Online Health Chat with Kate Patton, MEd, RD, CSSD, LD & Maxine Smith, RD, LD
July 26, 2017
The typical American diet is pro-inflammatory thanks to pre-packaged, processed meals that are washed down with sugary drinks. In addition, the majority of Americans are overweight or obese, which contributes to inflammation in the body. To prevent the development of chronic diseases associated with inflammation, it is time to treat food as medicine and help fight inflammation with the right foods.
What is a registered dietitian?
A registered, licensed dietitian practices the science of medical nutrition therapy. Based on your nutritional status, condition, illness or injury, a dietitian will work with you to optimize your treatment and aid your recovery. Not all "nutritionists" have the same expertise or training. It is important to check their training and credentials.
All of the dietitians employed at Cleveland Clinic are registered with the Commission on Dietetic Registration and Academy of Nutrition and Dietetics, and are licensed dietitians in the State of Ohio. Every dietitian at Cleveland Clinic has completed a four-year baccalaureate degree from an accredited college or university and a dietetic internship or comparable supervised experience. Several dietitians also have advanced degrees and/or specialty certifications.
About the Speaker
Kate Patton, MEd, RD, CSSD, LD, received her Bachelor of Science in dietetics/nutrition from University of Dayton and did her dietetic internship at Cleveland Clinic. She received her MEd in exercise science from Cleveland State University and has been a certified specialist in sports dietetics since 2011. Kate has worked at Cleveland Clinic since 2007.
Maxine M. Smith, RD, LD, is a graduate of The University of Akron where she earned her BS in dietetics and completed her internship at Metro Health Medical Center. She has been employed at Cleveland Clinic for eight years, providing nutrition services for the Executive Health Program and the Nutrition Therapy Outpatient Nutrition area. Her areas of interest include wellness and weight management, and she has earned the Academy of Nutrition and Dietetics’ Level 2 Weight Management Certification. She has experience in private practice and worked numerous years at Summa Health System in renal dietetics. She has provided numerous presentations and served as an expert resource for the media throughout her career of more than 25 years. She enjoys cooking and providing food preparation demonstrations.
Let’s Chat About Fighting Inflammation with Food
cvinson: I am a little confused. What does inflammation of the body actually mean, and how is it dangerous for my health? Also, what causes it and can it occur any place in the body?
Maxine_M._Smith,_RD,_LD: Inflammation is a natural response of the body to protect itself from potentially destructive agents such as infection. Acute inflammation often has obvious symptoms such as swelling and redness (think of a pimple). Chronic inflammation can lead to more sever and progressive damage often without obvious symptoms. Chronic inflammation can damage cells in any part of the body. This type of inflammation may lead to many chronic disease including heart disease, cancer, diabetes, arthritis, neurological diseases and autoimmune disease.
john: If there are no obvious symptoms for chronic inflammation, how does one find out if they have it?
Maxine_M._Smith,_RD,_LD: You may ask your physician to draw a hs-CRP level to give an indication. Some conditions such as rheumatoid arthritis, cardiovascular disease, diabetes, etc. are inflammatory diseases. Everyone has some degree of inflammation within their bodies. Eating healthfully in order to limit it is the goal.
Lpgabarb: Can this diet have a positive effect on inflammation due to fibromyalgia or sarcoidosis?
Kate_Patton,_MEd,_RD,_CSSD,_LD: Yes. An anti-inflammatory diet can have a positive effect on inflammation from fibromyalgia and may help manage symptoms of sarcoidosis-like fatigue.
LaFina: I am a 61-year-old female with congenital heart disease (repaired) and celiac disease. My mother has a diagnosis of celiac disease, and I feel that my grandmother may have had this condition as well. What is the correlation of females to celiac disease compared to that of the male population? Is celiac always genetic or can it be acquired? What advice do you have for cardiac patients and compliance to a non-inflammatory diet?
Kate_Patton,_MEd,_RD,_CSSD,_LD: A pro-inflammatory diet will increase the risk of developing or worsening cardiac risk factors such as high blood pressure, high blood cholesterol, high blood sugar and obesity, and elevate C-reactive protein.
