Can an Anti-inflammatory Diet Help Reduce Musculoskeletal Pain?

Nutrition plays an important role in maintaining brain and heart health as well as promoting musculoskeletal health. Our diet can help regulate the immune system and help to suppress pain and inflammation whilst supplying our body tissues and cells with key nutrients for growth, maintenance and repair. A number of dietary factors have been associated with chronic musculoskeletal diseases, therefore identifying these factors and eradicating them from the diet may help to reduce pain associated with inflammation.

The immune system has a defence mechanism that is triggered by stimuli such as pathogens, damaged cells and toxic compounds resulting in a biological response known as inflammation. Inflammation acts by removing the harmful stimuli and initiating the healing process.

Inflammation is a finite process that should resolve once the threat of infection diminishes and adequate repair to the tissues has occurred. The termination of inflammation is an active process that is tightly regulated involving cells and other anti-inflammatory mediators, particularly lipids (fats).

In order to identify inflammation in the body, certain blood tests need to be taken. C-Reactive Protein (CRP) is one of the main markers for inflammation within the body. CRP is known as an inflammatory biomarker and is produced when the body is in an inflammatory state.

Inflammation can be split into two categories.

Acute Inflammation:
This occurs when tissues are damaged as a result of injury, microbial disease or poisonous compounds which can initiate acute inflammation. It tends to start rapidly and become severe for a short time, lasting a few days.

Symptoms include:

• Swelling – A build-up of fluid and blood plasma proteins (known as oedema)
• Redness & Heat– Due to the emigration of white blood cells to the area of injury
• Tenderness – May result in a loss of mobility

Chronic Inflammation:
Persistent inflammatory stimuli leads to chronic inflammation in which the immune system is in a prolonged state of defence which can become harmful to the body. Chronic inflammation is a pathological feature associated with a wide range of diseases, including:

• Metabolic Syndrome
• Type 2 Diabetes Mellitus
• Inflammatory bowel disease
  • Crohn’s Disease
  • Ulcerative colitis
• Cardiovascular Diseases
• Chronic neurodegenerative diseases
  • Alzheimer’s disease
• Arthritis
  • Rheumatoid Arthritis
  • Osteoarthritis
• Chronic Obstructive Pulmonary Disease
• Acne, Eczema & Psoriasis

These diseases are thought to be connected to chronic low-grade inflammation, sometimes referred to as ‘silent inflammation’ whereby tissue damage and fibrosis are usually severe and progressive. An unhealthy lifestyle including smoking, poor diet, alcohol consumption, a sedentary lifestyle and stress can all influence this type of persistent inflammation.

Chronic low-grade inflammation not caused by a defined illness can be prevented by changes to your lifestyle. Strategies to combat the damaging effects on the body include:

• Reduce smoking and alcohol consumption
• Reduce stress levels – Meditation, yoga and deep breathing exercise
• Rest – Adequate sleep is necessary to allow our bodies to heal, 8 hours is the recommended amount of sleep
• Exercise – Try to go walking every day, incorporate both aerobic and strength training into your exercise routine
• Anti-inflammatory diet – Many studies have shown the correlation between nutritional composition of diet and inflammation status

There is accumulating evidence to indicate chronic low-grade inflammation, due to overnutrition and sedentary lifestyles, may also lead to a process known as oxidative stress which are both precursors for insulin resistance and metabolic syndrome.

Research has shown that when it comes to what we eat this can have a big effect on inflammation. A pro-inflammatory diet, especially long-term, has been linked with an increased risk of chronic inflammatory diseases. For example, the ‘Western diet’ which consists of calorie-dense, highly processed foods combined with a low fruit and vegetable intake are linked to higher levels of inflammation. Consuming an anti-inflammatory diet may help reduce inflammation and delay disease progression as well as reducing joint damage. Such diets include the Mediterranean Diet.

The truth about fats
Avoid the trans fats, limit the saturated fats and replace them with essential polyunsaturated fats.

Trans fats are a by-product of converting healthy oils into a solid form to prevent them from becoming rancid, this process is known as hydrogenation. Hydrogenated oil has no known health benefits and can increase the amount of harmful Low-Density Lipoprotein (LDL) cholesterol within the blood. Increasing LDL cholesterol further impacts your health by reducing the amount of beneficial High-Density Lipoprotein (HDL) cholesterol in the bloodstream and promotes the development of atherosclerosis. (a condition by which there is an increase in the amount of fatty plaques in the arteries).
Evidence indicates that trans fats are pro-inflammatory and consumption of these fats puts you at a higher risk of coronary heart disease and Type 2 Diabetes Mellitus.

