Accurate Education – An Anti-Inflammatory Diet

Nutrition:

An Anti-Inflammatory Diet

Since the time of Hippocrates, the role of the diet is believed to play a major role in health in general, but specicially in the experience of pain. This section is an overview of an anti-inflammatory diet that contributes to .improved health and reduced pain.

It is not meant to be exhaustive, but rather a reference for confirming recommended diets and foods. There are links to pages that will serve as more in depth sources of information for those who want to pursue greater knowledge of a subject.

 

See:

• An Anti-Inflammatory Diet
• Diet & Pain
• Omega fatty Acids
• Dietary Fiber

 

See also:

• Diet & Diets
• Diet & Fasting
• Diet & Pain
• Diet & Fibromyalgia
• Supplements

 

See also:

• Integrative, Complimentary and Alternative Medicine
• Nutrition: Amino Acids
• Nutrition: Carbohydrates

 

Key to Links:

• Grey text – handout
• Red text – another page on this website
• Blue text – Journal publication

Definitions and Terms Related to Pain

Page links:

• A Quick Look at anti-inflammatory Foods 
• A Quick Look at an anti-iflammatory diet
• A Quick Look at  pro-inflammatory foods
• A Quick Look at a pro-inflammatory diet
• The role of plant-based nutrients (phytonutrients)
• The role of the microbiome
• Guidelines for moving toward an anti-inflammatory diet
• Chia Seeds
• Food – Good Sources of Plant Proteins
• Food – Good Sources of Anti-inflammatory Fruits
• Fiber
• Brief Summary of Omega Fatty Acids
• Fats and Oils in Food
• Omega-3 and Omega-6 Fatty Acids
• Cooking Oils
• References & Resources

 

The Anti-Inflammatory Diet

The anti-inflammatory diet is encouraged as a remedy to battle chronic low grade inflammation throughout the body, known as “systemic inflammation.”  Inflammation is not always bad, because it is actually a healthy initial response by the  immune system in the setting of injury or illness. In these situations, the inflammatory response provides increased blood flow along with delivery of cells and other agents to fight infection and promote healing. Normally, as infection resolves or injuries heal, inflammation gradually subsides.

Inflammation becomes harmful when it inappropriately persists and begins to damage healthy cells, creating a “pro-inflammatory” state. This often occurs in chronic pain conditions and disorders when chronic low-grade inflammation in the nervous system develops, called “neuro-inflammation.” Chronic low-grade systemic inflammation also develops as a result of unhealthy lifestyles related to lack of exercise, high stress, and calorie-rich diets, termed “metaflammation.” (Note that the term “metaflammation” and “systemic inflammation” are often used interchangeably in the literature and on this website).

While both terms relate to widespread inflammation throughout the body, “metaflammation” specifically refers to a chronic, low-grade systemic inflammation primarily driven by metabolic factors like excess fat or sugar intake, whereas “systemic inflammation” is a broader term encompassing any inflammatory response affecting the whole body, which can be caused by multiple factors including infection, injury, or diseases. Metaflammation is considered a specific type of systemic inflammation with a metabolic origin.

Low-grade metaflammation does not usually produce noticeable symptoms, but over time metaflammation can contribute to a wide range of medical conditions as well as chronic pain including:

• Pain: Chronic pain and Transitioning from Acute to Chronic pain
• Migraines
• Osteoarthritis
• Autoimmune Diseases: Rheumatoid Arthritis, Lupus, Scleroderma
• Type 2 Diabetes
• Heart Disease
• Inflammatory Bowel Diseases: Crohn’s Disease and Ulcerative Colitis
• Non-alcoholic fatty liver disease
• Alzheimer’s disease
• Asthma
• Cancer: breast, colon
• Chronic Obstructive Pulmonary Disease
• Polycystic ovary syndrome
• Stroke

 

Pain: Chronic pain and Transitioning from acute to chronic pain

An anti-inflammatory diet (AID) has good research evidence for benefit for pain on many levels, including inflammatory conditions, such as arthritis as well as many chronic pain conditions associated with neuro-inflammation, oxidative stress, and central sensitization. Actually, not eating (fasting) is also beneficial for pain by reducing oxidative stress and nerve excitability. There is strong evidence of the benefits of an AID for migraine headaches, inflammatory bowel diseases, fibromyalgia even neuropathic conditions not generally considered “inflammatory conditions. See: Diet & Pain

Furthermore, an AID is strongly recommended in the peri-operative period before and after surgery as well as in acute post-traumatic circumstances to reduce the risk and severity of transitioning from acute to chronic pain. This is especially true for patients with pre-existing chronic pain, especially those on opioids.

