave – little HCAs

PAHs

 Polycyclic aromatic hydrocarbons occur

whenever fat drips on a flame, heating
element or hot coals
 PAHs waft up in the smoke and can land on
food
 Can also form directly on food when it’s
cooked to a crisp

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PAHs

 Studies have shown that exposure to HCAs

and PAHs can cause cancer in animals
 Many epidemiologic studies of humans have
found that high consumption of well-done,
fried, or barbecued meats was associated
with increased risks of colorectal,
pancreatic, and prostate cancer.

Tips to Reduce PAHs, HCAs

 Grill vegetables instead of meat!

 Marinate before grilling –significantly
reduces the amount of HCAs
 Trim the fat, remove the skin– less fat drips
into flames
 Partially pre-cook meats, fish, poultry in
oven or microwave before grilling
 Keep meat portions small – less time on
grill

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Tips to Reduce PAHs, HCAs

 Cover grill with punctured aluminum foil to

avoid letting meat juices drip onto flame
 Keep water spray bottle on hand to tame
flames
 Flip frequently
 Remove all charred
or burnt portions
before eating

What About Cooking Oils?

 Different oils have different uses, and each

performs best within a certain range of
temperatures.
 Every oil has a smoke point, the
temperature at which it begins to smoke.
 Oil should never be allowed to smoke as it
compromises nutritional value and releases
carcinogenic free radicals – promotes
inflammation!

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Olive Oil

 As an unrefined oil, extra virgin olive oil

should not be exposed to heat higher than
325°F, its smoke point
 Most of its characteristic flavor dissipates
under sustained heat
 Extra virgin olive oil is more suitable for use
as a condiment than in most cooking
applications.

Smoke points of oils

 Avocado 510 degrees F

 Almond 495
 Sesame 445
 Canola 425
 Walnut 400
 Olive 325
 Flax 225
 Resource: http://www.ebnaturalmedicine.com/wp-
content/uploads/2014/06/Spectrum-oil-guide.pdf

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Foods that PROMOTE inflammatory
disease

 Foods with high saturated fat content, such

as animal products and most full-fat dairy
products
 Foods with high omega-6 fatty acid content
and low omega-3 fatty acids such as partially
hydrogenated oils, margarine, oils from corn,
cottonseed, safflower, sesame and sunflower
 Foods with high glycemic load, such as
bagels, instant rice, white pasta, sugar

Foods that promote inflammatory

disease

 For some people - food with high allergy

potential, such as dairy products, wheat and
eggs
 These inflammatory foods can increase
production of inflammatory mediators
 Foods with high allergy potential may also
increase intestinal permeability, triggering
immune response and potential increase in
inflammatory disease

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Anti-Inflammatory Foods

 Foods with high omega-3 fatty acids, such as cold

water fish: salmon, sardines, herring, tuna;
flaxseeds, walnuts
 Foods with high levels of antioxidants, such as
vegetables, citrus fruits, cherries, garlic, onion and
tea, cocoa
 Spices, in particular, ginger, garlic, rosemary,
turmeric, oregano, cayenne, clove and nutmeg
 Low glycemic index/load foods
 Mediterranean Diet – high in omega 3 fats, F/V,
nuts and seeds and whole grains

Recipe: Blueberry Almond Turtles

 Almonds
 Blueberries
 Bittersweet
Dark chocolate

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Nuts

 Frequent consumption of nuts, has been shown in multiple

studies to be inversely related to inflammatory markers in
the body
 A study published in The American Journal of Clinical
Nutrition in 2011 found that over a 15-year period, men and
women who consumed the most nuts had a 51% lower risk of
dying from an inflammatory disease compared with those
who ate the fewest nuts.
 Study published in the journal Circulation found that subjects
with lower levels of vitamin B6 – found in most nuts – had
higher levels of inflammatory markers.

