Dr. Seaman practices what he preaches. He chewed unflavored fish oil capsules (I can barely swallow mine each morning!) during our talk. Amazing.
Q: Can you describe the "anti-inflammatory" diet?
A: The best way to start looking at the anti-inflammatory diet is from the perspective of fatty acid balance. Research has clearly demonstrated that an imbalance in omega-6 (n-6) and omega-3 (n-3) fatty acids is pro-inflammatory, and a promoter of heart disease; all types of cancer; pain; neurodegenerative diseases such as Alzheimer's; and most other degenerative diseases.
Both n-6 and n-3 fatty acids are polyunsaturated fatty acids. Research suggests that through the ages, man subsisted on a diet that contained a 1:1 ratio of n-6 and n-3 fatty acids. The goal should be to consume a ratio that is less than 4:1; however, today the intake ratios range from 10:1 to 30:1, which promotes inflammation and disease.
In the past several thousand years, the human diet has shifted from a food-foraging, hunter-gatherer approach, which largely involved the consumption of greens; wild game; fruits; roots; etc., to one that heavily emphasizes the consumption of grains. This shift changes the ratio of fatty acids to which our genes and cells are exposed, favoring n-6 fatty acids. This is because corn, grains, seeds and their oils contain only n-6 fatty acids, which are ultimately pro-inflammatory. So an anti-inflammatory diet is basically low in n-6-rich grains, and starches are high in n-3-rich green vegetables and olive oil (for cooking and salad dressings).
Q: The description of the diet seems a little simplistic. Is that all there is to it?
A: Specifically no, but in general, yes! Consider the average lunch or dinner at the typical American home, "sit-down" or fast-food restaurant. Just imagine how much different the meal would look if 75-90% of the grains and starches were replaced with n-3-rich green vegetables. Such a shift would dramatically change the complexion of the American diet. Add two-to-three pieces of raw fruit per day, eat fish three or more times per week, and drink eight or so glasses of water per day, and the standard disease-promoting American diet becomes one that is anti-inflammatory and health-promoting.
Q: How about oatmeal? I like oatmeal, but it is a grain.
A: The health-promoting benefits of oatmeal are well known, and most people are not likely to give it up; I don't think they should give it up if they like it. However, it is important to know that oatmeal provides an n-6-to-n-3 ratio of about 10:1. To restore fatty acid balance, all one really needs to do is emphasize n-3-rich foods the remainder of the day, and avoid n-6-rich foods. Additionally, after the oatmeal is cooked and in the bowl, one can add flaxseeds or flaxseed oil, which contain appreciable amounts of n-3 fatty acids.
Q: You say to avoid n-6 foods and emphasize n-3 foods.
What would that mean practically, if I were going to explain this to a patient?
A: It is really quite simple. From a practical perspective, we should consider that grains, seeds, and their respective oils contain exclusively n-6 fatty acids. This means that n-6 fatty acids are found in bread, bagels, rolls, pasta, corn, chips, all flours, seeds, nuts, cakes, cookies, and therefore, in almost every packaged food at the supermarket. Every time I go to the market, I see carts filled with n-6 fatty acids. These are foods that we should be avoiding and replacing with vegetables and fruits. Also, it is important for patients to realize that meat animals, chicken and farm-raised fish are all fed grains, which is a sharp transition from the n-3, green-rich diets these animals would consume if they were in the wild. This shift in animal-derived fatty acids demands that we be very judicious about getting enough n-3s from greens.
Q: What about n-3 supplementation?
A: That's a good question. Considering the extreme imbalances in fatty acids, it seems prudent to supplement the diet with n-3 fatty acids. Dr. Simopoulos, a premier researcher in the area of n-3 fatty acids, suggests that most people would do well to supplement with about one gram of *EPA/DHA per day, and about two grams of ALA (alphalinoelic acid) from flaxseed oil.
Based on our work with dietary assessments, in which we determine the n-6-to-n-3 content in the diet, we have yet to see anyone below the 4:1 ratio. And considering that dietary changes are slow to come for most people, and the fact that it is just plain hard to get n-3-rich foods anymore, I think most should consider supplementation. Personally, I do not go a day without supplementation.
- Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are sources of omega-3 essential fatty acids.
A: Vegetables such as kale; broccoli; cauliflower; spinach; collard and mustard greens; arugala; Swiss chard; and chicory are excellent sources. The spring green mix, also called field greens, California greens or Mesclun greens, is a great source. These make an excellent salad and should replace iceberg lettuce. Most fresh fish is rich in n-3s, as is wild game. Today, people can even buy n-3-rich eggs, such as Eggland's Best, found in most supermarkets. Health food stores typically carry the Country Hen or Gold Circle Farms brands. Flaxseed can be sprinkled on salads and fruits, and flaxseed oil can be used in salad dressings.
Q: What about tunafish?
A: This is a little tricky. Fresh tuna is a good source of n-3s, but canned tuna is a different story. If you eat tuna packed in water or olive oil, you are in luck, as n-3 levels will resemble that of fresh tuna. However, canned tuna can be packed in other oils, such as soybean oil, which are rich in n-6 fatty acids. So, make sure it is packed in water or olive oil. On this note, imagine how n-3-rich your lunch would be if you ate a can of tuna in a salad with field greens.
Q: What are the best sources of n-3 fatty acids as far as nuts and seeds are concerned?
A: The problem with all nuts and seeds, is that they contain n-6 fatty acids. However, if you want to at least get some n-3s, your best choice would be walnuts, pumpkin seeds, and of course flaxseeds.
Q: Let me ask you a biochemical question. We discussed how n-6 fatty acids are pro-inflammatory, versus n-3s. How does this work?
A: These fatty acids are involved in the synthesis of eicosanoids, which include prostaglandins, leukotrienes, and thromboxanes. Generally speaking, eicosanoids can be either anti-inflammatory or pro-inflammatory. And generally speaking, n-6 fatty acids are converted into pro-inflammatory eicosanoids, while n-3s convert to anti-inflammatory eicosanoids. As an example, prostaglandin E-2 derived from n-6 fatty acids has been shown to play a pathogenic role in pain (disc, muscle, and joint); cancer; heart disease; Alzheimer's disease; and other inflammatory diseases. Also consider that NSAIDs, which block prostaglandin synthesis, are used to treat these conditions. This means that we basically eat ourselves into inflamed states, then medicate ourselves to reduce the inflammation and related diseases. Rarely if ever, is dietary modification prescribed.
Q: What's the story with olive oil? Does it play a role in inflammation and eicosanoid synthesis?
A: Olive oil contains predominately omega-9 fatty acids, which is a monounsaturated fatty acid (MUFA), and these do not participate in eicosanoid synthesis. MUFAs have a beneficial effect on cholesterol, such that they lower LDLs and maintain or raise HDLs. Olive oil contains squalene, which helps to lower LDL. Additionally, olive oil contains a host of anti-inflammatory phytonutrients and antioxidants that are thought to be more potent than vitamin C and E. It is really a great oil, and the best variety is called "extra virgin olive oil."
Editor's note: Part two of Dr. Andersen's interview will appear in his column in the June 18 issue of Dynamic Chiropractic.
G. Douglas Andersen,DC,DACBSP,CCN
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