The Ultimate Anti-Inflammatory Diet Part 2
So, what should you eat to reduce inflammation?
In part 1, I explored how research generally suggests that tobacco, overconsumption of alcohol, refined carbohydrates, fried foods, and highly processed oils promote chronic inflammation while proper hydration, vegetables, whole fruit, omega 3-rich foods, nuts, and seeds decrease inflammation. I also postulated that the reason there isn’t a universal anti-inflammatory diet is that everyone is different and responds uniquely to the foods they ingest.
For many of us, implementing lifestyle changes such as reducing stress, moving more, getting 8 hours of sleep, drinking plenty of water, and eating less processed foods is enough to achieve the level of health that we desire. However, those with complex, chronic conditions such as IBS, fibromyalgia, and migraines continue to struggle with symptoms even after implementing generally healthy habits.
A common cause of these symptoms are underlying food sensitivities which trigger the immune system to release chemicals called mediators (histamine, prostaglandins, cytokines, etc.) from white blood cells. These mediators cause inflammation, pain, and a wide range of symptoms. More than half of people with IBS, for instance, may have food sensitivities.
Food sensitivities are completely different from food allergies and food intolerances even though these terms are sometimes used interchangeably.
Food allergy: an IgE-mediated reaction that takes place usually immediately or within an hour of ingestion of the food and can cause anaphylaxis, hives, nausea, vomiting, and lip or tongue swelling.
Food sensitivity (sometimes called a non-IgE-mediated food allergy): also an immune system reaction but is not life-threatening, occurs hours or days after ingestion of a food antigen, and can cause bloating, diarrhea, migraines, skin rashes, fatigue, brain fog, joint pain, and other symptoms.
Food intolerance (not related to the immune system): difficulty digesting a certain food which can cause gas, bloating, and diarrhea. The most common is lactose intolerance which is a deficiency of the enzyme lactase.
Food sensitivities can be difficult to determine, and someone can take a test or try to avoid a variety of potential triggers and hope for the best.
Since symptoms of food sensitivities can occur up to 72 hours after ingestion of the triggering food antigen, you can imagine how improbable identifying food sensitivities can be on your own. Even meticulous food and symptom journaling leaves people confused about what might be causing their symptoms.
There is research on the Autoimmune Protocol Diet, an elimination diet that showed improvement in “symptoms and endoscopic inflammation in patients with IBD [ulcerative colitis and Crohn’s].” It was able to “decrease systemic inflammation and modulate the immune system.” However, for thyroid disease, there were “no statistically significant changes noted in thyroid function or thyroid antibodies.”
The Autoimmune Protocol Diet is an extremely restrictive and difficult elimination diet to follow and initially cuts out: grains, legumes, nuts, seeds, nightshade vegetables, eggs, dairy, alcohol, coffee, oils, food additives, refined and processed sugars, and certain medications. Despite all this restriction, it does not account for possible food sensitivities to the allowed (“safe”) foods. If an elimination diet like this sounds like a “shot in the dark,” you’re not wrong.
So, what about testing?
There are two main categories of food sensitivity tests: IgG and the Mediator Release Test. The IgG food sensitivity test is widely criticized, and the American Academy of Allergy Asthma and Immunology reports that it has “never been scientifically proven to be able to accomplish what it reports to do,” and that “the presence of IgG is likely a normal response of the immune system to exposure to food.” High levels of IgG could either suppress or cause an immune response, so they may not directly correlate to symptoms. IgG is also not involved in Type 4 Hypersensitivity which is the most common food sensitivity pathway involved in IBS, migraine, and fibromyalgia.
The Mediator Release Test (MRT), on the other hand, clearly demonstrates methodology and accuracy. MRT is an endpoint test, meaning that all the immune based adverse reactions end up causing mediator release. Remember, the mediators (histamine, prostaglandins, cytokine, etc.) are causing the inflammation and symptoms. MRT also identifies reactions to chemicals unlike IgG testing. No test is perfect, but the MRT has a sensitivity of 94.5% (meaning few false negatives) and a specificity of 91.8% (meaning few false positives).
Registered dietitians that are Certified LEAP (Lifestyle Eating and Performance) Therapists utilize MRT to create a personalized elimination and reintroduction plan that is as close to an “ultimate anti-inflammatory diet” as one could achieve.
Research on the LEAP protocol showed “significant reduction in GI symptoms associated with IBS (16.6 vs. 6.7, P<0.001) and increase in QoL [physical functioning (81.1 vs. 90.6, P=0.003), role physical (27.0 vs. 78.3, P<0.001), vitality (30.2 vs. 57.9, P<0.001), bodily pain (47.4 vs. 73.1, P=0.003), and emotional well-being (61.6 vs. 77.8, P=0.003).”
Further research demonstrated a 67.8% reduction in global symptoms of IBS, migraine headaches (73%), fibromyalgia (46%), and arthritis (44%).
The evidence and effectiveness of the Mediator Release Test and the LEAP protocol is why I use it in my practice for people with clear evidence of systemic inflammation.
Addressing underlying food sensitivities as a potential cause of inflammatory symptoms is a complex process. However, thanks to all of the research in recent years, we have a better understanding of the role that food and food sensitivities play in inflammation.
Congratulations on making it through part 1 and part 2, and I hope this has provided some useful information about inflammation and anti-inflammatory eating patterns!
References
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The myth of IGG Food Panel Testing. American Academy of Allergy Asthma & Immunology. (n.d.). https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/igg-food-test
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Zarini GG, Masters J, McLean MA, Strobel CT. Clinical and Anthropometric Improvements with a Tailored Dietary Approach in Pediatric Crohn’s Disease. Altern Ther Health Med. 2021 Mar 13:AT6717. https://pubmed.ncbi.nlm.nih.gov/33711815/
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