Many of you coming to our Peak Sports and Spine physical therapy clinics for treatment of a painful condition have been diagnosed with something that ended with "-itis." When "itis" is on the end of your diagnosis, it means the pain you feel is from inflammation. Inflammation is the name of the multi-step process our body uses to repair damaged tissue. When we have an "itis", we hurt, and when we hurt we want the hurt to stop. That simple cause and effect has lead to the development of a wide array of drugs to help limit that process so that the pain goes away. They are referred to as "anti-inflammatory" drugs, which are super common. The old standby is Aspirin. More recently, Ibuprofen has probably taken center stage, but there is still naproxen sodium and the list goes on and on. These drugs have one thing in common. They try to interfere with one or more steps in the inflammatory process so we feel less pain in the area with the "itis." Usually they do this by trying to limit arachadonic acid. The problem is arachadonic acid isn’t just involved in the inflammatory process we want to minimize, it’s also involved in making the protective layer inside the stomach so the stomach itself isn’t damaged by the acid inside it which dissolves our food. So unfortunately when you take a drug to limit one, you end up limiting them both. Ranging from mild stomach discomfort to something more severe like bleeding, you can understand why the most common side effect of anti-inflammatory drugs is some sort of gastrointestinal problem.
Because of that, many people choose to discontinue these drugs or avoid using them in the first place. Those of us in physical therapy provide ice as a helpful adjunct or alternative to medication. It decreases the inflammation and the only side effect is you feel cold for a short while. However, there is growing evidence that diet can help is well.
Inflammation is a somewhat complex process in the body. As mentioned before, arachadonic acid is part of the process. The body uses arachadonic acid to make hormone like substances called prostaglandins and the prostaglandins congregate in the inflamed area and are partly responsible for the pain we feel. The building blocks the body uses to make prostaglandins come from dietary fat. We can’t make prostaglandins without it. Also different types of fat result in production of different types of prostaglandins based on the essential fatty acids inside them. We can think of them simply as good (anti-inflammatory) and bad (pro-inflammatory). The "good" anti-inflammatory ones have the fatty acid known as Omega 3. The "bad" pro-inflammatory ones are known as Omega 6. Both are needed in the body but have opposing physiological functions. According to a 1999 article in the American Journal of Clinical Nutrition, our dietary fat should be about a 1:1 ratio between Omega 3s and 6s. However, the "typical" western diet is more like 15:1 favoring the Omega 6’s (bad ones.)
So if we are wanting to follow a more anti-inflammatory diet, we need to know which foods are which. Generally the "bad" Omega 6’s are in the most processed foods. Usually if it comes in a crinkly wrapper or if it leaves a grease stain behind on the paper plate its probably best avoided. Polyunsaturated and partially hydrogenated fats and oils make pro-inflammatory prostaglandins. Look for these words on the label and do your best to avoid them.
The anti-inflammatory diet is generally just good eating. Oily cold water fish like salmon, and brightly colored fruits and vegetables like blueberries, strawberries, apples and red onions are all good. Also flaxseed and walnuts are great sources of Omega 3s. For oils, good options include: coconut oil, olive oil, rice bran oil, grapeseed oil and walnut oil. Brown rice, wheat germ, lentils, garbonzos and non-instant oat meal are good as well. Generally with grains you want whole grain. Spices such as ginger and turmeric (aka cumin) are another good and flavorful source to help you improve your ratio.
Added into the mix is the importance of buying organic when possible. As an example, eggs from organic free range chickens have an ideal 1:1 Omega 3 to Omega 6 ratio. Whereas, eggs from conventionally raised chickens are imbalanced at 20:1 with more Omega 6 "bad" (see "The Omega Diet" Harper Collins Publishers, 1999). There are similar results with organic pasture fed cattle compared with domestic grain fed cattle when looking at the beef they produce. Fortunately here in western Washington, our mainstream grocery stores are increasing the amount of organic food they offer. Specialty stores with only organic offerings such as PCC and Whole Foods are also available and often have knowledgeable employees who can help you if this is all new to you. I highly encourage you to begin shopping at these places and tasting the difference. There is ever increasing evidence that even though it’s a few cents more, organic food is a bargain in the long run for it’s health benefits and the taste is often noticeably better too.
In conclusion, to use diet to fight inflammation be aware it’s the ratio between the Omega 3s and 6s that’s most important. The benefit of additional Omega 3s can only be realized if you also limit the Omega 6s. Be aware also that some supplements offering Omega 3s include Omega 6s in them as well. So read labels carefully, eat whole grain and organic whenever possible, try to eat a lot of colorful fruit and veggies, and avoid food in crinkly wrappers that leave stains behind. With that, I hope your diet, ice and physical therapy treatments solve all your inflammatory pains.