[Food as Medicine] Foods and inflammation

What is inflammation and how is it useful?

Inflammation(염증) is the reaction of living tissue to local injury or damage.

A recent study with over 2,000 participants has shown that adults who had a high intake of antioxidant compounds from foods like apples and pears, strawberries and red wine had much lower levels of inflammatory biomarkers in their blood which would reduce their risk for many chronic diseases. For example, it is well established that people who have a high intake of fruit and vegetables in their diet have a lower risk of heart disease and stroke.

What happens?

The process of inflammation is designed to be helpful to the body in repairing injury. It should be an acute (or very fast) response whereby the immune cells quickly remove damaged tissue and destroy any invading micro-organisms.

Normal tissue structure is restored and the immune signals that amplify the inflammatory response are switched off. The immune cells retreat back into the bloodstream. Order is restored. This type of inflammation occurs with normal processes of healing for example after a slight cut or wound.

The inflammatory response in each case is similar. An early response is made by the cells lining the blood vessels(혈관) local to the site of injury. These are the cells of the vascular(혈관의) endothelium(내포조직). First they dilate(확장시키다) bringing more blood into the area. Then the cells pull apart slightly allowing fluid and proteins from the blood to move into the surrounding tissues, causing local swelling. 

The endothelial(내피의) cells also respond to the injury by initiating a cascade of signals directed at immune cells circulating in the blood. On receiving these signals, the immune cells immediately cluster(v모이다) in this local area and start to leave the blood, pushing their way across the now leaky endothelium to enter the tissue at the site of injury.

Together, these local changes initiate(개시하다,일으키다) the four cardinal signs of inflammation: redness, heat, swelling (from increased local blood flow, the escape of blood fluid into tissues and the influx of immune cells), plus pain (from damage to local nerve endings).

Dysfunctional inflammation occurs when the immune response becomes chronic and does not resolve or end. Chronic inflammation can occur in many different parts of the body in response to many different diseases. Examples where chronic inflammation develops and causes on-going problems include rheumatoid arthritis(류마티스관절염), inflammatory bowel (창자 염증?)disease, coronary heart disease and type 2 diabetes.

The harm can be caused by many different things: it can be physical (mechanical injury/heat/cold/sun exposure), toxic (corrosive chemical, X-ray), or due to an infectious agent (virus/bacteria/parasite).

What role does diet play?

A healthy diet is very important to sustain the acute inflammation that ends in wound healing. Wound healing is much slower in people who are malnourished. Different elements in the diet can also influence the course of chronic inflammation.

Foods that have pro-inflammatory properties will promote the influx of immune cells into the tissue and increase the risk of further damage and disease.

In contrast, foods with anti-inflammatory properties aid in resolution of inflammation, promoting healing so that immune cells can return to the blood.

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Acute(격심한) local inflammation and wound healing

One clear example of the beneficial effects of inflammation can be seen in the process of wound healing.

After a skin injury occurs, three phases of healing commence. The first involves inflammation, followed by formation of new tissue and last a phase of tissue remodelling so that complete healing is achieved and the appearance of the skin returns as closely as possible to its normal state.

The inflammation phase(단계)

In the inflammation phase, the first thing that happens is the activation of platelets in the blood which then clump together on exposed collagen and form fibrin clots which act to stop damaged blood vessels from further bleeding. This is sometimes called the vascular response part of wound healing.

Endothelial(내피의) cells lining the damaged blood vessels then quickly respond to injury by sending out a series of chemical signals that tell immune cells present in the bloodstream, to stop circulating and to become attached to the damaged endothelium. These immune cells then push their way between the epithelial cells lining the damaged blood vessels and enter into the local tissue area.

The presence of the fibrin clot aids these migrating cells by supplying a support structure as they move across the surface of the wound.

The phase of inflammation during wound healing should be of limited duration. It is not until inflammation has wound down that the second phase, new tissue formation can begin. The resolution of inflammation depends on a specific set of signals that prevent any more neutrophils (mature white blood cells) from entering the wound site. They also tell T-cells (another type of white blood cell) to stop proliferating and macrophages (developed from monocytes that engulf dying neutrophils, dell debris and pathogens), to leave the area.