Mo_Sharj: Hi. My grandfather had problems with his lungs. The doctor told us that ¼ part of a lung had fungus on it, and that’s why he was having a problem with blood, which came out of his mouth. The doctor says we have to make a decision to operate, but we can't. Surgery is dangerous for him because he is in poor health. If he eats any salty food, the bleeding starts. Today, he ate so much salty foods that a lot of blood came out. Everyone started crying, so I contacted you. Please tell me what precautions we should take, and what we should do next. I am waiting for your opinion.
Maxine_M._Smith,_RD,_LD: Please discuss this with your physicians.
Lpgabarb: Would an anti- inflammatory diet be of any benefit to people with sarcoidosis?
Maxine_M._Smith,_RD,_LD: Yes, it may, as sarcoidosis is an inflammatory condition.
prsg: I am a very healthy 68-year-old male who enjoys vigorous exercise, cycling and weight training primarily. I take 250 mg naproxen daily to minimize stiffness/inflammation. We have friends that swear by eliminating night shades, but I’ve read that is only for people with certain conditions. Besides, I love most of those veggies! What do you recommend?
Maxine_M._Smith,_RD,_LD: There is no compelling evidence to avoid nightshade vegetables. Anecdotally, some people will notice less stiffness and swelling when they avoid night shades such as tomatoes and peppers. I would hate for you to limit nutritious foods if not necessary.
Marfanista: Hello. For cardiac inflammation post heart surgery, what are the best foods and supplements? Also, does the method of food preparation affect how well the food fights inflammation? For example, what is the difference between boiled asparagus versus sautéed or grilled, canned veggies versus fresh/frozen? Thanks.
Maxine_M._Smith,_RD,_LD: The best eating pattern after heart surgery is a Mediterranean-style diet, which is basically what an anti-inflammatory diet is. The best foods are plant-based foods and less animal-based foods. I would recommend choosing whole foods first to obtain all your vitamins and minerals instead of taking supplements. If you have a vitamin or mineral deficiency, then supplements would be warranted. Yes, food preparation does make a difference. For example, Vitamins A, D, E and K require fat in order to be absorbed; therefore, incorporating unsaturated fats (olive oil, canola oil, olives, avocado, nuts and nut butter) in preparation of foods or paired with each meal will ensure that these vitamins are absorbed. Another example is tomatoes. They're rich in flavonoid and lycopene, which are better absorbed when tomatoes are cooked. I would recommend using fresh vegetables the most. Frozen are also okay as long as they do not have anything added to them (i.e., cheese sauce).
phyllis54: Do you suggest the autoimmune paleo diet to fight inflammation when dealing with inflammation in the body (pericarditis) when the source that caused the initial inflammation is unknown? I was previously diagnosed with leaky gut, but never had any food issues except I needed to stay away from gluten.
Kate_Patton,_MEd,_RD,_CSSD,_LD: I would not recommend a paleo diet, but instead would recommend a Mediterranean-style diet since this has been shown through extensive research to reduce risk of cardiovascular disease.
L B : I have what I think is an inflammatory response from eating any foods that have a high glutamic acid content. These include pinto beans, malted barley, celery seed, whey protein, fish sauce, lentils, parmesan cheese and many others foods, including MSG and all its different forms. I will gain three lbs overnight, and then takes three to four days to get back to normal. I also cannot lose weight with a calorie-restrictive diet while in this state. I wonder if this issue of MSG and glutamates is another reason there is such an obesity crisis. Proper labeling would sure help. I am wondering if there is any way to prevent this response besides eliminating all the culprits.
Maxine_M._Smith,_RD,_LD: I do not know of any relationship between high glutamic acid intake and inflammation, or MSG and glutamates and obesity.
faye1: Over the past couple of years, I have learned that certain foods cause me issues or discomfort, so I have learned to limit or avoid those foods. I want to learn the impact of following an anti-inflammatory diet to see if it will help with a few other issues I have, such as seborrheic dermatitis. I'm looking for a basic anti-inflammatory diet that I can follow to see how it will impact my overall health and wellbeing. Do you have one that you can recommend for me to follow?
