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How can the food we eat - and the foods we don’t eat - soothe or prevent inflammation in the body? Registered dietician Julia Zumpano explains the health benefits of an anti-inflammatory diet, including which foods can have a direct impact on pain, who should try this style of eating and how to decide which anti-inflammatory diet is right for you.

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The Benefits of an Anti-Inflammatory Diet with Julia Zumpano

Podcast Transcript

Intro:
There's so much health advice out there, lots of different voices and opinions, but who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough, intimate health questions so you get the answers you need. This is the Health Essentials podcast brought to you by Cleveland Clinic and Cleveland Clinic Children's.

This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Kate Kaput:

Hi, and thank you for joining us for this episode of the Health Essentials podcast. My name is Kate Kaput and I'll be your host today. We're talking to registered dietician Julia Zumpano about the benefits of an anti-inflammatory diet. Julia, thanks so much for being here with us today.

Julia Zumpano:
Thanks for having me.

Kate Kaput:
I'd like to begin by asking you to tell us a little bit about your practice at the Cleveland Clinic. What types of patients do you typically see and what does your work with them entail?

Julia Zumpano:
I am a registered dietician in the Department of Preventive Cardiology. So a majority of my patients have some form of cardiac or heart disease or history. They may have had some type of cardiac event such as a heart attack or stroke. They may also be trying to prevent a cardiac event. So they may have risk factors that put them at high risk for some of those events, such as high cholesterol, high blood pressure, they may be overweight or have pre-diabetes or some elevated blood sugar values. That is the majority of the patients I see. I also see some traditional weight loss patients and some transplant patients.

Kate Kaput:
Great. Thank you so much for that background. So let's talk terminology. Most of us are familiar with the concept of inflammation as it relates to say an injury or a wound, but what does inflammation mean when we're talking about our internal body? What exactly do we mean when we say anti-inflammatory in this context?

Julia Zumpano:
So when we look at inflammation, inflammation happens when there might be an insult or injury, just like we know if you fall and bump your knee, your knee gets inflamed, but that same process can also happen in certain disease states or certain states of your body, such as obesity can promote inflammation, heart disease, elevated blood pressure, or even certain foods can promote your body to be inflamed because your body may be reacting to that negatively.

So anti-inflammation or anti-inflammatory are foods that suppress when we're talking about it in the contents of your nutrition or your diet. They are foods that suppress those inflammatory responses, and that helps suppress the inflammation and also helps suppress the overall purpose of the inflammation, whether it might be obesity or high cholesterol or just the foods you eat.

Kate Kaput:
So if you're living with one of those chronic conditions that you just mentioned, does that sort of mean that you may be living with chronic inflammation as well?

Julia Zumpano:
Yes, it does mean that you may be living with chronic inflammation. Now, that doesn't mean everybody is, it's just your body's response to it. So there are blood tests that you can get that would test your body's inflammation. One of those blood tests is called highly sensitive C-reactive protein and/or CRP, but this is, again, it's a highly sensitive test. So the elevation does show there's inflammation somewhere in your body, but it doesn't pinpoint where or why that inflammation is occurring.

Kate Kaput:
Interesting. So you've mentioned some of the medical conditions that can result in inflammation. Talk to us about a little bit more about that. Who experiences this type of inflammation in the internal body and why might it occur? What particular types of medical conditions might induce inflammation? I know you mentioned obesity. What else falls on that list?

Julia Zumpano:
So almost any medical condition can pretty much induce inflammation, like Crohn's or ulcerative colitis, irritable bowel syndrome, so some of the gastrointestinal disorders, heart disease or anything that's associated with heart disease like elevated blood pressure, diabetes or poor controlled blood sugars can. We mentioned obesity, being overweight, being fluid overloaded. So anything that may cause you to consistently be fluid overloaded. So high alcohol intake can lead to inflammation.

So if you have an immune response to a few food, so what that means is that when you eat a certain food, your body's own antibodies rise, which means your body is kind of working against that food. It's almost looking at it as a foreign body. So any food that may create that increased antibody response could also lead to inflammation. So an example might be someone who has a dairy intolerance, and every time they have dairy, their antibody response increases, which can also lead to inflammation. So that could be another cause for inflammation.