Blueberries

 Numerous studies show that blueberries can:

 Improve heart health
 Reduce cancer risk
 Fight UTIs
 Improve brain health
 Are loaded with antioxidants
 Excellent anti-inflammatory food

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Cocoa

 Study in the American Journal of Clinical

Nutrition found that 40 g of cocoa powder
(about 5 Tbsp) per day for a period of 4
weeks reduced inflammatory mediators
involved in development of atherosclerosis in
subjects at high risk of CVD
 Helps to lower HTN

Recipe: Blueberry Almond Turtles

 Almonds
 Blueberries
 Bittersweet
Dark chocolate

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Recipe: Overnight Oatmeal

 Steel cut oats

 Unsweetened almond milk
 Unsweetened apple juice
 Apple
 Brown sugar
 Cinnamon
 Raisins
 Walnuts
 Omega 3 fatty acids from Omega Swirl

Whole Grains

 Every day, more and more studies show the

benefits of whole grains
 SLOW carbs, not NO carbs!
 Studies show that regular whole grain
consumption reduces the risk of both
cardiovascular disease and diabetes

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Whole Grains

 Scientists at the National Institutes of Health,

followed 259 healthy women for 2 years, to see if
whole grain consumption lowered levels of C-
reactive protein.
 They found that women who ate even small amounts
of whole grains – up to 1 serving a day – had, on
average, 11.5% lower concentration of hs-CRP
(measures inflammation) in their blood.
 Women eating a full serving or more of whole grain
had, on average, 12.3% lower CRP levels.

Omega 3s Fatty Acids

 Omega Swirl

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 Omega 3 Fatty Acids

 Omega-3 fatty acids are found in fish, such as salmon,

tuna, and halibut, other seafoods including algae and
krill, flaxseeds and nut oils.
 Also known as polyunsaturated fatty acids (PUFAs),
omega-3 fatty acids play a crucial role in brain function
 May reduce the risk of heart disease
 Helps lower high blood pressure
 The American Heart Association (AHA) recommends
eating fish (particularly fatty fish such as mackerel, lake
trout, herring, sardines, albacore tuna, and salmon) at
least 2-3 times a week.

Omega 3 Fatty Acids

 Hundreds of studies suggest that omega-3s may

provide benefits to a wide range of
diseases: cancer, asthma,depression, cardiovascular
disease, ADHD, and autoimmune diseases, such as
rheumatoid arthritis.
 All these diseases have a common genesis in
inflammation
 Typical dosage is 1,000 – 4,000 mg/day depending
on health status and medications

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 Balanced Omega 6/Omega 3

 EPA and DHA from fish oils are more biologically

potent than alpha-linolenic acid (ALA) from
flaxseeds and walnuts
 A balanced intake of omega-6 and omega-3 fatty
acids is anti-inflammatory
 Overconsumption of omega-6 fats in relation to
omega-3 fats leads to inflammation (common)
 Most appropriate ratio of omega-6 to omega-3 fatty
acids is approximately 2:1.

Polyunsaturated Fat

 Omega 6 to Omega 3 should be in a 2:1 ratio

 Typical American diet: more like 20:1 ratio
 We overeat Omega 6 fats and don’t get
enough Omega 3 fats
 Opposing but complimentary functions in the
body
 Omega 6 – pro-inflammatory
 Omega 3 – anti-inflammatory

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 Omega 6
 Widespread in foods
 Vegetable oils (safflower, sunflower, sesame, corn)
 Salad dressings made with above oils
 Margarines
 Crackers, bread, chips, popcorn, etc
 Increase inflammation in the body
 Reduce intake of Omega 6 fats

Omega 3 Fats
 Increase HDL “good”cholesterol
 Reduce blood clot formation
 Suppresses inflammation in the body
 Decreases triglyceride levels in blood
 Decreases risk/incidence of sudden death and
MI
 Inhibits growth of plaque
 Promote arterial relaxation, lowers BP
 Reduce susceptibility to arrhythmias

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 Sources of
Omega 3 fats

 Increase intake of Omega 3 fats

 Choose fatty fish (salmon, sardines, herring,
trout)
 Flaxseed and flaxseed oil
 Edamame
 Omega-3 eggs
 Dark leafy greens, wheat germ
 Walnuts and walnut oil, pumpkin seeds

Fish Oil Supplements

 Two omega-3 fatty acids – eicosapentaenoic acid

(EPA) and docosahexaenoic acid (DHA) found to
help lower triglycerides, reduce blood clotting and
decrease inflammation
 AHA: healthy people should get about 1,000 mg per
day of EPA and DHA
 High Blood pressure: 2,000 mg per day
 High triglycerides: 2-4 grams per day (under care of
health care provider)
 Fish oil supplements – quality matters
 Omacor/Lovaza/Vascepa – prescription fish oils

