Inflammation and the Mediterranean Diet

The Mediterranean Diet is the most anti-inflammatory diet studied.

The inflammatory response is the body’s mechanism to fight infection, repair itself and rid itself of cancer.  Inflammation is a coordinated response to trauma, infection and cancer. Without inflammation, we would be dead within twenty-four hours.

Too little or too much

Too much inflammation results in wanton destruction of tissues, pain, fevers, and misery. It is associated with heart disease, cancer, aging. It is that delicate balance of inflammation we need.

Does diet play a role with inflammation? The answer is “sort of.”

Short Course about Inflammation

Inflammation is involved in:

• Wound healing, removing dead cells – breaking them down into components so they can be recycled
• Removing and destroying bacteria
• Inactivating and eliminating viruses
• Destroying cells that have changed into cancer cells
• Repairing injury from infection
• Destroying parasites
• Removes toxic chemicals
• The immune system is one branch of the inflammatory response.

Five Signs of Inflammation

The five signs of acute inflammation and their Latin names:

• Redness – in Latin this is called rubor.
• Swelling – in Latin this is called tumor.
• Fever – in Latin this is called calor
• Pain – in Latin this is called dolor
• Secretion – in Latin this is called fluor

Medical school teaches inflammation as one of the first series of lectures.

Simple Inflammation

Your finger was hit with a hammer. You have an injury to your finger. Some cells are injured. The cells send a distress signal, and immediately white blood cells begin to swarm into the area to help the injured cells.  All that extra blood flowing to the area will lead to redness (rubor) and swelling (tumor). Soon, the finger will feel a bit hot (calor) and will have pain (dolor).

Some cells are so badly injured that they are no longer viable. Your inflammatory reaction breaks down these cells, removes the debris, and recycles the parts to create new tissue in the area.

Unwanted Inflammation

I love nature walks, but like to avoid Poison Ivy

Sometimes, we want to decrease the immune response. Inflammation is the response of our skin to poison ivy.  We reduce the immune response by reducing hives and itching.

Rheumatoid arthritis is another example of unwanted inflammation.  Rheumatoid arthritis is an auto-immune disease.  The resulting inflammation leads to pain, fever, and joint destruction. The aim of the treatment is to reduce the inflammatory response that saves joints and improves well-being.

The inflammatory response of COVID, influenza or the common cold is reduced by the use of non-steroidal anti-inflammatory drugs, such as aspirin or Motrin.

Acute Disease and Inflammation

Heart disease is partially the result of inflammation. When you have a heart attack, the coronary arteries are blocked. As a result, a part of your heart muscle is without oxygen. The cells send out inflammatory signals, and you begin to feel pain (dolor). If the blood flow is restored, your cells can heal, but if it takes too long, some of those cells will die. Then your body will get rid of those dead cells and replace them with scar tissue. The result is that your heart becomes less effective.

Cardiovascular disease and inflammation

Plaque formation in the arteries is the result of genetics, diet and inflammation. The increased cholesterol, either from the genetics, or from a diet high in saturated fat, is deposited in the arteries.  When cholesterol enters the artery wall, the body’s inflammatory response tries to get rid of it, causing inflammation in the arteries. Did you know that 18 year olds already have signs of early plaque formation in their arteries?

Chronic Inflammation

Chronic inflammation is when your body continues to send inflammatory signals, even when there is no acute injury or danger. This is what happens in rheumatoid arthritis, lupus, long Covid, and is involved in diabetes, obesity, dementia, and premature aging.

Western Diet and Inflammation

It is easy to obtain calories in western societies. In human history, we have gone from people on the verge of starvation to being overfed. We have also increased lifespan because of sanitation, vaccination, clean water, availability of food, and modern medicine. Living longer means seeing more chronic diseases. The role of diet in those diseases has never been in doubt, since Hippocrates said, “Let thy food be thy medicine.” The result has been an increase in inflammatory diseases

How Diet Has Changed in the US

Contrary to the Mediterranean diet, the typical US diet has changed to a diet rich in fats. Fat consumption has risen by 11% at the expense of healthy carbohydrates.

Refined sugars have increased from 18 pounds a year in 1800 to over 180 pounds per year in 1999. Since 1999 sugar consumption has been decreasing in the United States.

The typical western diet has decreased in the amounts of fruits, nuts, seeds, vegetables, legumes, and fish. All while increasing meats, ultra-processed foods, dairy and alcohol.

Increasing Inflammatory Diseases

Diseases caused by inflammation have increased in the United States. Obesity is now considered an inflammatory disease. But other diseases of inflammation have increased:

• Inflammatory Bowel Disease
• Rheumatoid arthritis, lupus, and other auto immune diseases
• Hidradenitis suppurativa and other skin diseases
• Food allergies, such as allergies to peanuts
• Dementia, Alzheimer’s and Vascular dementia, as well as cognitive decline with age
• Asthma
• Diabetes, both type 1 and type 2
• Multiple Sclerosis and Amyotrophic Lateral Sclerosis
• Diabetic complications, such as neuropathy, cardiovascular disease, kidney disease
• Fatty liver disease (Non Alcoholic Fatty Liver Disease)

Summary

Diet contributes to inflammatory conditions. If inflammation is like a fire, then some dietary components are adding kindling to the fire of inflammation. The Mediterranean diet has led to reduced inflammation and improved quality of life.

Antiinflammatory components of the Mediterranean Diet include anti-oxidants, polyphenols, omega 3 fatty acids, vitamins, potassium, magnesium, zinc, fiber, and lower sodium and saturated fat consumption.