One signal comes from the lipoxins are made from arachidonic acid, which is an omega-6 polyunsaturated fatty acid. Other signals come from resolvins and protectins which are made from omega-3 fatty acids.

So both types of polyunsaturated fat are important in this response.

Once inflammation has died down new tissue can start forming. Keratinocytes from the basal layers of the skin migrate into the wound to form a new protective cover, fibrocytes start filling in the underlying dermis between strands of newly formed supporting collagen while new capillary vessels supply the regenerating tissue with oxygen and nutrients.

The role of nutrition

Nutrition is very important in wound healing. The presence of a large skin wound increases the body’s energy requirements by around 120% if the wound is clean. If the wound becomes infected these requirements rise to 150%.

If the person is not eating well because of their injury then the additional calories required for healing can not come from food- they must be taken from body stores. This means that the health of the person before the wound occurred can have a large effect on the healing outcome. If the person is malnourished and has poor body stores, then healing can be delayed.

The body stores calories mainly as body fat which can be broken down to supply the extra energy required for healing. But it is not only calories that are needed. Considerable amounts of protein and micronutrients are required to sustain the rapid cell proliferation that occurs during inflammation, and further nutrients will also be needed for tissue regeneration.

Unlike fat, the body has limited stores of protein. If little protein is consumed during recovery, then the protein needed for healing will come from body muscle causing the muscle wasting often seen after injury. To reduce this wasting process it becomes very important to feed the injured person an easily digested diet that is rich in protein.

Foods like eggs and rich beef broth have therefore often been used to aid recovery.

The role of micronutrients

Micronutrients are also important. Zinc for example, is required for good immune function, and for collagen synthesis, and for fibrocyte migration into the wound. It is also a co-factor for an important antioxidant enzyme, superoxide dismutase. Other micronutrients needed include vitamin K for speedy clotting in the initial response to injury, vitamin D for effective immune responses during the inflammatory phase, and vitamin A for tissue repair.

Additionally, vitamin C not only provides an important antioxidant compound but also is important for collagen formation. Vitamin B1 increases the strength of newly formed tissues. Vitamin E has antioxidant properties and helps prevent excessive scar formation. Polyunsaturated fats are important for the signalling molecules that allow inflammation to be replaced by tissue regeneration.

Successful healing can therefore be highly dependent on a protein-rich and nutritionally rich diet during the recovery phase.

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Chronic inflammation(만성염증) and rheumatoid arthritis

Chronic inflammation, an inflammatory state that continues and which does not resolve, develops in many disease states. Here we will discuss the example of chronic inflammation in rheumatoid arthritis.

What is it?

Rheumatoid arthritis is an autoimmune disease (a disease where the immune system starts attacking the body rather than protecting it). In rheumatoid arthritis, the autoimmune attack leads to the development of chronic inflammation in the synovial membrane within the joints.

The synovial membrane(활막?) is a sac of specialised connective tissue containing the synovial fluid which acts to cushion the area where the bones of the joint articulate.

In rheumatoid arthritis the connective cells in the synovial membrane first begin to proliferate abnormally so that the synovial membrane thickens considerably. Then the membrane becomes invaded by many small blood vessels bringing immune cells to the site. These immune cells leave the blood and accumulate in the synovial membrane making it even thicker and very inflamed.

Over time, the presence of this inflammation can be very damaging as the synovial membrane begins to eat into the cartilage of the joint, eventually eroding the bone. Joints become increasingly swollen, painful and difficult to move, leading to disability.

How does it start?

The initial trigger for the rheumatoid arthritis that causes the autoimmune damage remains uncertain. Part of the susceptibility is inherited, but environmental factors may also play a role particularly in sustaining the chronic inflammation that plays such an important role in the development of the disease.

Smoking which introduces many pro-oxidant compounds into the body is well-known to increase risk. Research has also looked for possible risk factors in the diet.

What has research found?

One large epidemiological(전염학의) study undertaken in American women found that soft drinks sweetened with high fructose corn syrup (HFCS) increased the risk of rheumatoid arthritis, while diet soft drinks which contained no fructose had no effect. A second study widened this association to include not only soft drinks but other drinks high in fructose such as apple juice and other fruit drinks.