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Fish Oil Supplements

 Over the counter brands:

 Nordic Naturals
 Carlson

Cinnamon

 Cinnamon has a long history both as a spice and as

a medicine.
 Seasoning a high carb food with cinnamon can help
lessen its impact on your blood sugar levels.
 Cinnamon slows the rate at which the stomach
empties after meals, reducing the rise in blood sugar
after eating (Ceylon cinnamon is best)
 Adding cinnamon to the rice pudding lowered the
gastric emptying rate from 37% to 34.5% and
significantly lessened the rise in blood sugar levels
after eating. Am J Clin Nutr. 2 007 Jun;85(6):1552-6.

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Recipe: Overnight Oatmeal

 Steel cut oats

 Unsweetened almond milk
 Unsweetened apple juice
 Apple
 Brown sugar
 Cinnamon
 Raisins
 Walnuts
 Omega 3 fatty acids from Omega Swirl

Recipe: Pumpkin Black Bean Soup

 Black beans
 Tomatoes
 Chicken broth
 Onion and garlic
 Pumpkin
 Black bean burgers
 Tea seed oil

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Black beans

 The "protein-plus-fiber" combination in

black beans and other legumes is key to their
outstanding support for blood sugar balance
and blood sugar regulation
 Numerous studies show decreased risk of
type 2 diabetes following increased intake of
fiber from plant foods (and especially
legumes)

Black beans

 Much of the research on bean intake and decreased

risk of cardiovascular disease focus on the
outstanding soluble fiber content of beans.
 One cup of black beans provides over 4 grams of
soluble fiber, and this is precisely the type of fiber
that researchers have found especially helpful in
lower blood cholesterol levels.
 Decreased risk of coronary heart disease (CHD)
and myocardial infarct (MI, or heart attack) have
both been associated with increased intake of
soluble fiber from food, especially beans

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Anti-Inflammatory Fruit/Vegetables

 A high fruit and vegetable intake has been shown to

be associated with a low level of inflammation
 Fruit and vegetable intake has been shown to be
inversely related to oxidative stress and
inflammation in type 2 diabetics
 Consuming a diet high in fruits and vegetables is
associated with lower risks for numerous chronic
diseases, including cancer and cardiovascular
disease.
 Tomatoes, onions, garlic, pumpkin

Pumpkin

 A 2010 article published in "Nutrition Research

Reviews" notes that pumpkin reduces inflammation
 Alpha- and beta-carotene antioxidants are a class of
carotenoids that convert into usable vitamin A within
the body.
 Beta-carotene is anti-inflammatory
 Alpha-carotene hinders tumor growth, slows aging
and protects against cataracts.
 Additionally, carotenoids reduce the risk of
cardiovascular disease and boost immunity.

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Recipe: Pumpkin Black Bean Soup

 Black beans
 Tomatoes
 Chicken broth
 Onion and garlic
 Pumpkin
 Black bean burgers
 Tea seed oil

Recipe: Spicy Cherry Salsa

 Cherries and cherry juice

 Cider vinegar
 Garlic
 Agave
 Ginger, allspice,
cayenne, cardamom,
cinnamon

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Cherries
 Scientific studies show that cherries are packed with
unique anthocyanins and other compounds that
naturally mediate the inflammatory process
 These compounds deliver comparable anti-inflammatory
activity to ibuprofen (Advil®) and naproxen (Aleve®)7—
but without the significant side effects!
 The compounds found in cherries modulate numerous
pathways to protect against other conditions associated
with inflammation—including cancer, cardiovascular
disease, metabolic syndrome, and Alzheimer’s disease.

Cherries

 Tart cherry constituents can switch critical genes off

and on
 Tart cherries were ranked 14th among the top 50
foods for highest antioxidant content per serving—
surpassing such well-known antioxidant sources as
red wine and dark chocolate, according to the
American Journal of Clinical Nutrition

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Guard Against Degenerative Disease and
Inflammation with Tart Cherries

 Physical exercise can induce muscle damage that

generates inflammation and with it, burning,
stiffness, and pain. The effect worsens with age.
 Standard treatment with nonsteroidal anti-
inflammatory drugs such as Ibuprofen (Advil®)
involves potentially deadly adverse effects, such
as stroke.
 Evidence shows that the complex anthocyanins and
phenols in tart cherries provides superior protection
against muscle injury—by safely inhibiting the pain
and inflammatory effects.