References for diet and disease:

Tsigalou C, Konstantinidis T, Paraschaki A, Stavropoulou E, Voidarou C, Bezirtzoglou E. Mediterranean Diet as a Tool to Combat Inflammation and Chronic Diseases. An Overview. Biomedicines. 2020 Jul 8;8(7):201. doi: 10.3390/biomedicines8070201. PMID: 32650619; PMCID: PMC7400632.

Malesza IJ, Malesza M, Walkowiak J, Mussin N, Walkowiak D, Aringazina R, Bartkowiak-Wieczorek J, Mądry E. High-Fat, Western-Style Diet, Systemic Inflammation, and Gut Microbiota: A Narrative Review. Cells. 2021 Nov 14;10(11):3164. doi: 10.3390/cells10113164. PMID: 34831387; PMCID: PMC8619527.

References for chronic diseases:

Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease. J Clin Invest. 2017 Jan 3;127(1):1-4. doi: 10.1172/JCI92035. Epub 2017 Jan 3. PMID: 28045402; PMCID: PMC5199709.

Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, Panaccione R, Ghosh S, Wu JCY, Chan FKL, Sung JJY, Kaplan GG. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2017 Dec 23;390(10114):2769-2778. doi: 10.1016/S0140-6736(17)32448-0. Epub 2017 Oct 16. Erratum in: Lancet. 2020 Oct 3;396(10256):e56. PMID: 29050646.

Raghupathi W, Raghupathi V. An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach. Int J Environ Res Public Health. 2018 Mar 1;15(3):431. doi: 10.3390/ijerph15030431. PMID: 29494555; PMCID: PMC5876976.

D’Antona S, Caramenti M, Porro D, Castiglioni I, Cava C. Amyotrophic Lateral Sclerosis: A Diet Review. Foods. 2021 Dec 17;10(12):3128. doi: 10.3390/foods10123128. PMID: 34945679; PMCID: PMC8702143.

References for Specific Diseases:

Yarla NS, Polito A, Peluso I. Effects of Olive Oil on TNF-α and IL-6 in Humans: Implication in Obesity and Frailty. Endocr Metab Immune Disord Drug Targets. 2018;18(1):63-74. doi: 10.2174/1871530317666171120150329. PMID: 29165098.

Esposito S, Sparaco M, Maniscalco GT, Signoriello E, Lanzillo R, Russo C, Carmisciano L, Cepparulo S, Lavorgna L, Gallo A, Trojsi F, Brescia Morra V, Lus G, Tedeschi G, Saccà F, Signori A, Bonavita S. Lifestyle and Mediterranean diet adherence in a cohort of Southern Italian patients with Multiple Sclerosis. Mult Scler Relat Disord. 2021 Jan;47:102636. doi: 10.1016/j.msard.2020.102636. Epub 2020 Nov 22. PMID: 33333418.

Bianchi VE, Herrera PF, Laura R. Effect of nutrition on neurodegenerative diseases. A systematic review. Nutr Neurosci. 2021 Oct;24(10):810-834. doi: 10.1080/1028415X.2019.1681088. Epub 2019 Nov 4. PMID: 31684843.

Forsyth C, Kouvari M, D’Cunha NM, Georgousopoulou EN, Panagiotakos DB, Mellor DD, Kellett J, Naumovski N. The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatol Int. 2018 May;38(5):737-747. doi: 10.1007/s00296-017-3912-1. Epub 2017 Dec 18. PMID: 29256100.

Pocovi-Gerardino G, Correa-Rodríguez M, Callejas-Rubio JL, Ríos-Fernández R, Martín-Amada M, Cruz-Caparros MG, Rueda-Medina B, Ortego-Centeno N. Beneficial effect of Mediterranean diet on disease activity and cardiovascular risk in systemic lupus erythematosus patients: a cross-sectional study. Rheumatology (Oxford). 2021 Jan 5;60(1):160-169. doi: 10.1093/rheumatology/keaa210. PMID: 32594173.

Castro-Rodriguez JA, Garcia-Marcos L. What Are the Effects of a Mediterranean Diet on Allergies and Asthma in Children? Front Pediatr. 2017 Apr 21;5:72. doi: 10.3389/fped.2017.00072. PMID: 28484688; PMCID: PMC5399020.

Grahovac M, Kumric M, Vilovic M, Martinovic D, Kreso A, Ticinovic Kurir T, Vrdoljak J, Prizmic K, Božić J. Adherence to Mediterranean diet and advanced glycation endproducts in patients with diabetes. World J Diabetes. 2021 Nov 15;12(11):1942-1956. doi: 10.4239/wjd.v12.i11.1942. PMID: 34888018; PMCID: PMC8613665.

Velluzzi F, Anedda J, Pisanu S, Dell’Antonia M, Deledda A, Boi A, Ferreli C, Atzori L. Mediterranean diet, lifestyle and quality of life in Sardinian patients affected with Hidradenitis suppurativa. J Public Health Res. 2021 Nov 29;11(2):2706. doi: 10.4081/jphr.2021.2706. PMID: 34850622; PMCID: PMC8958440.

Castiglione D, Platania A, Conti A, Falla M, D’Urso M, Marranzano M. Dietary Micronutrient and Mineral Intake in the Mediterranean Healthy Eating, Ageing, and Lifestyle (MEAL) Study. Antioxidants (Basel). 2018 Jun 23;7(7):79. doi: 10.3390/antiox7070079. PMID: 29937504; PMCID: PMC6071131.