Kate Kaput:
So it sounds like there are probably a lot of folks out there who are or maybe experiencing internal inflammation maybe without even recognizing it.

Julia Zumpano:
Absolutely. A lot of the times it's unrecognizable. And there are physical side effects that you can recognize inflammation. For instance, you could have some swollen fingers, like your ring might be more tight. Your shoes might be tighter. You may notice some abdominal distention or fluid retention in your abdomen. Your chest or lungs could carry extra maybe fluid retention. Now, I know fluid retention and inflammation can be a little bit kind of hand-in-hand at some points, but your inflammation could be fluid related. It could just be tissue related. It could be shown in multiple forms.

Kate Kaput:
So tell us the basics of what anti-inflammatory diets are, what that means. How can the foods that we eat or the foods that we don't eat soothe or prevent inflammation?

Julia Zumpano:
So an anti-inflammatory diet is one that has minimally processed foods. So when you think of a processed food, you think of anything that's in a box, bag or can that has multiple ingredients, specifically ingredients that you don't recognize or not really food. So that's the ultra-processed foods. And we're thinking packaged desserts, commercial baked goods, potato chips, donuts, microwave popcorn, those things that really have a lot of processed ingredients.

So then you think of also another step would be foods that don't maybe fit into the obvious, but still can promote inflammation, and those are things like processed meats. So bacon or sausage or hot dogs or pepperoni or salami, those have been shown to be pro-inflammatory, even processed cheeses, so cheddar or American cheese, or specifically cheeses that might be found at a restaurant that are ultra-processed like nachos and cheese, that type of product.

Then you have your other higher processed foods which might be packaged snack foods that are maybe considered healthy by some populations like granola bars or trail mixes or baked chips or crackers, which kind of fall in that middle ground, but still have a lot of those processed ingredients and sodium and sugar added. So the least amount of processed foods you eat is going to be the closest version of an anti-inflammatory diet that you can follow.

What we consider a whole food is really a food in its entire entity. So it's a one ingredient food, an apple, an orange, a cucumber, a slice of bread. Now I know bread can have some ingredients that can be questionable. So that's where some of that gray line occurs. Choosing whole grain bread, minimally processed, minimally preserved. So you have things like whole wheat pasta, brown or wild rice, legumes, which are dried beans and peas, nuts, those are all one ingredient foods. Some may have more than one ingredient, but just kind of minimizing the amount of ingredients in there that are whole foods. Chicken breast, a piece of fish, an egg, those are all one unit food.

So when you get into foods that have multiple ingredients, specifically, again, that list of ingredients we don't recognize, is where you're going to get more and more processed.

Kate Kaput:
Got it. So basically any food found in nature is sort of on the safer side it sounds like.

Julia Zumpano:
Absolutely. Yes.

Kate Kaput:
So with all of that in mind, the term anti-inflammatory diet doesn't refer to a specific diet regimen, but as you were saying, to an overall style of eating. Can you tell us about some of the specific diet regimens that fall within the overarching category of anti-inflammatory diet? I know people have heard of the Mediterranean diet, the DASH diet. What can you tell us about some of those specific diets within this broader category of anti-inflammatory diets?

Julia Zumpano:
The Mediterranean diet has been shown to be a very anti-inflammatory diet and the reason is because the focus is whole foods. So foundationally, the Mediterranean diet includes fish, specifically omega-3 fish, which are fish that are high in this specific oil or fatty acid called omega-3 fatty acid. And omega-3 fatty acid has been clinically proven to reduce inflammation. So it does help and it has been shown. So oily fish, such as salmon or tuna, hearing or mackerel, those fish have higher amounts of omega-3. So those are highly encouraged on a Mediterranean diet.

Other sources of omega-3 include things like chia seeds and flax seeds and hemp seeds and soy beans. Those also have good sources of the plant-based omega-3 fatty acid, which is called alpha-linolenic acid, also been shown to be helpful to reduce inflammation.