Maxine_M._Smith,_RD,_LD: We can counsel patients on this diet if they make an appointment with one of our dietitians by calling 216.444.3046.
Nab: My personal approach to non-inflammatory diet is twofold: 1. Adopting (as much as possible) the nearest-to-vegetarian diet including more veggies, fruits, legumes, oily fish and very few animal products, respecting my point #2. 2. Consider the food intolerance limitations by doing a blood test every six months to see which foods to avoid. My question: is there any scientific evidence behind such food intolerance testing (although I observe that it practically works)? Thanks.
Kate_Patton,_MEd,_RD,_CSSD,_LD: Blood tests for foods may help indicate which foods your body is setting up a heightened immune response to or could generally indicate such things as leaky gut. I would not avoid any specific foods based on these blood tests unless recommended by a trained allergist/physician.
Nab: Is an anti-inflammatory diet connected to food intolerances?
Maxine_M._Smith,_RD,_LD: Yes. If you have a food intolerance, it may cause your body to produce antibodies against that food, which is part of the inflammatory process. The food/faulty digestion-metabolism of the food could also cause damage to cells such as the lining of the gut, which could trigger inflammation.
PANPAN: Dear moderator, I want to ask: 1. Is olive oil pro-inflammatory since the omega 6/omega 3 ratio is not the right ratio? 2. 14% of the fat of olive oil is saturated fat that slows the speed of blood, but saturated fats are pro-inflammatory and, anyway, if olive oil slows the blood, speed is unhealthy. 3. Fish increases insulin secretion and contains growth factors. Is it healthy? I would appreciate an answer. Thanks.
Kate_Patton,_MEd,_RD,_CSSD,_LD: It is impossible to have virtually no saturated fat in your diet since it is found even in plant-based foods. Therefore, the key is to limit your total intake. The benefit of extra virgin olive oil outweighs the fact that it contains a small amount of saturated fat. EVOO does not slow the speed of blood, rather research shows that intake of olive oil can improve markers of endothelial function and inflammation. There is consistent evidence that it can improve cardiovascular risk markers and lower risk of death from cardiovascular disease.
Barney33: Walnut oil is lower in saturated fat than olive oil. Does walnut oil fit in an anti-inflammatory diet? Thank you.
Kate_Patton,_MEd,_RD,_CSSD,_LD: Yes, walnut oil does fit in an anti-inflammatory diet.
EMG: I am trying to cut out coffee/caffeine and am using herbal teas. I am now drinking decaf green tea. Are the other herbal teas better or worse to use to help with osteoarthritis?
Maxine_M._Smith,_RD,_LD: White or green decaf tea would be a good choice. Teas made with ginger, cinnamon and ginseng, and gingko-biloba tea and licorice tea in addition to other herbal teas have anti-inflammatory components. Typically, one needs to drink at least cups of tea a day to have an effect.
dankrist: Are turkey, fish and low-fat dairy products anti-inflammatory?
Maxine_M._Smith,_RD,_LD: These would all be part of an anti-inflammatory diet. Just take off the skin.
EMG: I have changed from margarine to butter with canola oil on my toast. Now I see even that is not healthy. Other than olive oil, which I cook with but don't care for on bread, could you recommend another spread for my toast? Thank you.
Kate_Patton,_MEd,_RD,_CSSD,_LD: Using butter w/canola oil in small amounts is okay to use on toast. Other spreads to consider include natural almond or peanut butter OR try spreading avocado on toast.
GJL56: Hello. Can you please comment on what I call the "yogurt craze." I am 60 years old and my generation saw little yogurt growing up. Now the supermarket dairy case is 2/3 yogurt. I see shoppers buying cases of it. At work, the fridge is about ¼ full of yogurt. Is it generational (i.e., many of the consumers appear to be in their 30s)? I am wondering if the stresses of young life (working hard, not seeing the end of the tunnel with a pension or health insurance issues, day care, etc.) are causing stomach issues leading to the yogurt craze to correct this. Is it marketing or are they just health conscious. Please comment. Thank you.
