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Inflammatory Foods: Separating Fact From Fiction

Did you ever hear the term, “You are what you eat?” Well, it’s true. There are so many courses on culinary medicine and food as medicine because what we eat greatly influences our overall wellbeing and health. And I think a lot of people know this, but there is still a lot of misinformation regarding what to eat and what to avoid. I have multiple patients who eliminate wheat, lactose, and/or all forms of sugar in an effort to reduce inflammation.

Here’s the thing though. Many of these patients don’t have celiac disease or any documented sensitivities. They may subjectively feel better with these elimination diets, and I respect that, but when it comes to reducing inflammation, those dietary changes aren’t backed by evidence. When I share this with patients, they are surprised by how much misinformation is out there. That made me realize this is a topic worth writing about, so this week, I separate fact from fiction when it comes to inflammatory foods.

What is Inflammation?

Inflammation is a natural response by our immune system to injury, infection, or the presence of harmful substances like germs or toxins. It’s a crucial part of our survival. When our body detects injury or invasion, it activates a cascade of different signaling molecules, known as cytokines, and inflammatory cells to repair damaged tissue, trap pathogens, and restore normal function. Common signs of inflammation include pain, redness, swelling, and fever.1 Most of the time this system works very well, but sometimes it can become chronically activated due to repeat offenders, autoimmune issues, and in some cases, food.

The Science Behind “Inflammatory Foods”

The term “inflammatory foods” refers to foods that may trigger or exacerbate inflammation within the body. Scientific research consistently demonstrates that diet patterns high in processed foods, refined sugars, saturated fats, and artificial additives are associated with increased levels of systemic inflammation.2-4 This is measured by examining cytokine levels, such as C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α), in the bloodstream after exposure to these foods. When inflammation is chronically elevated, it can contribute to the development of cardiovascular disease, type 2 diabetes, and autoimmune disorders.5,6

Conversely, anti-inflammatory diets, which are characterized by high intake of whole, minimally processed foods such as fruits, vegetables, whole grains, legumes, nuts, and healthy fats, are associated with lower levels of inflammatory cytokines and reduced risk of chronic disease.7-9 The American Heart Association emphasizes unprocessed or minimally processed foods and limiting ultra-processed foods to improve cardiometabolic health and reduce inflammation-related disease.10

Here’s where things get a bit cloudy. Many wellness “gurus” have taken items from proven anti-inflammatory diets and slapped them on the pro-inflammation list and vice versa, so now it is confusing for most people to figure out what to eat and what to avoid. Let’s take a look at what the evidence says about these foods.

Foods Commonly Blamed for Inflammation

Certain foods are frequently blamed for causing or worsening inflammation, but that may not be the case for everyone. Here’s a closer look at some of the most discussed foods.

Wheat and Gluten

There is no strong evidence to support wheat or gluten elimination for reducing inflammation in patients who do not have celiac disease or non-celiac gluten sensitivity (NCGS); most benefits are limited to those with confirmed diagnoses.11,12 NCGS itself is tough to diagnose because no validated biomarkers exist. It’s a diagnosis based on exclusion and self-reported symptoms. Additionally, the role of gluten versus other wheat components (such as FODMAPs or amylase trypsin inhibitors) remains unclear.13-15 For most individuals without celiac disease or NCGS, gluten-free diets are not healthier, may lead to nutritional deficiencies, and are not recommended for the general population.11,16,17   

Dairy and Lactose

Dairy products are often suspected of causing inflammation, but research shows that, for most people, dairy does not trigger an inflammatory response outside of lactose intolerance or milk protein allergy. Unnecessary avoidance may lead to nutritional deficiencies, particularly in calcium and vitamin D, and may increase the risk of osteoporosis.18 There is limited data on the long-term health effects of unnecessary dairy elimination in otherwise healthy individuals.

Refined Sugar vs. Natural Sugar

The source of sugar determines whether it is pro-inflammatory or not. Natural sugars found in whole fruits DO NOT promote inflammation to the extent that refined sugars do. Several studies have demonstrated that fructose-containing sugars from whole fruits are associated with either no effect or a decrease in inflammatory biomarkers such as CRP and TNF-α, whereas sugars from sugar-sweetened beverages, such as sodas and juices, and those in processed foods are associated with an increase in CRP levels.19-21 This is likely due to the presence of fiber. Juices, sodas, and processed foods typically do not contain fiber, which has anti-inflammatory properties. Excessive consumption can also lead to chronic illnesses. So, no need to avoid everything that contains sugar. Fruits are a good source of natural sugar and fiber.