Saturated fats are solid at room temperature and found in red meat, whole milk dairy products, cheese and the majority of commercial bakery goods. A high consumption of saturated fats may increase the total cholesterol, in particular, harmful LDL cholesterol. Therefore, recommendations to replace saturated fats with polyunsaturated fats may reduce the risk of heart disease.

Unsaturated fats can be either polyunsaturated or monounsaturated. Monounsaturated fats are known as Omega-9 fatty acids and good sources include olive oil, avocados, peanuts and almonds. There are two types of polyunsaturated fat (1) Omega-3 fatty acids and (2) Omega-6 fatty acids, they are known as essential fatty acids. Humans cannot make their own Omega-3 and Omega-6 and therefore have to be obtained from the diet. However, the ratio of Omega-6 to omega-3 should be fairly balanced. Studies have shown a higher consumption of Omega-6 to Omega-3 may promote chronic inflammation in individuals.

Omega-3s are anti-inflammatory and may aid the reduction of blood pressure, raise HDL cholesterol (the good cholesterol) and reduce the risk of heart disease and stroke. Sources of Omega-6 include vegetable oils (e.g corn, sunflower, safflower, sesame), nuts, seeds, lean meat, eggs, poultry and evening primrose oil. Sources of Omega-3 include flaxseeds, soybeans, rapeseed oil, walnuts, oily fish (salmon, mackerel, anchovies), algae and liver.

The truth about grains

What’s the difference between refined grains and whole grains?
Cereals are members of the grass family and are grown for their seeds (grain) which are high in carbohydrate and protein. Whole grains refer to the entire grain kernel including the bran, germ and endosperm. Refined grains comprise mainly of the endosperm due to the milling process that removes the bran and germ, this is done in order to extend their shelf life but in doing so removes dietary fibre and nutrients.

Diets high in whole grains are associated with lowered risk of cardiovascular disease, Type 2 Diabetes, Metabolic syndrome, weight gain and improved gut digestion. This may be due to phytochemicals produced by plants that have beneficial effects on our health.

The truth about fibre
There are two types of fibre: soluble and insoluble. Soluble fibre helps to slow digestion and promote absorption of nutrients whilst lowering LDL cholesterol in the blood. Insoluble fibre adds bulk to your stool aiding the digestive system to reduce constipation.

Studies have found that a diet high in fibre may lower CRP levels, as mentioned before this is an inflammatory biomarker, and further reduce inflammation by lowering body weight and feeding beneficial bacteria within the gut. The recommended guidelines for fibre intake are 30 grams daily.

Foods to Avoid
Certain foods can be pro-inflammatory, they trigger the release of chemical messengers to stimulate the immune system’s inflammatory response, such as the formation of free radicals which can lead to cell damage. These include:

• Refined Grains
  • White Pasta, bread and rice – these quickly break down and convert into sugar, promoting inflammation.
• Red & Processed Meat
  • Pork – arachidonic acid within red meat such as pork is considered pro-inflammatory and processed pork products tend to contain nitrates for preservation which have been found to increase the risk of Type 2 Diabetes and heart disease.
  • Beef – high in saturated fat.
• Trans & Saturated Fats
  • Fast Foods
  • Margarine
  • Commercial baked goods
  • Processed products
  • Fried Food – Hydrogenated Oil
  • Sweet Desserts
  • Whole dairy products
• Refined Sugar
  • Soda
  • Chocolate
  • Commercial baked goods
  • Fruit Juice
• Alcohol

Foods to eat
However, foods can be anti-inflammatory. In particular, colourful fruits and vegetables that contain phytonutrients which are rich in antioxidants, aiding the body’s healing process and reducing inflammation within the body by reducing free radicals. These include:

• Wholegrains
  • Brown Rice
  • Quinoa
  • Whole Oats
  • Rye
  • Buckwheat
  • Barley
  • Bulgur
• Fruit
  • Strawberries
  • Blueberries
  • Cherries
  • Citrus Fruits
  • Grapefruit
  • Kiwi
  • Olives
  • Jackfruit
• Nuts & Seeds
  • Chia Seeds
  • Flaxseeds
  • Hemp Seeds
  • Sesame Seeds
  • Walnuts
  • Almonds
  • Macadamia nuts
• Fish
  • Sardines
  • Trout
  • Herring
  • Salmon
  • Mackerel
• Legumes
  • Pinto Beans
  • Red kidney Beans
  • Edamame
  • Tofu
• Oil
  • Extra Virgin Olive oil
  • Cold Rapeseed Oil
  • Flaxseed Oil
• Beverages
  • Green Tea
  • Black Coffee
  • Herbal Tea
  • Coconut Water
  • Water
• Other
  • Low fat Dairy Products (Low sugar)
  • Manuka Honey
  • Coconut Oil
  • Herbs
  • Parsley
  • Rosemary
  • Cloves
  • Chilli
  • Turmeric
  • Pepper
  • Cinnamon
  • Ginger
• Vegetables
  • Beets
  • Garlic
  • Broccoli
  • Cauliflower
  • Bok Choy
  • Asparagus
  • Brussel Sprouts
  • Cabbage
  • Kale
  • Spinach
  • Carrots
  • Onions
  • Mushrooms
  • Cucumber
  • Red Bell Pepper