Although an anti-inflammatory diet will generally be rich in antioxidants, there are additional nutriceutical supplements with established antioxidant and anti-inflammatory benefits that are highly recommended as part of a complete approach to the nutritional management of pain. It should not be forgotten, however,  that the most successful approach to managing pain is multifaceted and should include exercise and activities that reduce stress along with efforts to maintain quality and adequate quantity of sleep.

For more information, please explore the following links:

See:

• • Diet & Pain
  • Fasting
  • Sensitization – Peripheral and Central
  • Oxidative Stress, Pain and Disease
  • Transitioning from Acute to Chronic Pain
  • Nutriceuticals for Pain (coming)

 

“Diet” vs Foods

There is no single anti-inflammatory diet (AID). Generally the AID simply emphasizes eating a wide variety of foods considered “anti-inflammatory,” including fruits and vegetables, unsaturated fats, minimally refined whole grains, tea, coffee, herbs, spices, and oily fish. This is commonly represented by the “Mediterranean diet,”  popular in the cuisines of mediterranean countries like Sicily. But the important thing to emphasize is that amongst these different categories of food, there’s a definitive benefit of some choices over others, which is the emphasis of this section of the website. The healthiest diet emphasizes foods that are anti-inflammatory and avoids foods that are pro-inflammatory. In a systematic review published in 2020, seven out of nine research studies reported a pain-relieving effect of dietary changes.

In addition to the diets influence on to chronic pain and inflammation,  diet is extremely important for influencing risks for heart disease and diabetes.

Oxidative Stress and Antioxidants

It should be noted that the “anti-inflammatory” diet is also one that is “anti-oxidant,” and includes foods that are noted for their antioxidant compounds. Tissues in the body are constantly being damaged by “oxidation” in which environmental and metabolic processes in the body produce “free radicals” that are highly reactive and damaging to cells and tissues.

When the level of oxidation processes in the body becomes excessive it is termed “oxidative stress,” a condition that contributes to systemic inflammation, neuroinflammation and chronic pain as well as the diseases associated with by metaflammation. The chief health goals related to the AID are to minimize systemic inflammation,  oxidative stress and in turn as related to pain, peripheral and central sensitization. Because antioxidants can reduce oxidative stress and oxidative stress contributes to systemic inflammation, antioxidant compounds and food come under the umbrella of “anti-inflammatory.”

In summary, when it comes to promoting the AID, it is unrealistic to expect complete avoidance of any or all pro-inflammatory foods, but rather to simply emphasize anti-inflammatory foods and improve upon other common dietary deficiencies. Typically, the American diet is problematic in just a few major categories:

Excessive:

• • Pro-inflammatory foods

Inadequate:

• • Anti-inflammatory foods
  • Fiber
  • Omega-3 fatty acids
  • Antioxidants

Pro-inflammatory Foods:

Pro-inflammatory Proteins

• • Beef, pork, lamb
  • Whole Milk
  • Cheese
  • Poultry Skin

Pro-inflammatory Carbohydrates

For more information about sugars and carbohydrates, See: Carbohydrates

• Enriched flour products • Processed foods
• Syrups, sugar, juice, soda

• • Enriched flour products
  • Processed foods
  • Syrups, sugar, juice, soda
  • Fried foods 

Pro-inflammatory Fats

• • Cream, butter
  • Hydrogenated oils, oils (corn, vegetable, cottonseed, sunflower, palm, safflower)

An Overview of a Pro-inflammatory Diet

Foods that contribute to systemic inflammation are common and generally recognized by the public as “unhealthy,” but despite this knowledge people continue to eat these foods, often in enormous quantities! Why? They taste good. They tend to be inexpensive. They are very accessible. And they are often calorie and fat-dense so they can be energizing and satiating.

A lifetime of habitual eating patterns and a society that constantly encourages the intake of these foods are major barriers to avoiding these foods. Yet, for one’s health it is highly recommended to do so. Furthermore, a pro-inflammatory diet contributes to increased pain (See: Diet & Pain). The following lists common foods ingested in excess that significantly contribute to systemic inflammation and the accompanied increased risk for developing cardiovascular diseases, elevated cholesterol, diabetes and some forms of cancer.

