COMMENTARY

The Anti-inflammatory Diet's Surprising Benefits in Children

Diane L. Barsky, MD

Disclosures

April 03, 2018

Editorial Collaboration

Medscape &

Fighting Back Against Inflammation

Hello. I am Diane Barsky, attending physician in the Division of Gastroenterology, Hepatology, and Nutrition at the Children's Hospital of Philadelphia (CHOP). I have a special interest in nutrition for children, and today I'd like to talk to you about the anti-inflammatory diet.

Why should you consider an anti-inflammatory diet for your patients or for yourself? As you know, inflammation is a natural way the body reacts to protect us and help us heal. But sometimes chronic inflammation goes awry. Those cycles of cytokines and anti-inflammatory mediators can continue to escalate; and, in turn, the body's immune response produces mediators that allow inflammation to occur in an ongoing and out-of-control manner. This chronic inflammation can increase our lifetime risk for obesity, type 2 diabetes, heart disease, and some forms of cancer as well as other autoimmune diseases.

Our goal is to maintain health, prevent the chronic inflammatory cycle if possible, or utilize the diet when it occurs. In doing so, we need to remember that food is not a replacement for medicine but a part of medicine for prevention and intervention.

The Basics of the Anti-inflammatory Diet

What is an anti-inflammatory diet? It's a diet based on two ancient healthy patterns of eating: the Asian diet and the Mediterranean diet. The combination of the two is thought to be one of the healthiest ways of eating on a daily basis. The Mediterranean diet has actually been studied for the past 30 years.

The anti-inflammatory diet encourages fresh foods and avoids processed foods, artificial flavors, high-fructose corn syrup, and trans fat. Instead, it incorporates healthy monounsaturated and polyunsaturated fats, which have a higher omega-3 to omega-6 fatty acid ratio. It includes a variety of sources of plant proteins that are high in fiber with a low glycemic index, such as beans and other legumes. It is lower in saturated animal fat and thus includes healthier fats. The emphasis is on fruits and vegetables that have important antioxidants as well as herbs, nuts, seeds, and green tea.

What are the mechanisms by which the anti-inflammatory diet works? The phytochemicals in this diet have key anticarcinogenic and anti-cardiovascular disease properties, promote important antioxidants (eg, polyphenols, flavonoids), and are high in oleic acid and polyunsaturated fatty acids and low in monounsaturated fatty acids, which promote the anti-inflammatory, antithrombotic prostaglandin pathway.

Because this diet is high in fiber and has a low glycemic index, there is a decreased risk for diabetes. The higher magnesium content reduces inflammation and improves cognitive ability. Spices that are rich in phytochemicals such as ginger, garlic, cayenne, black pepper, rosemary, and turmeric, are associated with maintaining a favorable microbiome. Other phytochemicals in these diets (eg, alpha linolenic acid, beta-carotene, curcumin) offer important anti-inflammatory mediators.

Benefits in a Pediatric Population

The Asian diet is relatively less studied than the Mediterranean diet. However, the ongoing China Project from Cornell University evaluated approximately 6500 people and demonstrated an association that the consumption of the Asian diet in rural China protected against many of the cancers we see in Western civilization.[1] There was also a decrease in the incidence of cardiovascular disease and significantly greater longevity. However, as soon as the rural Chinese moved into cities and acquired the Western diet, a much higher incidence of diabetes, breast cancer, colon cancer, and cardiovascular disease was reported.

The anti-inflammatory Mediterranean diet has been studied in pediatrics for the past 20 years. In that time, it has been associated with not only a reduction in the severity of asthma and allergies in children but a reduction in the recurrence of asthma and also in the prevention of chronic asthma.[2] A study in an Italian population found that the earlier in life subjects adhere to this diet, the more it reduced the risk for nonalcoholic steatohepatitis (NASH) and obesity in children.[3] The effect was also seen in children who already had NASH, who nonetheless had a reduction in the severity and even a regression the more adherent they were to the diet.

A recent study in Pediatrics[4] linked attention-deficit/hyperactivity disorder (ADHD) to the Mediterranean diet. It is not clear if those with ADHD are more likely to consume an unhealthy diet of fast food and processed foods, or if those following the Mediterranean diet have less of a risk for ADHD. That association should be monitored in future studies.

Two Regional Diets, Connected by Health

Traditional Mediterranean and Asian diets have many similarities. They are rich in vegetables, with a primary focus on legumes, fruits, and fresh foods. Both are moderately rich in fish and associated omega-3 fatty acids. They include some lean meats and eggs but avoid processed foods, artificial flavoring, high-fructose corn syrup, saturated fat, and trans fat. They're high in antioxidants that protect the body from many chronic diseases.

There is also a social component to these diets, with their focus on slower eating together with the extended family. It is a whole-foods approach, with minimal commercial processing and using more organic practices that minimize herbicides, insecticides, and toxic residues. It emphasizes the interconnection between the food, the people, and the land. Adherents know where their food is coming from, either through their own agriculture or through their local villages and neighbors.

The Mediterranean diet is composed of healthy fats with high monounsaturated fats, such as olives and olive oil, nuts, and seeds. It includes spices, eggs, and meat, but with a focus on white meat and soy proteins. It also advises the regular consumption of water.

The traditional Asian diet focuses on oily fish; miso soup; and fermented foods such as kimchi, pickles, and natto (fermented soybeans) that encourage and stimulate a favorable microbiome. This is associated with a lower incidence of irritable bowel disease.[5] The mushrooms consumed in the Asian diet (shiitake, enoki, and oyster) are actually now being studied in cancer centers in the United States because they've been linked to improvement in cancer risk and recurrence. The inclusion of herbs, medicinal garnishes, spices, turmeric, phenol, and green seaweed, just to name a few aspects of this diet, offer important antioxidants.

Conclusion

The anti-inflammatory diet is a combination of Mediterranean and Asian diets. It incorporates vegetables (4-6/day) and emphasizes fruit, fish, and plant proteins. It includes healthier fats (eg, canola oil, olive oil, seeds, nuts, avocados) that provide omega-3s, which promote a different prostaglandin pathway that is not proinflammatory. This diet highlights the intake of antioxidant-rich foods as well as beverages like green tea. Remember, it is not only about nutrition but a healthier lifestyle.

For those seeking an informational resource, CHOP offers a pediatric anti-inflammatory diet pyramid on its website.

With these diets, we are promoting a lifelong attitude of healthy eating, family togetherness, and physical activity. It's all-important in preventing chronic disease or managing inflammatory diseases in pediatrics. Thank you.

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