Tart Cherries

 The potent components in tart

cherries have been demonstrated
to deliver high-level protection
against inflammatory and
degenerative diseases, including
cardiovascular disease,
metabolic syndrome, and
neurodegenerative diseases
such as Alzheimer’s.

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 Tart Cherries

 A study conducted by scientists at Boston University found

that intake of cherry extract reduced the risk of gout attacks
in those who suffered recurrent gout attacks by 45%
 Additionally, the researchers discovered that when cherry
intake was combined with allopurinol use, the risk for gout
attacks was reduced by 75%versus no intervention.
 What’s more, these results persisted even across
subgroups stratified for sex, obesity status, purine intake,
and alcohol use
 Tart cherries appear to be a natural—and safe—way to
inhibit the key gout pathway.

Sweet Cherries

 An impressive study released in 2013 reported that

after 28 days of consumption, sweet cherries were
found to selectively and significantly reduce a
number of biomarkers associated with inflammatory
diseases.
 Among other decreased inflammation indicators,
blood levels of C-reactive protein were reduced by
over 20%

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 Garlic

 Garlic has been used as a medicinal plant

since ancient times
 Researchers have shown that garlic may
promote an anti-inflammatory environment
by cytokine modulation that leads to overall
inhibition of NF-(kappa)B activity
 NF-(kappa)B is a central transcription factor
in adaptive immunity and a central regulator
of pro-inflammatory gene expression

Ginger
 Ginger contains very potent anti-inflammatory
compounds called gingerols.
 These substances are believed to explain why so many
people with osteoarthritis or rheumatoid arthritis experience
reductions in their pain levels and improvements in their
mobility when they consume ginger regularly.
 In two clinical studies involving patients who responded to
conventional drugs and those who didn't, physicians found
that 75% of arthritis patients and 100% of patients with
muscular discomfort experienced relief of pain and/or
swelling.

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Spices: Ginger

 Ginger belongs to the same botanical family

as turmeric and cardamon
 Has been used as an anti-inflammatory
agent for centuries
 Researchers have found that ginger inhibits
prostaglandin biosynthesis – similar to
NSAIDs

Spices: Ginger

 Ginger extract also inhibits the induction of several

genes involved in the inflammatory response
 In a study of 261 people with osteoarthritis (OA) of
the knee, those who received a ginger extract twice
daily experienced less pain and required fewer pain-
killing medications compared to those who received
placebo.
 For analgesic purposes, 2 to 4 grams fresh ginger
juice or extract taken daily is recommended

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 Zyflamend

 Food- and herb-based supplement that

combines ten of the very top anti-
inflammatory concentrates
 One of the top herbal supplements sold in
the world
 Rosemary, Turmeric, Ginger, Holy Basil,
Green Tea, Hu Zhang, Chinese
Goldthread, Barberry, Oregano, Baikal
Skullcap

Cayenne
 Arthritis is generally thought to be an inflammatory
disorder resulting in destruction of the tissues lining the
joints.
 Cayenne pepper has been used topically to increase
blood supply and provide a warming sensation to affected
joints.
 Taken internally as a supplement, cayenne may also help
to reduce joint inflammation through its antioxidant
activity.
 Applied as a topical cream, gel or patch, capsaicin works
by depleting the amount of a neurotransmitter called
substance P that sends pain messages to the brain.

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Capsaicin

 Many studies have shown that capsaicin

effectively reduces pain from
osteoarthritis, rheumatoid arthritis and
fibromyalgia.
 In a 2010 German study, joint pain
decreased nearly 50% after three weeks' use
of 0.05 percent capsaicin cream.