Jackfruit Curry

• 1tsp Coconut Oil
• ½ tsp Cumin Seeds
• ½ tsp Mustard Seeds
• ½ tsp Nigella Seeds
• 1 ½ tsp Garam Masala
• 3 cloves of Garlic, mined
• 1 Onion chopped
• 2 Dried Red Chillies (if you like it spicy)
• ½ tsp Black Pepper
• ½ tsp Sea Salt
• 1 inch of Ginger, chopped
• 1 inch of Turmeric, chopped (or 1tsp turmeric powder)
• 1 Red Bell Pepper
• Handful of Spinach
• 1 Sweet Potato diced
• 1 can of Chopped Tomatoes
• 1 can of Green Jackfruit, drained
• 1 cup of water
• Juice of 1 lime
• Handful of Coriander
• ¼ Cup of Quinoa
• 1 cup of water

1. Add the quinoa and water to a pan and bring to the boil, then reduce, cover and simmer for approximately 12 minutes.
2. Heat the oil in a pan and add the chopped onion and sauté until soft.
3. Add the garlic, seeds, ginger, turmeric and chilli and allow to release aromas, make sure not to burn.
4. Next add the garam masala, sweet potato, red bell pepper, black pepper and salt and stir well.
5. Now add the tin of chopped tomato and water and simmer with the lid on until the sweet potato is tender. The quinoa should be fully cooked and the water absorbed, take off the heat and leave to rest.
6. Add the chunks of jackfruit and spinach and allow to simmer for a further 5 minutes. Shred the jackfruit or leave in chunks and add the lime juice.
7. Serve with quinoa and a sprinkle of coriander.

Shredded Cabbage and Tofu Stir Fry

• 1 Onion diced
• 2 Cloves of Garlic
• 1 inch of Turmeric
• 1 inch of Ginger
• 2 tbsp Extra Virgin Olive oil
• 1 Sweetheart Cabbage Shredded
• 396g Firm Tofu
• 1 Red Bell Pepper, sliced
• ½ Bok Choy, chopped
• 3 Large Tomatoes, chopped
• 1 Dried Chilli
• Juice of 1 lime
• ½ tsp of Salt
• Handful of Coriander
• Sprinkle of Sesame Seeds

1. Add the oil to a frying pan with the onion and cook on a medium heat.
2. Grate the garlic, turmeric, chilli and ginger and slice the tofu into square chunks. Add all to the frying pan, stir and make sure the tofu is coated.
3. Add the cabbage, red bell pepper, bok choy and tomatoes and allow to simmer for 4 minutes.
4. Take off the heat, and serve with a sprinkle of coriander and sesame seeds. This can be served with brown rice, quinoa or on its own as a light dish.

Beetroot & Smoked Mackerel Salad

• 2 Cooked Beetroot, diced
• 1 Avocado, diced
• 1 Red Onion, diced
• ½ Cucumber, diced
• 170g Edamame, shelled
• 100g Lettuce, shredded
• 50g Brussel Sprouts, aliced
• 15 Cherry Tomatoes, halved
• 25g Walnut Pieces
• 2 Smoked Mackerel Fillets, shredded
• 2 tsp Cumin Seeds
• 2 tbsp Extra Virgin Olive Oil
• 4 Spring Onions, chopped

Dressing

• Juice of 1 lemon
• ½ cup Low Fat Plain Yoghurt
• 1 tsp horseradish
• Pinch of Salt
• Pinch of Black Pepper
• Handful of Parsley

1. Add the lettuce, brussel sprouts, cucumber, red onion and edamame to a bowl and mix.
2. Make the dressing by adding the lemon, yoghurt and horseradish together and add the salt and pepper, to taste.
3. Add ½ the beetroot, avocado and cumin seeds to the bowl of lettuce and gently mix. Then plate up and sprinkle the rest of the beetroot, avocado and cherry tomatoes.
4. Add the smoked Mackerel, walnuts and the cumin seeds and drizzle the dressing over the top.
5. Finally add the spring onions and parsley and serve.