While it remains uncertain exactly how this risk occurs, it has been argued that when excessive amounts of fructose reach the gut they promote the formation of advanced glycation end-products (AGE). AGE are highly pro-inflammatory compounds which if absorbed by the body may aggravate inflammation in the joints.

출처 https://terms.naver.com/entry.nhn?docId=2119912&cid=51004&categoryId=51004

Dietary factors(식단요인, 식이요법)

Research has also looked for dietary factors that may help resolve the inflammatory state in rheumatoid arthritis. Foods rich in anti-oxidants or anti-inflammatory compounds may be of benefit. Extra virgin olive oil is rich in a polyphenolic compound called hydroxytyrosol which has strong antioxidant properties.

What we know

One study in mice found that hydroxytyrosol acetate effectively reduced the inflammation of arthritis. Resveratol(resveratrol-레스베라트롤: 폴리페놀의 일종*), an antioxidant compound found in grape skins and may be another dietary compound with similar useful effects. Another study found that resveratol decreases symptoms of arthritis in rats. Both olive oil and resveratol are components of the Mediterranean diet.

While studies have examined the benefit of this diet in rheumatoid arthritis, results to date are inconclusive, and more work is needed to establish clear benefit.

Anti-oxidant compounds

Interestingly, many anti-oxidant compounds such as those found in many vegetables are fat soluble and are absorbed more readily if oil is present in the diet. This may explain why one study from southern Greece found that cooked vegetables eaten with olive oil were protective against rheumatoid arthritis whereas a Danish study where the diet was much lower in oil, found no association between vegetable intake and this disease.

Instead, the Danish study reported that people who ate fatty fish like salmon and sardines had a lower risk of rheumatoid arthritis. Other studies have confirmed this association, likely to be due to the presence of anti-inflammatory omega-3 fatty acids in these types of fish. Swedish women who ate fatty fish more than once a week had a reduced risk of rheumatoid arthritis. In another study, EPA, one of the omega-3 fatty acids present in fish oil has been found to increase the chance of remission in patients with recent onset rheumatoid arthritis.**

FAM_Inflammation_Nightshade.pdf

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FAM_WK1_Inflammation_adipose_tissue.pdf

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FAM_WK1_Inflammation_and_gut.pdf

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FAM_WK1_Inflammation_heart_disease.pdf

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Foods and inflammation

Using foods to reduce inflammation is an area of nutrition that many are interested in; public, nutrition researchers and healthcare professionals alike.

SIMONE GIBSON: video transcript 

(중략)------Another thing to be careful of is your weight. Being obese or overweight or obese can increase inflammation as well, even if you are having a lot of anti-inflammatory foods. So let's explore the Mediterranean diet a little bit further. As you can see, it's very high in fruits and vegetables, which are high in antioxidants. Also, there's a lot of unrefined grains that are eaten and a lot of olive oil, which has its own antioxidant properties. The olive fruit is particularly interesting. It contains over 230 antioxidant compounds. And of course, olive oil is made from the olive fruit. So olive oil also contains a lot of those compounds. The best olive oil is the extra virgin olive oil, which comes from the first press of processing of the olive fruit. So therefore, it contains a lot more of those delicate compounds, which have those really beneficial health properties.

The Mediterranean diet also has really good sources of protein, in addition to lots of healthy fats. The protein sources aren't only from meat, but they also come from legumes and nuts and seeds. So it's important to realize that the Mediterranean diet has a synergistic effect of all these foods working together. So almonds-- yes, they're very healthy, but having them by themselves is probably not going to do you as much good as having the combination of all the foods that are represented in the Mediterranean diet.

In comparison, there's diets that are high in refined foods and processed foods. You can see here that there's not really that much color to them, as opposed to the Mediterranean diet with all those beautiful, rich colors of the fruit and vegetables. The reason is the refinement and processing has removed a lot of those valuable nutrients and antioxidants. Not only do they lack the antioxidant properties of an unrefined diet, they're also high in pro-inflammatory properties, such as refined sugar, saturated fat(포화지방), and salt. The other thing about these foods is they're high in kilojoules while lacking those nutrients. So having a lot of foods that are high in kilojoules can contribute to weight gain. And being overweight is a really strong risk factor for putting your body in an inflammatory state.