Processed Foods

Ultra-processed foods are highly pro-inflammatory and, unfortunately, a staple in the typical American diet. Rather than go on for several paragraphs regarding everything bad about ultra-processed foods, I will direct you to the blog I previously wrote on this topic: https://thewholehumanhealthandwellbeing.com/ultra-processed-foods-and-the-health-impact/.

Bottom line: these foods don’t deserve to be called foods. If you want to reduce pro-inflammatory foods from your diet, eliminate these.

Nightshade Foods

There are more than 2000 nightshade vegetables. The most familiar ones are tomatoes, white potatoes, eggplants, and peppers. These foods contain glycoalkaloids and lectins, which may promote gut inflammation in patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).22 However, there is also some evidence that suggests these foods may have anti-inflammatory properties.23-25 So it appears nightshades may promote gut inflammation, not systemic, in select individuals with underlying sensitivities or gastrointestinal disorders, but safe and helpful for general, healthy individuals.

Proven Anti-inflammatory Foods

Anti-inflammatory foods include fruits, vegetables, whole grains, legumes, nuts, fish rich in omega-3 fatty acids, olive oil, and fermented foods. Yes, it’s true. The kombucha lovers are onto something. These foods are rich in antioxidants, polyphenols, dietary fiber, and other bioactive compounds that reduce oxidative stress and support gut health. Several studies demonstrate that higher intake of fruits and vegetables is associated with a reduction in CRP and TNF-α, and improved immune cell function.8,26,27

If you need a specific diet to follow, the Mediterranean diet has the most consistent reductions in inflammatory markers in randomized controlled trials.8 And that’s it. That’s the evidence regarding anti-inflammatory foods. Everything else you are hearing is an opinion and health trends.

So Now What?

You can see there’s a lot of misinformation regarding what foods to eat or avoid. Unless you have a known sensitivity or medical condition, you don’t need to eliminate any foods other than processed ones. It really just boils down to eating fresh foods and maintaining a balanced diet.