• An excess of red meat
• Processed high-fat meats like bacon, sausage, hot dogs
• An excess of refined carbohydrate foods like white bread, pasta, white rice
• Sweetened beverages like soda, juice drinks, iced tea  
• High sugar desserts
• Saturated fats like full-fat dairy from cream and butter
• Processed foods
• Fast foods
• An excess of alcohol
• Hydrogenated and partially hydrogenated oils like fatty cuts of meat and poultry 

Hydrogenated oils are vegetable oils that have been chemically altered to prevent rancidity and increase shelf life. They are used in the food industry to improve the taste and texture of processed foods. For example, margarine is made from hydrogenated vegetable oils, which gives it a spreadable consistency. Hydrogenated fats are also used in chocolates and sweets to improve their texture.

However, hydrogenated oils can contain trans fats, which are considered the worst type of fat for people to consume. Trans fats negatively affect heart health, inflammation, and blood sugar control. To minimize intake of hydrogenated vegetable oils, read food labels carefully.

 

An Overview of an Anti-Inflammatory Diet

Proteins

• Salmon, sardines, herring, mackerel, trout, tuna, omega-3 yolk
• Bison, wild game
• Nuts, seeds, nut butters
• Beans, lentils, soybeans, tofu

Carbohydrates (For more information about sugars and carbohydrates, See: Carbohydrates)

• Whole fruits, variety, blueberries, cherries
• Oats, quinoa, millet, brown and wild rice, barley, farro
• Yogurt, kefir, tea (white, green, oolong) , coffee, 70% cocoa

Non-Starchy Vegetables

• Dark leafy greens
• Tomatoes, mushrooms, garlic, onion
• Broccoli, cauliflower, brussel sprouts
• Ginger, turmeric, spices, herbs, peppers

Fats & Oils (high Omega-3)

• Nuts: walnuts, almonds, pistachios 
• Seeds: Ground flaxseed, chia, hemp
• Oils: cold-pressed extra virgin olive oil, canola, almond oil, flaxseed oil

Fiber

• Whole grains: wheat, barley, rye, oats
• Seeds: flax, chia, hemp

 

Foods that deserve special mention

Some food are particularly beneficial but may not be on everyone’s radar – so here they get special mention:

(1) Chia Seeds

Chia Seeds are the edible seeds of Salvia hispanica, a flowering plant in the mint family. They have excellent nutritional value and are particularly rich in fiber and omega fatty acids (omega-3 (ALA) and omega-6 (at an excellent 3:1 ratio). Chia Seeds are also a good source of calcium, magnesium and zinc. They are the highest recommended food supplement for most people. The best part of this is that they are readily available and easily incorporated into one’s diet.

• See: Fiber below
• See: Omega Fatty Acids below

One serving (1 ounce (oz), which is 28 grams (g) or 2-1/2 tablespoons (tbsp) of chia seeds) contains:

• • Calories: 138 calories per serving
  • Protein: 4.7 grams per serving
  • Fat: 8.7 grams per serving
  • Fiber: 9.8 grams per serving (the recommended daily fiber intake for adults is 25–30 grams)
  • Carbohydrates: 11.9 grams per serving
  • Alpha-linolenic acid (ALA): 5 grams per serving
  • Calcium: 14% of the Daily Value (DV)
  • Iron: 12% of the DV
  • Magnesium: 23% of the DV
  • Phosphorus: 20% of the DV
  • Zinc: 12% of the DV
  • Vitamin B1 (thiamine): 15% of the DV
  • Vitamin B2 (riboflavin): 5% of the DV
  • Vitamin B3 (niacin): 16% of the DV
  • Vitamin B9 (folate): 4% of the DV

 

(2) Oysters

6 raw oysters (3 oz or 85 g) contains:

• • Omega-3: 329 mg of EPA and DHA (combined)
  • Zinc: 289% of the DV
  • Copper: 69%; for copper
  • Vitamin B12: 567% for vitamin B12.

The Anti-Inflammatory Diet – What does it look like?