Maxine_M._Smith,_RD,_LD: Stress is definitely a factor that can manifest in the gut and lead to stomach issues. There is more research available to promote foods rich in probiotics for a healthy gut. These include yogurt. On the other hand, yogurt may be marketed as "healthy" yet be loaded with sugar and other unhealthy components. Going with plain, low-fat yogurt is the way to go. Sweeten with your own fresh fruit and a dash of cinnamon if desired. Frozen, thawed berries are good mixed in, and add a few crushed walnuts on top for crunch.
ChezLA: I am a cancer survivor and have read articles and books that suggest cancer survivors eliminate or greatly reduce dairy products with the issue being the protein casein in dairy. Does casein contribute to inflammation? I have not been able to find a lot of research on this subject. Thank you.
Maxine_M._Smith,_RD,_LD: Many foods have both pro- and anti-oxidant properties. It also depends on individual allergies/sensitivity. Milk has two main proteins, whey and casein. Whey has anti-inflammatory properties while casein may have pro-inflammatory properties. In general, I would include a limited amount of dairy in the diet, as it is a good source of nutrients such as protein, calcium and Vitamin D. However, I would choose low-fat and, even better, fermented sources such as yogurt and kefir.
Diagnosis and Testing
Jie: What are the best tests for determining inflammation and the level of inflammation? What are the tests trying to determine? Are there one or several tests that are recommended? What are the appropriate (healthy and unhealthy) ranges for these tests? What are the major causes of high levels of inflammation? What are the very best ways (specifically additions or subtractions from diet and/or exercise) to reduce levels of inflammation without drugs, and how long should that take? At what level of inflammation do you recommend the use of drugs and what are they?
Maxine_M._Smith,_RD,_LD: CRP-HS is a lab test that is readily available to help in the evaluation of inflammation. The causes of inflammation are multiple including: environmental toxins/pollutants, stress, ultraviolet radiation, diet, microbes such as bacteria and viruses, illnesses/chronic diseases, and the condition of the gut bacteria.
You want to look at your diet. Consume whole, unprocessed foods that include a variety of produce of various colors and types. Include ample fluids, olive oil, dark green and cruciferous vegetables (those from the cabbage family). Starchy beans and lentils are good choices as are nuts. Dark purple/red fruits such as berries and grapes are a good choice; herbs such as turmeric, ginger and basil are other winners as well as onion and garlic. Low-fat dairy is a healthy choice particularly if fermented such as yogurt or kefir. Include whole grain such as oats, quinoa and brown rice. Include cold water fatty fish such as salmon, tuna, trout or sardines. Include healthy, plant-based fats such as olive oil, nuts, seeds and avocado. Add a variety of herbs to your list such as ginger and turmeric. Green tea is another winner. Lean protein sources such as poultry and limited red meat is part of an anti-inflammatory diet pattern.
Foods that you want to limit are foods rich in omega 6 fats such corn oil, safflower oil, margarine and sunflower oil; trans or hydrogenated fats, saturated fats such as in butter, cheese, and high-fat meats and dairy; high sugar and salt foods; excessive alcohol; and foods made from white/refined grains such as white bread.
Drug questions must be addressed by a physician.
BlueViolet: If I follow the recommended diet and eat the right foods, how do I know they're working for me? For example, will I see my high-sensitivity CRP go down or other inflammation markers?
Maxine_M._Smith,_RD,_LD: Hs CRP may go down as well as other markers such as white blood cell levels if they were increased. Others will base improvement on symptoms such as pain or stiffness.
john: Maybe you answered it earlier, but what is the normal range for hs-CRP?
Maxine_M._Smith,_RD,_LD: Labs often vary as far as reference ranges. You may ask your doctor this question.
kelley: What foods or food groups are good for managing inflammation? For individuals with pre-diabetes, are there foods that will help with glucose control as well as manage inflammation? I have heard about the benefits of a ketogenic diet, but am worried about the higher amounts of fat and animal protein on inflammation. Is there information or research about inflammation and a ketogenic diet?