 

It's not only really important to eat lots of those healthy foods, but how we eat them is important as well. So most of those antioxidant properties sit just below the skin of the fruit or vegetable or within the skin, which is what gives it its beautiful color. So making sure that you eat the whole food and not peel it and throw all of that goodness away.

OK, so let's have a look at the color of a strawberry, for example. So you can see here that the really rich part of the strawberry color is right around the very edges of it. Now, it's not as though you usually peel strawberries, but that represents other fruits as well. The best way to get the most out of these nutrient rich foods is to add them to the unrefined diet that has a lot of fruits, vegetables, whole grain cereals, and lean choices of meats and other healthy fats. That way you're going to be doing the best for your body and getting a whole plethora of nutrients and antioxidant properties.

If you choose to use specific foods to assist you in reducing your inflammation, then that's fantastic. But really make sure that you're doing it on a baseline diet that's unrefined with lots of fruit and vegetables.

A diet high in antioxidants can help prevent chronic disease.But if you already have an inflammatory condition, a diet high in antioxidants is a really good basis as part of your overall health management. But just remember it's just one piece of the puzzle. So avoiding the pro-inflammatory foods that are likely to heighten your inflammatory condition is a really good start and maximizing your intake of the foods high in antioxidant properties is going to give you the best health benefits. So that means having fruit and vegetables every day, trying to have the skin whenever you can, and legumes, whole grains, and lean meat, chicken and fish.

Some of the high antioxidant foods you might like to choose are things like cherries, blueberries, raspberries, strawberries, all kinds of nuts are fantastic, lots of leafy green vegetables, having eggplant or aubergine with the skin on. And there's other new, novel foods that you can have a try of as well, things like cacao, which actually chocolate is made from. But it's the dark chocolate that has the highest level of antioxidants(산화방지제) and white chocolate has none of those antioxidant properties at all. So really try for the darkest ones. And they actually taste pretty good, too. Salmon is one of the great oily fishes that you can try, but there are other ones as well, such as sardines. And most of the anti- inflammatory omege-3 fats are found just under the skin, so make sure that you eat the skin. Don't forget the humble apple. Apples are really high in antioxidants. And a lot of studies have shown that apple can actually reduce inflammation. In summary, eat real food, not too much, and mostly plants.

FAM_Anti_Inflam_Foods.pdf

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• Reference 

레스베라트롤[ resveratrol ]*

https://terms.naver.com/entry.nhn?docId=1256287&cid=40942&categoryId=32282

레스베라트롤

오메가 3 **

https://terms.naver.com/entry.nhn?docId=3574033&cid=58949&categoryId=58983

오메가-3

각주 포화지방-불포화지방산: 접촉이 많아서 분자들끼리 많이 뭉치게 되면 분자는 고체가 될 것이다. 따라서 포화지방은 녹는점이 높고, 불포화지방은 녹는점이 낮은 것이 일반적이다. 녹는점이 낮은 불포화지방은 실온에서 액체로 존재할 가능성이 높고, 혈액 내에서도 액체를 유지한다. 반면에 녹는 점이 높아서 실온에서 고체로 존재하는 포화지방은 당연히 고체로 존재할 가능성이 높다. 지방 덩어리가 혈액 내에서 고체로 존재한다면 혈액의 흐름을 방해할 수 있다. 마치 액체가 흘러가는 파이프에 고체 찌꺼기가 포함되어 있다고 상상하면 쉽게 이해가 된다. 그러므로 포화지방이 많이 포함된 음식은 줄이고, 불포화지방이 포함된 음식을 먹으라고 권장하는 것이다.

채식주의자들은 동물성 오메가-3 지방산 대신에 들기름을 먹으면 부족한 오메가-3 지방산을 채울 수 있다. 

[네이버 지식백과] 오메가-3 - 정상적인 성장과 건강을 위한 필수 지방산 (화학산책, 여인형, 대한화학회)

 

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