The other components of a Mediterranean diet are whole foods, fresh fruits, fresh vegetables, dried beans and peas, which are legumes, nuts, and of course, extra virgin olive oil as your primary source of oil and fat. So it does eliminate all those processed oils which is found in a lot of those ultra-processed foods. So you have the cottonseed and soybean oil, and those are ultra-processed oils, vegetable oils. We're looking at a very pure, high quality oil being extra virgin olive oil, being your primary source of oil and added fat in the diet.

Kate Kaput:
So you mentioned the Mediterranean diet. Can you talk a little bit about the DASH diet? What is that one exactly?

Julia Zumpano:
DASH stands for Dietary Approaches to Stop Hypertension. So the purpose of the diet was to help reduce blood pressure or hypertension, which is considered high blood pressure. So it is a very whole foods based diet, it is very high in fruits and vegetables and grains, and does limit protein and sweets and desserts and processed foods significantly.

The difference between the Mediterranean diet and the DASH diet is that the DASH diet doesn't specifically encourage the fish or the extra virgin olive oil to the extent that the Mediterranean diet does. And the DASH diet includes a little bit more dairy in the form of low fat yogurt, fat-free milk, than the Mediterranean diet, but they both do really encourage whole foods, meaning specifically plant-based foods, fruits, vegetables, legumes, and grains as being the foundation.

So it has also been shown to reduce inflammation, but it could also be a side effect of the fact that it's reducing blood pressure, which is inflammatory, and it's so whole foods based and low calorie that it's been shown to promote weight loss too, which we already have discussed is inflammatory.

So I think either of those diets are phenomenal diets to consider because they've had so much positive research that supports their success in not only inflammation, but also reducing cholesterol, reducing weight, reducing blood pressure, reducing blood sugars. So those are really great places to start. Plus, there's a lot of good resources that help you begin on one of these journeys with these diets and it can help you kind of support your success of following it.

Kate Kaput:
You mentioned that some meats are known to cause inflammation. Can eating a vegetarian or pescatarian diet ease inflammation?

Julia Zumpano:
So that's a great question. Vegetarian diets can include ultra-processed foods. So Oreos are vegan, so we can still eat potato chips and French fries and Oreos and consider ourselves vegetarian.

Now, if it is a whole foods plant-based diet, then that can certainly help suppress inflammation, but it would still have to be the same concept of whole foods. And you can include some meat and still get the benefits of an anti-inflammatory diet, it just would be really high quality grass-fed, if you can afford it, organic lean cuts of meat. So poultry that's skinless, very lean beef, and then the other majority of your protein would come from the fish and the legumes.

Kate Kaput:
That makes sense. So we often hear from people who want to know, say, the top five foods that help with chronic pain. Can individual foods have an impact, positive or negative, on inflammation, or is it really about your overall diet and the combination of foods that you're taking in?

Julia Zumpano:
So I think it's a bit of both. So there are individual foods that some people react to, but it's very specific to that person. So for instance, someone may react highly to gluten where another person may not, and they may have the same medical concern.

And so really, it's a matter of personalizing which foods create a reaction, meaning an inflammatory reaction for you, and that may create more inflammation in whatever state that inflammation is being carried, whether it's rheumatoid arthritis or IBS or heart disease. So everyone's specific inflammatory triggers can be different.

Now, there are some general associations that we know, that bread, processed meats are not good for heart disease and gluten and dairy cannot be very favorable for any bowel disorders. There's things like nightshades that have been known to be inflammatory for arthritis.

So again, there's categories, but each person needs to find what's their personal trigger. So we don't want to overly eliminate foods if it's unnecessary, specifically when they're cutting out foods that might have nutrients like the nightshades. So that's where we want to be very cautious on our decisions and what foods we're cutting out.

Kate Kaput:
So what is the best way to figure out what those foods are for you, to figure out what the foods are that trigger inflammation in your body and which foods are the foods that kind of do well by your body? How can people go about identifying those foods for themselves on a kind of individualized level?

Julia Zumpano:
Great question. So it would start with an elimination diet. So you would, first of all, of course, cut out all the ultra-processed foods because there's no nutritional benefit to those. So you're not really lacking anything when you cut those out. And if that alone solves the problem, great. If you're still having symptoms, then we start to look at maybe other foods that could be creating some of those symptoms.