Kate_Patton,_MEd,_RD,_CSSD,_LD: Plant-based foods that have been minimally processed include fruits, vegetables, nuts, seeds, beans, lentils, whole grains-oatmeal and shredded wheat. Choosing all of the plant-based foods mentioned and balancing their portion sizes will help to maintain blood glucose control, with the addition of lean animal protein in moderation. Aim for ½ plate non-starchy vegetables, ¼ plate complex carbohydrates (whole-grain starch, beans, lentils and/or fruit) and ¼ plate protein (fish, chicken, turkey, yogurt). For pre-diabetes, I would start with a carbohydrate-controlled, moderate protein, moderate fat type of diet first. Yes. A ketogenic diet could increase inflammation.
ccuser1000: How does this diet compare with DASH or Weight Watchers?
Kate_Patton,_MEd,_RD,_CSSD,_LD: The DASH diet is similar to an anti-inflammatory diet in that the DASH diet emphasizes fruits, vegetables, whole grains, legumes, nuts/seeds, lean protein and minimal added fat. From what I know about Weight Watchers, it encourages intake of fruits and vegetables, but is based on counting points associated with different foods in order to support weight loss. An anti-inflammatory diet does not necessary mean you will lose weight like you would with Weight Watchers.
cvin: What constitutes a pro-inflammatory diet?
Kate_Patton,_MEd,_RD,_CSSD,_LD: A pro-inflammatory diet is one that is high in refined grains such as white bread, white rice, white pasta and white flour; saturated fat sources including high-fat cuts of beef, pork, veal, lamb and cheese, full-fat milk and butter; and sugary foods such as soda, sweetened drinks, high fructose corn syrup, desserts and sweets.
Lpgabarb: Is an anti-inflammatory diet similar to FODMAP?
Maxine_M._Smith,_RD,_LD: No. An anti-inflammatory diet is high in fiber-rich foods, which promote the growth of healthy bacteria in the gut (one way the diet assists to control inflammation). A FODMAP diet, which is low in fermentable carbohydrates to assist some people with gastrointestinal problems, is low in fiber.
MsFit: Can we please have a top 20 list of foods to get at the grocery store? Also, can following this diet help to undo damage in the body (i.e., cardiomyopathy or high liver enzymes)? Thank you.
Maxine_M._Smith,_RD,_LD: This list would be very limiting. Base your grocery list on whole, unprocessed foods that include a variety of produce, as we as a list of various colors and types. Include whole grain such as oats, quinoa and teff. Include cold water fatty fish such as salmon, tuna, trout or sardines. Include healthy plant-based fats such as olive oil, nuts, seeds and avocado. Add a variety of herbs to your list such as ginger and turmeric. Green tea is another winner.
swo: What are the best and easiest foods to buy/eat for picky eaters that will help with inflammation?
Kate_Patton,_MEd,_RD,_CSSD,_LD: If you are a picky eater, I would recommend you aim to include as much variety in your diet as you can. If you tend to eat the same foods over and over, then there is a chance you are missing out on phytonutrients (health-promoting nutrients) found in certain foods. Aim to eat a variety of different colored fruits and vegetables. Eat a variety of lean proteins-animal sources such as chicken, turkey, fish, fat-free or low-fat milk/yogurt and plant-based sources such as beans, lentils, nuts and natural nut butter. Choose whole grain starches (wheat, rye) more than white versions. Try to avoid processed foods and fast foods, also.
john: All things equal, which foods (specifics would help) should you eat to reduce/minimize inflammation?
Maxine_M._Smith,_RD,_LD: While it is important to look at the healthfulness of the diet as a whole, there are a few standouts that fight inflammation such as onions, green tea, cinnamon, tomato products, fatty/cold-water fish, berries, purple/red grapes, broccoli and other cruciferous vegetables, and garlic and spices such as turmeric and ginger. Limit red and processed meat, high sugar and white flour foods, highly processed foods and beer.
dankrist: Can you recommend anti-inflammatory foods that can be eaten instead of taking ibuprofen?
