Anti-Inflammatory Diet

Diet has a major influence on inflammatory status of the body1-4. A healthy dietary pattern such as the Mediterranean diet, characterized by high intake of produce, fish, and olive oil, has been associated with lower inflammation 3,5,6, including in studies 7-10. In contrast, a modern Western dietary pattern, characterized by high intake of processed foods, is associated with high inflammation 2,4,11.

     The apparent contrast between the two types of patterns led to creation of a comprehensive index to rate the potential impact of diet on inflammatory influence: the Dietary Inflammatory Index (DII®) 12,13. Based on comprehensive scientific literature reviews, a high DII score represents pro-inflammatory potential of the diet, while a low score represents anti-inflammatory potential 11,13,14. In turn, the DII has been extensively studied to confirm its link to inflammatory markers 14-18, as well as many chronic diseases19-22, including MS 23-26.

     The DII is based on the following 45 dietary factors, listed in order of influence score:

According to the parameters of the DII12,13 and other research4,7,27,28, the following contribute to composition of an anti-inflammatory diet:

Foods to Favor

• Vegetables, especially green leafy and brightly colored (e.g., broccoli, collard greens, kale, peppers, spinach, tomatoes)

• Fruits, especially brightly colored (e.g., berries, citrus, pomegranate)

• Mushrooms

• Nuts (e.g., almonds, Brazil nuts, walnuts)

• Seeds (e.g., chia, flax, pumpkin)

• Fatty fish (e.g., mackerel, salmon, sardines)

• Soy protein, minimally processed (e.g., miso, soy “milk,” tofu, tempeh) – as tolerated

• Legumes (e.g., beans, lentils) – as tolerated

• Fermented foods (e.g., natto, sauerkraut, plain yogurt) – as tolerated

• Olives and their oil

• Avocados and their oil

• Herbs, spices, and similar seasonings (e.g., garlic, ginger, oregano, rosemary, turmeric)

• Cocoa, pure (e.g., unsweetened)

• Green and white teas

Foods for Moderation

• Whole grains and pseudograins, gluten-free (e.g., brown Basmati rice, buckwheat, millet, quinoa, sorghum) – as tolerated

• Lean red meat, pastured/grass-fed or wild game

• Poultry, pastured/grass-fed or wild game

• Coffee, preferably organic

Foods to Forgo

• Refined carbohydrates (e.g., white bread, white rice, pastries)

• Fried foods (e.g., French fries)

• Red meat, conventionally produced (e.g., beef, pork)

• Processed meat (e.g., cured bacon, cold cuts, frankfurters, sausage)

• Ultraprocessed foods (i.e., based on refined flours, oils, and proteins and incorporating artificial additives)

• Saturated and trans fats (e.g., conventional margarine, shortening, lard)

• Sugar-sweetened beverages (e.g., cola)

References

1. Koppula S, Akther M, Haque ME, Kopalli SR. Potential Nutrients from Natural and Synthetic Sources Targeting Inflammaging-A Review of Literature, Clinical Data and Patents. Nutrients. Nov 13 2021;13(11)doi:10.3390/nu13114058

2. Malesza IJ, Malesza M, Walkowiak J, et al. High-Fat, Western-Style Diet, Systemic Inflammation, and Gut Microbiota: A Narrative Review. Cells. Nov 14 2021;10(11)doi:10.3390/cells10113164

3. Smidowicz A, Regula J. Effect of nutritional status and dietary patterns on human serum C-reactive protein and interleukin-6 concentrations. Adv Nutr. Nov 2015;6(6):738-47. doi:10.3945/an.115.009415

4. Vasefi M, Hudson M, Ghaboolian-Zare E. Diet Associated with Inflammation and Alzheimer’s Disease. J Alzheimers Dis Rep. Nov 16 2019;3(1):299-309. doi:10.3233/ADR-190152

5. Clark JS, Dyer KA, Davis CR, et al. Adherence to a Mediterranean Diet for 6 Months Improves the Dietary Inflammatory Index in a Western Population: Results from the MedLey Study. Nutrients. Jan 11 2023;15(2)doi:10.3390/nu15020366

6. Steck SE, Shivappa, N., Tabung, F.K., Harmon, B.E., Wirth, M.D., Hurley, T.G., Herbert, J.R. The Digest. 2014;48(3):1-10. 

7. Georgoulis M, Yiannakouris N, Tenta R, et al. A weight-loss Mediterranean diet/lifestyle intervention ameliorates inflammation and oxidative stress in patients with obstructive sleep apnea: results of the “MIMOSA” randomized clinical trial. Eur J Nutr. Oct 2021;60(7):3799-3810. doi:10.1007/s00394-021-02552-w

8. Esposito K, Marfella R, Ciotola M, et al. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. Sep 22 2004;292(12):1440-6. doi:10.1001/jama.292.12.1440

9. Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C. Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study. J Am Coll Cardiol. Jul 7 2004;44(1):152-8. doi:10.1016/j.jacc.2004.03.039

10. Wood AD, Strachan, A.A., Thies, F., Aucott, L.S., Reid, D.M., Hardcastle, A.C.,, Mavroeidi A, Simpson, W.G., Duthie, G.G., Macdonald, H.M. Patterns of dietary intake and serum carotenoid and tocopherol status are associated with biomarkers of chronic low-grade systemic inflammation and cardiovascular risk. Br J Nutr. 2014;112(8):1341-1352. 