References

  1. Soares CLR, Wilairatana P, Silva LR, et al. Biochemical aspects of the inflammatory process: A narrative review. Biomed Pharmacother. Dec 2023;168:115764. doi:10.1016/j.biopha.2023.115764
  2. Bujtor M, Turner AI, Torres SJ, et al. Associations of Dietary Intake on Biological Markers of Inflammation in Children and Adolescents: A Systematic Review. Nutrients. 2021;13(2):356. doi:10.3390/nu13020356
  3. Mignogna C, Costanzo S, Di Castelnuovo A, et al. The Inflammatory Potential of the Diet as a Link Between Food Processing and Low-Grade Inflammation: An Analysis on 21,315 Participants to the Moli-Sani Study. Clinical Nutrition (Edinburgh, Scotland). 2022;41(10):2226-2234. doi:10.1016/j.clnu.2022.08.020
  4. Ma X, Nan F, Liang H, et al. Excessive Intake of Sugar: An Accomplice of Inflammation. Frontiers in Immunology. 2022;13:988481. doi:10.3389/fimmu.2022.988481
  5. Giugliano D, Ceriello A, Esposito K. The Effects of Diet on Inflammation: Emphasis on the Metabolic Syndrome. Journal of the American College of Cardiology. 2006;48(4):677-685. doi:10.1016/j.jacc.2006.03.052
  6. Lane MM, Gamage E, Du S, et al. Ultra-Processed Food Exposure and Adverse Health Outcomes: Umbrella Review of Epidemiological Meta-Analyses. BMJ (Clinical Research Ed). 2024;384:e077310. doi:10.1136/bmj-2023-077310
  7. Yu X, Pu H, Voss M. Overview of Anti-Inflammatory Diets and Their Promising Effects on Non-Communicable Diseases. The British Journal of Nutrition. 2024;132(7):898-918. doi:10.1017/S0007114524001405
  8. Koelman L, Egea Rodrigues C, Aleksandrova K. Effects of Dietary Patterns on Biomarkers of Inflammation and Immune Responses: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Advances in Nutrition (Bethesda, Md). 2022;13(1):101-115. doi:10.1093/advances/nmab086
  9. Hart MJ, Torres SJ, McNaughton SA, Milte CM. Dietary Patterns and Associations With Biomarkers of Inflammation in Adults: A Systematic Review of Observational Studies. Nutrition Journal. 2021;20(1):24. doi:10.1186/s12937-021-00674-9
  10. Lichtenstein AH, Appel LJ, Vadiveloo M, et al. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. 2021;144(23):e472-e487. doi:10.1161/CIR.0000000000001031
  11. Lerner BA, Green PHR, Lebwohl B. Going Against the Grains: Gluten-Free Diets in Patients Without Celiac Disease-Worthwhile or Not? Digestive Diseases and Sciences. 2019;64(7):1740-1747. doi:10.1007/s10620-019-05663-x
  12. Lidón AC, Patricia ML, Vinesh D, Marta MS. Evaluation of Gluten Exclusion for the Improvement of Rheumatoid Arthritis in Adults. Nutrients. 2022;14(24):5396. doi:10.3390/nu14245396
  13. Hill ID, Fasano A, Guandalini S, et al. NASPGHAN Clinical Report on the Diagnosis and Treatment of Gluten-Related Disorders. Journal of Pediatric Gastroenterology and Nutrition. 2016;63(1):156-165. doi:10.1097/MPG.0000000000001216
  14. Barbaro MR, Cremon C, Wrona D, et al. Non-Celiac Gluten Sensitivity in the Context of Functional Gastrointestinal Disorders. Nutrients. 2020;12(12):E3735. doi:10.3390/nu12123735
  15. Mumolo MG, Rettura F, Melissari S, et al. Is Gluten the Only Culprit for Non-Celiac Gluten/Wheat Sensitivity? Nutrients. 2020;12(12):E3785. doi:10.3390/nu12123785
  16. Abdi F, Zuberi S, Blom JJ, Armstrong D, Pinto-Sanchez MI. Nutritional Considerations in Celiac Disease and Non-Celiac Gluten/Wheat Sensitivity. Nutrients. 2023;15(6):1475. doi:10.3390/nu15061475
  17. Dieterich W, Zopf Y. Gluten and FODMAPS-Sense of a Restriction/When Is Restriction Necessary? Nutrients. 2019;11(8):E1957. doi:10.3390/nu11081957
  18. Szilagyi A, Ishayek N. Lactose Intolerance, Dairy Avoidance, and Treatment Options. Nutrients. 2018;10(12):E1994. doi:10.3390/nu10121994
  19. Qi X, Chiavaroli L, Lee D, et al. Effect of Important Food Sources of Fructose-Containing Sugars on Inflammatory Biomarkers: A Systematic Review and Meta-Analysis of Controlled Feeding Trials. Nutrients. 2022;14(19):3986. doi:10.3390/nu14193986
  20. O’Connor L, Imamura F, Brage S, et al. Intakes and Sources of Dietary Sugars and Their Association With Metabolic and Inflammatory Markers. Clinical Nutrition (Edinburgh, Scotland). 2018;37(4):1313-1322. doi:10.1016/j.clnu.2017.05.030
  21. Gonzalez JT. Are All Sugars Equal? Role of the Food Source in Physiological Responses to Sugars With an Emphasis on Fruit and Fruit Juice. European Journal of Nutrition. 2024;63(5):1435-1451. doi:10.1007/s00394-024-03365-3
  22. Kuang R, Levinthal DJ, Ghaffari AA, Del Aguila de Rivers CR, Tansel A, Binion DG. Nightshade Vegetables: A Dietary Trigger for Worsening Inflammatory Bowel Disease and Irritable Bowel Syndrome? Dig Dis Sci. Jul 2023;68(7):2853-2860. doi:10.1007/s10620-023-07955-9
  23. Wang Y, Xiang L, Yi X, He X. Potential Anti-Inflammatory Steroidal Saponins From the Berries of Solanum Nigrum L. (European Black Nightshade). Journal of Agricultural and Food Chemistry. 2017;65(21):4262-4272. doi:10.1021/acs.jafc.7b00985
  24. Kenny OM, McCarthy CM, Brunton NP, et al. Anti-Inflammatory Properties of Potato Glycoalkaloids in Stimulated Jurkat and Raw 264.7 Mouse Macrophages. Life Sciences. 2013;92(13):775-782. doi:10.1016/j.lfs.2013.02.006
  25. Emmanuela N, Muhammad DR, Iriawati, et al. Isolation of Plant-Derived Exosome-Like Nanoparticles (PDENs) From Solanum Nigrum L. Berries and Their Effect on Interleukin-6 Expression as a Potential Anti-Inflammatory Agent. PloS One. 2024;19(1):e0296259. doi:10.1371/journal.pone.0296259
  26. van Zonneveld SM, van den Oever EJ, Haarman BCM, et al. An Anti-Inflammatory Diet and Its Potential Benefit for Individuals With Mental Disorders and Neurodegenerative Diseases-a Narrative Review. Nutrients. 2024;16(16):2646. doi:10.3390/nu16162646
  27. Hosseini B, Berthon BS, Saedisomeolia A, et al. Effects of Fruit and Vegetable Consumption on Inflammatory Biomarkers and Immune Cell Populations: A Systematic Literature Review and Meta-Analysis. The American Journal of Clinical Nutrition. 2018;108(1):136-155. doi:10.1093/ajcn/nqy082

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