So you look at maybe artificial sweeteners, you look at gluten and you look at some processed dairy, sugar. So you start to look at some of those basic ingredients, specifically ingredients that aren't going to serve you well like sugar or artificial sweeteners, and then see if that elimination of those help. And then you can even go further to eliminate some of the highly allergen producing foods to see if any of those foods are creating a reaction for you. So it's a lot of elimination and trial and error.

There are skin tests and blood tests that you can get that can give you more of a guideline as to which foods your body creates an increased antibody response to, and that could also be helpful to get you started. But I would really just start with the basics first.

Kate Kaput:
Are there any other foods that we haven't talked about that can be beneficial to an anti-inflammatory diet?

Julia Zumpano:
Yes, there are. So we talked a lot about extra virgin olive oil, but there are other healthy fats that can help promote anti-inflammatory responses, as well as decrease inflammation. So unprocessed oils such as avocado oils, avocados, olives, nuts, or nut oils, seed oils, like flax seed oil, walnut oil, walnuts, those are all very helpful, as well as some herbs. So turmeric has been shown to reduce inflammation, ginger, garlic, those have been shown to really be helpful with reducing inflammation, as well as cinnamon and some of the peppers like a cayenne pepper, all of those foods have been shown to help.

Kate Kaput:
I think that's helpful to hear because that means that all your food can still be super flavorful, even when you're eating whole foods. I think that's a worry that people sometimes have when they're changing their way of eating. So that's great to hear.

Can you talk a little bit about how dieticians can help throughout that process? What is it that dieticians do to kind of help people in the process of figuring out what foods are right and wrong for their bodies?

Julia Zumpano:
So dieticians can be very helpful in this process. We usually take a diet history. So we look at what you're eating and what you generally eat. We look at day to day diet as well as kind of what is a foundation in your grocery list.

When you meet with a dietician, you'll get an extensive review of what you're eating, and then the dietician can specifically provide some foods that she or he may think could be leading to some of the inflammation. If you do have any blood test results, the dietician can help you decipher some of those results and can also help you start an elimination diet, and also can help you, once the elimination diet is done, the dietician can help you add some of those foods back in in moderation with tracking some of the symptoms.

So the important part is when you eliminate a food, you do want to rechallenge by adding the food back in and seeing what happens with some of the symptoms you experience after eating that food that we've eliminated for so long.

Kate Kaput:
So you talked about tracking and kind of keeping track of what you're eating and what those symptoms are. For someone who's not yet working with a dietician and is trying an elimination diet on their own, is there anything that you can recommend in the way of tracking? What's the best way to keep track of the progress that you're seeing or the issues that you're seeing? Anything in particular that you can suggest to people?

Julia Zumpano:
Yeah, tracking is essential when you're following an elimination diet. It's very important because we forget. So let's say, for instance, you decide to eliminate all sugar and artificial sweeteners for three weeks, it's important to track when you started and when you decide to end, and any changes, physical changes, mental changes that you see in your body.

One thing I didn't mention when it came to signs of inflammation, they can also be mental based. So you can have some brain fog, difficulty concentrating, anxiety, depression, difficulty sleeping. Some of those can also lead to the side effects of inflammation in the brain. So that was one area we didn't address. But I do think it's important to note any mental, physical, or even skin changes that you might see with elimination of whatever food category you decide to begin with.

I generally recommend eliminating the food for two to three weeks and then re-challenging after that in a small portion. So usually like half of a normal serving size is what I'd recommend that you start with on day one, then a full serving size on day two, and then even two servings on day three. And that's where it's important to track those side effects and symptoms because there it's where you could find also if you have a threshold for some of those foods. So maybe at a half portion, you were okay, once you kind of progressed to a full portion or two portions, then you started seeing some of these symptoms come back. So it's nice to have an understanding of what your threshold is if you have one.

Kate Kaput:
Are there any particular diets that are known to be particularly inflammatory? Maybe they're good for weight loss or quick weight loss or trend diets that are actually increasing inflammation in the body.