Recipe: Spicy Cherry Salsa

 Cherries and cherry juice

 Cider vinegar
 Garlic
 Agave
 Ginger, allspice,
cayenne, cardamom,
cinnamon

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Recipe: Apricot Chicken Tagine

 Canola oil  Vegetable broth

 Chicken  Apricots
 Onion, garlic, ginger  Garbanzo beans
 Turmeric  Tomatoes
 Nutmeg  Cashews
 Cinnamon  Cilantro
 Saffron

Spices: Turmeric

 Curcumin is a naturally occurring chemical

compound that is found in the spice turmeric
 Turmeric is a mustard-yellow spice from Asia.
 Main ingredient in curry
 Laboratory and animal research has
demonstrated anti-inflammatory,
antioxidant, and anti-cancer properties of
turmeric and its constituent curcumin.

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 Spices: Turmeric

 Researchers tested turmeric extracts in

animal models and found evidence of anti-
arthritic and anti-Alzheimer’s disease efficacy
 They found that curcuminoid extract inhibits
a transcription factor, NF-KB, from being
activated in the joint
 Typical dose used therapeutically 400 mg
twice a day

Turmeric

 One of the most comprehensive summaries of

turmeric benefits studies to date was published by the
respected ethnobotanist James A. Duke, Phd., in the
October, 2007 issue of Alternative & Complementary
Therapies, and summarized in the July, 2008, issue of
the American Botanical Council publication HerbClip.
 Reviewing some 700 studies, Duke concluded that
turmeric appears to outperform many pharmaceuticals
in its effects against several chronic, debilitating
diseases, and does so with virtually no adverse side
effects.

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Turmeric

 Alzheimer's disease: Duke found more than 50

studies on turmeric's effects in
addressing Alzheimer's disease.
 The reports indicate that extracts of turmeric contain
a number of natural agents that block the formation
of beta-amyloid, the substance responsible for
the plaques that slowly obstruct cerebral function
in Alzheimer's disease.
 Dosages of 400 to 600 mg, taken three times daily
have been used in studies

Turmeric

 Arthritis: Turmeric contains more than two dozen

anti-inflammatory compounds, including six
different COX-2-inhibitors (the COX-2 enzyme
promotes pain, swelling and inflammation; inhibitors
selectively block that enzyme).
 By itself, writes Duke, curcumin - the component in
turmeric most often cited for its healthful effects - is a
multifaceted anti-inflammatory agent, and studies of
the efficacy of curcumin have demonstrated positive
changes in arthritic symptoms.

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Salicylic Acid

 Salicylic acid is the active component of

willow-bark, long used as a folk remedy for
pain
 Aspirin is a synthetic derivative of willow
bark
 Foods high in salicylic acid: berries, grapes,
broccoli, spinach, chili peppers,
cinnamon, ginger, rosemary, nutmeg,
sage, basil, strawberries

Mediterranean Diet

 Studies have found that the Mediterranean

diet can produce beneficial changes on
markers of inflammation, including reduction
in C-reactive protein and pro-
inflammatory cytokines, as well as reduced
platelet aggregation and improved
endothelial function

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Mediterranean Diet

 High cardiovascular risk participants from the

PREDIMED trial eating a Mediterranean diet,
rich in olive oil and nuts, showed improved
lipid profiles, decreased insulin resistance
and reduced concentrations of
inflammatory molecules compared with
those allocated to a low-fat diet

Tagine

 Definition: A tagine is like a casserole dish

used in north African cooking, most
commonly in Morocco.
 It consists of two pieces - a plate like bottom
and a conical shaped lid. The bottom doubles
as a serving dish.

 Can purchase in cooking stores or online.

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Recipe: Apricot Chicken Tagine

 Canola oil  Vegetable broth

 Chicken  Apricots
 Onion, garlic, ginger  Garbanzo beans
 Turmeric  Tomatoes
 Nutmeg  Cashews
 Cinnamon  Cilantro
 Saffron

Anti-Inflammatory Diet

• 90% plant-based foods (or more)

• Fresh produce at every meal – Fruits and veggies
• No processed foods (made in a factory)
• No fried foods, no cheap oils
• Good fats: extra virgin olive, walnuts, and omega 3
fats in fatty fish like salmon, sardines, herring and tuna
• Lots of avocados, fresh tomatoes, cucumbers,
herbs and spices, etc.
• Low glycemic foods like berries, and legumes
• Green tea and water as your beverages

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Cook well, live long . . .

Richard Collins, MD and

Susan Buckley, RDN, CDE

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