11. Wood LG, Shivappa, N., Berthon, B.S., Gibson, P.G., Hebert, J.R. Dietary inflammatory index is related to asthma risk, lung function and systemic inflammation in asthma. Clin Exp Allergy. 2015;45(1):177-185. 

12. Cavicchia PP, Steck SE, Hurley TG, et al. A new dietary inflammatory index predicts interval changes in serum high-sensitivity C-reactive protein. J Nutr. Dec 2009;139(12):2365-72. doi:10.3945/jn.109.114025

13. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hebert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. Aug 2014;17(8):1689-96. doi:10.1017/S1368980013002115

14. Shivappa N, Steck SE, Hurley TG, et al. A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). Public Health Nutr. Aug 2014;17(8):1825-33. doi:10.1017/S1368980013002565

15. Kotemori A, Sawada N, Iwasaki M, et al. Dietary Inflammatory Index Is Associated With Inflammation in Japanese Men. Front Nutr. 2021;8:604296. doi:10.3389/fnut.2021.604296

16. Yang Y, Hozawa A, Kogure M, et al. Dietary Inflammatory Index Positively Associated With High-Sensitivity C-Reactive Protein Level in Japanese From NIPPON DATA2010. J Epidemiol. Feb 5 2020;30(2):98-107. doi:10.2188/jea.JE20180156

17. Shivappa N, Bonaccio M, Hebert JR, et al. Association of proinflammatory diet with low-grade inflammation: results from the Moli-sani study. Nutrition. Oct 2018;54:182-188. doi:10.1016/j.nut.2018.04.004

18. Shivappa N, Wirth MD, Hurley TG, Hebert JR. Association between the dietary inflammatory index (DII) and telomere length and C-reactive protein from the National Health and Nutrition Examination Survey-1999-2002. Mol Nutr Food Res. Apr 2017;61(4)doi:10.1002/mnfr.201600630

19. Fowler ME, Akinyemiju TF. Meta-analysis of the association between dietary inflammatory index (DII) and cancer outcomes. Int J Cancer. Dec 1 2017;141(11):2215-2227. doi:10.1002/ijc.30922

20. Phillips CM, Chen LW, Heude B, et al. Dietary Inflammatory Index and Non-Communicable Disease Risk: A Narrative Review. Nutrients. Aug 12 2019;11(8)doi:10.3390/nu11081873

21. Shivappa N, Godos J, Hebert JR, et al. Dietary Inflammatory Index and Colorectal Cancer Risk-A Meta-Analysis. Nutrients. Sep 20 2017;9(9)doi:10.3390/nu9091043

22. Hariharan R, Odjidja, E.N., Scott, D., Shivappa, N., Nebert, J.R., Hodge, A. The dietary inflammatory index, obesity, type 2 diabetes, cardiovascular risk factors and diseases. Obes Rev. 2022;23(e13349):1-18. 

23. Abdollahpour I, Jakimovski D, Shivappa N, et al. Dietary inflammatory index and risk of multiple sclerosis: Findings from a large population-based incident case-control study. Clin Nutr. Nov 2020;39(11):3402-3407. doi:10.1016/j.clnu.2020.02.033

24. Bohlouli J, Namjoo I, Borzoo-Isfahani M, et al. Modified Mediterranean diet v. traditional Iranian diet: efficacy of dietary interventions on dietary inflammatory index score, fatigue severity and disability in multiple sclerosis patients. Br J Nutr. Aug 16 2021:1-11. doi:10.1017/S000711452100307X

25. Da Costa Silva BY, De Carvalho Sampaio HA, Shivappa N, et al. Interactions between dietary inflammatory index, nutritional state and Multiple Sclerosis clinical condition. Clin Nutr ESPEN. Aug 2018;26:35-41. doi:10.1016/j.clnesp.2018.04.018

26. Shivappa N, Hebert JR, Behrooz M, Rashidkhani B. Dietary Inflammatory Index and Risk of Multiple Sclerosis in a Case-Control Study from Iran. Neuroepidemiology. 2016;47(1):26-31. doi:10.1159/000445874

27. Mousavi-Shirazi-Fard Z, Mazloom Z, Izadi S, Fararouei M. The effects of modified anti-inflammatory diet on fatigue, quality of life, and inflammatory biomarkers in relapsing-remitting multiple sclerosis patients: a randomized clinical trial. Int J Neurosci. Jul 2021;131(7):657-665. doi:10.1080/00207454.2020.1750398

28. Rondanelli M, Perdoni F, Peroni G, et al. Ideal food pyramid for patients with rheumatoid arthritis: A narrative review. Clin Nutr. Mar 2021;40(3):661-689. doi:10.1016/j.clnu.2020.08.020