Food as Medicine:Relationship of Nutrition to Inflammation,

Pain and Chronic Disease

Dorothy D. Zeviar, Ed.D., LAc

MPH Student, COPH, USF

1 April 2011

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Basic Review of Inflammatory Process

Acute Inflammation

Chronic Inflammation

Inflammation911.com

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Basic Review of Inflammatory Process

Triggering Events Injury, Infectious invasion, allergies

Signs of Inflammation: Tumor, Rubor, Calor, Dolor, Loss of Fx

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Basic Review, con’t

• Phase 1 – Vascular – Immediate b.v. constriction to halt entry of pathogens (seconds)– b.v. dilate ^ blood flow edema

• ^ rubor and calor – ^ b.v. permeability ^ blood plasma leakage ^ edema, tumor, dolor– ^ blood plasma loss thicker blood volume and blood stasis – ^ macrophage and neutrophils in area ^ secretion of cytokines and

signals to bone marrow to ^ production of WBCs – ^ secretion of chemotaxins to attract leukocytes to area

Rocleara.comMagnetictherapyfacts.org

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Basic Review, con’t

• Phase 2: Cellular Exudate

– Neutrophils ^ creating pus, attack and destroy pathogens, remove dead tissue through phagocytosis

– ^ cytokines released ^ tissue macs, ^ phagocytosis

– Arachidonic acid cascade ^ inflammatory response• COX AA prostaglandins, thromboxanes, kinins, leukotrienes continue

infl response• COX inhibitors/NSAIDS inhibit the cascade, thus < pain

Dynamicchiropractic.com

Prostaglandins mediate inflammatory process, stimulateneural receptors for pain Thromboxanes mediate inflammatory process, vaso-constrictor, aggregates platelets (clots)Leukotrienes mediate inflammatory process, broncho-constrictors and vasodilators (asthma, RA, IBD)

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Basic Review, con’t

We’ll look at other natural anti-inflammatories in a moment.

Interferes w/ cancer apoptosis

Lef.org

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Basic Review, con’t

We’ll look at other natural anti-inflammatories in a moment. Lef.org

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Basic Review, con’t

• Phase 3 – Tissue Repair and Replacement

– Begins with initial injury or invasion; continues with growth of new tissue

– Stimulates cells to divide

– Leukocytes “roll” to injury site

– Stimulates fibroblasts to grow and release collagen to form scaffold for scar tissue loss of fx

Hbsprotocols.coom

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Resolution of Inflammation

• Prevents secondary tissue damage/destruction

• Most mediators naturally have a short half-life

• Macs release Transforming Growth Factor (TGF) and IL-10

• Leukotrienes are down-regulated

• TNF receptor and IL-1 receptor antagonist up-regulated

• Prostaglandins and leukotrienes convert to lipoxins (derived from Omega-6) which terminate inflammation cascade

• Cellular apoptosis

• Neutrophils stop generation; macs clean up; lymph system cleans up macs

• Resolvins enter, derived from Omega-3 (EPA and DHA)

Archives.gov.on.ca

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Fatty Acid production of inflammatory substances

• Omega-6 FA (Linoleic Acid)– Margarine, shortening, vegetable

oils (corn, safflower, sunflower, peanut, cottonseed, soy), meats

– Trans-fatty acids (hydrogenated)– Makes Arachidonic acid – Stimulates prostaglandin PGE2– ^ Platelet aggregation (clots),

^LDL, <HDL– Prolongs inflammatory response

• Omega-3 FA (Linolenic Acid)– Leafy green veggies, flax, cold-

water fish, canola oil, soy, nuts, free-range chicken eggs

– Converts to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – Anti-inflammatory, < clot, <LDL, ^HDL, <stress

– Turns off inflammation cascade – gamma-linolenic acid is O-6, but

acts like O-3 (Evening Primrose Oil, black current oil, wild meat)

• Omega-9 FA (Oleic Acid) – works with O-3 FA – found in virgin olive oil, avocados,

macs

Appropriate ratio =2:1 O-6 to O-3Current ratio = 20:1

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Anti-Inflammatory food pyramid

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Anti-inflammatory Herbs/Substances

• All foods high in Omega-3 and Omega-9• Fruits and vegetables, esp berries, dark green leafy and bright

yellow/orange • Nuts and seeds, legumes• Whole grains• Green tea• Boswelia• Bromelain (pineapple)• Ginger • Pycnogenol • Turmeric (curry)

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Markers of Inflammation

• C-reactive protein (CRP) – non-specific indicator of inflammation – Optimal = 1mg/dl– Average = 3 mg/dl– High = > 3 mg/dl– Exercise lowers CRP and raises HDL!