Julia Zumpano:
Well, so it's really depending on whether you have a reaction to a food that might be included on the diet. So I would say the typical Atkins diet that was popular several, several years ago which was a very high fat, specifically encouraging fat in the form of processed meat like bacon and butter and cheese. So I'd say that is a quite pro-inflammatory diet that may produce weight loss, but not in a healthy means.

And another is the standard American diet. That is very high in inflammatory foods. Actually, the acronym for the standard American diet is SAD. And it is so sad that that is our standard diet as Americans because it is very, very ultra-processed, high sugar, high saturated and trans fats and high sodium. So those are the two I would steer clear from.

Kate Kaput:
So in terms of tracking and figuring out everything for yourself, it sounds like it's really an individualized balancing act. It can be really difficult to transition into a new way of eating in general for anyone no matter what that new way of eating might be, especially when it's one that you're hoping to adopt for the long-term. What tips can you provide to help ease that transition for people who are new to eating an inflammatory diet?

Julia Zumpano:
So it can be very overwhelming to start a new diet, especially when you're eliminating a food that you eat on a regular basis. So what I would recommend is starting with the foods that you know don't serve you well. Keep it very simple. So for instance, it may be the ultra-processed coffee creamer you put in your coffee, or it might be the vending machine snack that you grab on your lunch break or your snack break.

So just look at really what we take in on a regular daily basis that is very processed that we can start there. So instead of fully eliminating everything at once, start with the foods that are the highest processed and then kind of stepped down from there. So maybe we start to eliminate sugar and we start to really look at where we're getting sugar and we try to really limit how much sugar we have. And then the next thing we maybe look at is where we're getting a lot of salt. So you're looking at, again, packaged foods, canned foods, processed needs.

So I'd keep it very simple and do it in small steps, because again, you’re eating habits didn't happen overnight, so the change in your eating habits should not be expected to happen overnight. I would say give yourself anywhere between six months to a year to fully change your diet because drastic changes never lead to long-term success. So just make small changes that you know will be very impactful to begin with and get comfortable with those changes, and then continue to add on.

Kate Kaput:
That makes sense. So you don't have to start right off the bat with the elimination diet. You can kind of ease yourself into it with some of the easier steps before kind of going all in and figuring out what those issues really are.

What is your body going to feel like if an anti-inflammatory diet is working for you? What sort of changes might you notice and how can you tell that it's doing what it's supposed to do?

Julia Zumpano:
So you can tell by some of the symptoms that you have every day. Those symptoms may start to decrease. So you may start to see that there's less swelling in your hands and feet. You may see that your sleep has improved. You may see some weight loss. You might see some blood pressure values going down, blood sugar values going down. You may see your waist getting smaller, your pants getting looser. You may see that you have a little less anxiety, a little less stress, a little less brain fog. You might see your skin has cleared up or that itchiness that you have all the time has gone down. So there's a lot of different ways that your body can react to an anti-inflammatory diet.

Kate Kaput:
Those are all good things. It sounds like there are a lot of reasons to try to focus on anti-inflammation. Is there anything that we haven't talked about today that you think is particularly important for our listeners to know as they sort of start to figure out what anti-inflammatory diets might look like for them?

Julia Zumpano:
Yeah. So I wanted to talk about the elimination piece of the anti-inflammatory diet. That sometimes is not necessary, and quite often, is not necessary. So the elimination piece is only necessary if you feel like you're following an anti-inflammatory diet, you've cut on all the things that your body doesn't already need that has really very minimal nutrition or nutrients, and you're still having a reaction.

So you're eating real food, you're eating whole foods like we talked about, the fruits and vegetables and grains and proteins and dairy, but you're still having a reaction. So that's when we take it a step further to say, "Well, is there something that may still be a whole food like gluten or dairy or a nightshade that could be creating a reaction still for me?"

So generally that elimination diet step is not necessary. Very rarely is it included, unless, again, we are still reacting. And that's where you might consider that elimination or consider getting some further blood or skin test to see if your body is reacting to a certain food that still could be considered a whole food.

Kate Kaput:
Thank you so much to our guest, Julia Zumpano, for being here today. If you'd like to learn more about working with a registered dietician, visit clevelandclinic.org/nutritiontherapy, or call 216-444-7000. Thanks for being with us today.

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