Kate_Patton,_MEd,_RD,_CSSD,_LD: Anti-inflammatory foods are not likely to have as much of an immediate response on lowering inflammation as would ibuprofen. Following an anti-inflammatory diet is something that gradually over time will help to lower inflammation. Anti-inflammatory foods include fresh fruits and vegetables, especially berries and dark green leafy lettuce; whole-grain starches such as wheat, rye, oats and quinoa; beans and lentils; omega-3-rich fish including salmon, tuna, herring and sardines; nuts and seeds; and extra-virgin olive oil.
sinaihospital: What type of diet can I use to fight inflammation? I have bad inflammation. Thank you for your help.
Kate_Patton,_MEd,_RD,_CSSD,_LD: Anti-inflammatory foods to CHOOSE: Fresh fruits and vegetables, especially berries and dark green leafy lettuce; whole-grain starches such as wheat, rye, oats and quinoa; beans and lentils; omega-3-rich fish including salmon, tuna, herring and sardines; nuts and seeds; and extra-virgin olive oil. FOODS TO LIMIT: Saturated fat, found in high-fat cuts of beef, pork, veal, lamb, bacon, sausage, bologna, salami and hot dogs as well as butter, cheese, cream and whole milk. Also limit sugar and any form of added sugar. This includes white sugar, brown sugar, honey, maple syrup, molasses, any form of sugar added to foods such as high-fructose corn syrup and corn syrup; soda; sweet tea; fruit punch. Limit alcohol to no more than one drink per day for women and no more than two drinks per day for men. FOODS TO AVOID: Trans fat (partially hydrogenated oils) found in solid margarine, certain brands of pre-packaged baked goods, energy/granola bars, peanut butter, liquid and powdered coffee cream.
Vitamins and Supplements
gm: Could you please comment on silent aging and the relation of same to aging. Also, is a turmeric supplement on daily basis helpful to neutralize body inflammation?
Kate_Patton,_MEd,_RD,_CSSD,_LD: Turmeric has been shown to fight inflammation in the body. You can use the actual spice or in supplement form. A daily recommended dosage would be 400mg per day.
Flamingo32: After a few bad experiences, I can't eat fish. Would you recommend taking a fish oil supplement instead or should I be looking toward other foods that produce more omega-3?
Kate_Patton,_MEd,_RD,_CSSD,_LD: You do not have to take a fish oil supplement. You can obtain omega-3 fatty acids (a different form than what is found in fish) from plant-based foods such as walnuts, flaxseeds, chia seeds, edamame and soy products. If you have a chronic condition that is causing inflammation, then I would talk to your primary care doctor to see if he or she recommends taking a fish oil supplement.
chickbull: I am 83 and in fairly good health, but had triple bypass surgery at age 60, and hip replacements at age 62 and 63. I have osteoarthritis and think that's starting to show some difficulties, as I no longer play baseball. (I was OK until age 77. Now, no golf but was OK until age 78.) I walk slowly. I'm taking a few supplements and only two medications, both for urination, no pain medications. Can you suggest how to build up my energy?
Maxine_M._Smith,_RD,_LD: Eating a healthy diet, maintaining a healthy weight, staying well-hydrated, continuing to exercise (as cleared by your physician), getting good and adequate sleep, and limiting or avoiding alcohol can help build up your energy. A daily multivitamin/mineral supplement may be helpful; however, please discuss any supplements with your physician before taking them.
ccuser1000: Can you please provide a diet reference guide to get us started?
Kate_Patton,_MEd,_RD,_CSSD,_LD: Here are two resources:
Bbird: What resources can you recommend to learn about adopting an anti-inflammatory diet?
Maxine_M._Smith,_RD,_LD: A couple of books that may be useful are The Anti-Inflammatory Eating and Action Plan and Anti-inflammatory Eating Recipes from Your Dietitian's Kitchen.
SummerFun: My husband suffers from RA. I am wondering if there is a cookbook or reference guide we could purchase to help him with restricted foods?
Kate_Patton,_MEd,_RD,_CSSD,_LD: I would recommend any Mediterranean diet cookbook since this is also an anti-inflammatory diet. See these sites as reference guides.
That is all the time we have for questions today. Thank you, Ms. Patton and Ms. Smith, for taking time to educate us about an Anti-inflammatory Diet.
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