• Sedimentation (SED) rate – non-specific indicator of inflammation – Optimal = 15-20 mm/hr

• Homocysteine – related to higher meat consumption and B vitamin defs, thus ^ risk cardio-vascular accidents, Alzheimers dz

– Optimal = 4-12 mmol/L– Average = 12 -15 mmol/L– High = > 15 mmol/L

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Chronic Inflammation

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Chronic low-grade inflammation in body. May be localized (RA) or diffuse (obesity).Inflammation cascade does not stop. May injure tissue, joints, organs.

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How does this occur?

• Hyper-glycemic diet (whites, processed food), too few fruits and veggies (low Vit C) changes in micro-vasculature of b.v.

• Constant “scarring” of b.v. by sugar (Brillo pad) continuous inflammation cascade to repair b.v. epithelium.

• Sugar increases blood viscosity; b.v. compensate initially by vasodilation. After stress of continued vasodilation and repeated assaults on b.v. epithelium by sugar injuries, the basement membrane (extra-cellular matrix) below epithelium thickens; this continues as long as blood is hyper-glycemic. Studies have shown no improvement in b.v. ECM even with lifestyle changes.

• Without ability to follow normal inflammatory process, body is in constant inflammation, cannot get nutrients, O2 to injury site.

• Can also lead to other vascular conditions – blood clots, atherosclerosis, MI, stroke

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From: Christopherson, K. (2003) The impact of diabetes on wound healing:Implications of micro-circulatory changes. Wound Care, 8(12), S6-13

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Relationship of Chronic Inflammation and Pain

• Nociceptive nerve fibers conduct pain sensations to the brain when damaged or injured.

• Nociceptive nerve fibers are depolarized, thus propagating action potentials (APs) to the brain.

• Inflammatory mediators such as prostaglandins and cytokines further sensitize the nerve fibers and carry pain signals to the brain.

• With chronic inflammation, nerve fibers are constantly stimulated and pain is continuously propagated along the nerve fiber. (Substance P)

• As stated previously, NSAIDS, anti-inflammatories and prescription pain pills down-regulate the production of prostaglandins (pain pills cover up the pain)

• Other pain-reduction treatments are under investigation, such as acupuncture, bio-feedback, anti-inflammatory herbs/substances, meditation, prayer, massage, etc.

From: Schaible, H., Ebersberger, A., & Natura, G. (2011). Updateon peripheral mechanisms of pain: Beyond prostaglandins and pain.Arthritis Research and Therapy, 13(210). Doi: 10.1186/ar3253

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How can Acupuncture Help?

• Three theories:

– Gate Control theory – see previous slide

– Central biasing theory – enkephalins and seratonin block pain signal transmission from brain

– Endogenous opioids theory – endorphins and enkephalins are released (“Acu-land”)

From: http://www.educ.uidaho.edu/jwilliams/HS%20468/PAIN%20CONTROL%20THEORIES.ppt#290,24,Endogenous Opiates Theory

Zu San Li

Qu chi

Both points are analogous

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Suggested Resources

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References

• Ambrose, S. (2006). Diet and Nutrition. Portland, OR: Author• Bond, B. (2006). Inflammation: The Silent Epidemic. Portland, OR: Author• Challem, J. (2003). The Inflammation Syndrome. Hoboken, NJ: Wiley & Sons• Ignatavicius, D. & Workman, L. (2006). Medical-Surgical Nursing, 5th ed. St Louis,

MO: Elsevier

• Meissner, N. (2009). Acute Inflammation [Powerpoint slides]. Retrieved from

http://www.docstoc.com/docs/61173539/Acute-Inflammation-Powerpoint • Pagana, K. & Pagana, T. (2007). Mosby’s Diagnostic and Laboratory Test

Reference, 8th ed. St. Louis, MO: Mosby Elsevier• Venes, D (Ed.). (2005). Taber’s Cyclopedic Medical Dictionary, 20th ed.

Philadelphia, PA: F.A. Davis Company• Wikipedia. (n.d.). Inflammation. Retrieved from http://en.wikipedia.org/wiki/Inflammation

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