The Mediterranean Diet (MedD) is often put forth as the best example of an anti-inflammatory diet. It can lower cholesterol,  reduce central obesity and reduces the risk of developing Type 2 diabetes by as much as  40%. The MedD has been shown to reduce inflammatory and oxidative stress biomarkers,

The MedD is characterized by a high intake of fruits, vegetables, cereals, legumes, nuts, and olive oil; a moderate consumption of fish and dairy products; and low amounts of red and processed meat, butter, cream, and sugary drinks.

MedD is recognized for its antioxidant and anti-inflammatory activity attributed to the high content of mono- and poly-unsaturated Omega-3 fatty acids from extra virgin olive oil and fish. The MedD also includes foods rich in polyphenols (see below) and fiber, such as legumes, fruit, vegetables and nuts which restore a healthy intestinal microbiome (see below), leading also to improved insulin sensitivity.

Mediterranean Diet 

• Fruits and vegetables: 7-10 servings per day
• Whole grains: 4-6 servings per day
• Nuts and seeds: 1-2 servings per day
• Olive oil: Used as the primary fat source
• Fish and seafood: 2-3 servings per week
• Poultry and eggs: Moderate consumption
• Red meat: Limited consumption 
• Carbohydrate: <4.5 servings/wk

 

 

Nutrients that Contribute to an Anti-inflammatory Diet

Phytonutrients – Polyphenols

An Anti-Inflammatory Diet includes a variety of foods and spices with potent anti-inflammatory polyphenols. Polyphenols are a diverse group of bioactive food compounds found primarily in plants, including berries, colorful vegetables, green tea, cocoa, and nuts. Many clinical studies have shown the health benefits of food-derived polyphenols.

The main benefit of phenolic compounds is there ability to increase the activity of antioxidant enzymes and inhibit the production of free radicals. They also inhibit the number and size of fat cells (adipocytes). Polyphenols not only have anti-inflammatory benefits, they also may improve the functioning of the cardiovascular system and normalize the lipid profile (cholesterol) and blood pressure.

There are more than 8,000 types of polyphenols but common polyphenols with anti-inflammatory and antioxidant properties include:

• Flavonoids (flavones, flavonols, flavanols, flavanones, isoflavones, proanthocyanidins, and anthocyanins)  Particularly abundant flavanoids in foods are catechin (tea, fruits), hesperetin (citrus fruits), cyanidin (red fruits and berries), daidzein (soybean), proanthocyanidins (apple, grape, cocoa), and quercetin (onion, tea, apples).
• Phenolic acids include caffeic acid
• Lignans – polyphenols found in flax seed and other cereals.
• Anthocyanins – colorful vegetables
• Sulforaphanes – broccoli, cauliflower
• Epigallocatechin (EGCG) – green tea
• Resveratrol – grapes and wine
• Lycopene – Tomatoes, watermelon, pink grapefruit
• Capsaicinoids – chili peppers

Where are dietary polyphenols found?
Polyphenols are found in fruits, vegetables, herbs, spices, tea, dark chocolate, and red wine. Some examples of foods high in polyphenols include grapes, apples, pears, cherries, berries, red wine, tea, coffee, cereals, dry legumes, and chocolate. 

Common spices with healthy polyphenols:

Spices commonly used for flavor enhancement when cooking may also be excellent sources of healthful polyphenols.

Black Pepper

Black pepper extract is rich in piperine, but additionally it is also very rich in beta-caryophyllene (BCP), a terpene with important anti-inflammatory and analgesic properties.

Cinnamon

Cinnamon extract is high in cinnamaldehyde, a potent anti-inflammatory, which may also help reduce blood sugar and cholesterol. It is also rich in other highly potent polyphenol antioxidants. Compared to 26 other spices, the antioxidant activity of cinnamon outranks “superfoods” like garlic and oregano.

Ginger

Ginger extract has powerful components that regulate the production of insulin and may lower blood sugar levels. It also has cholesterol-lowering properties that may help prevent heart-related diseases and strokes. Additionally, ginger is believed to have potent anti-inflammatory and anti-oxidant benefits.

Holy Basil

Holy Basil (Ocimum tenuiflorum) extract (not the same as sweet basil) is an adaptogen, which means it helps the body deal with stress. Based in Ayurvedic medicine, holy basil has antidepressant and anti-anxiety properties, purported to be as “calming as yoga.” It fosters clear thoughts, relaxation, and a sense of well-being. It is also believed to have anti-inflammatory properties that reduced arthritis pain and it may reduce blood sugar.

Nutmeg

Nutmeg extract is rich in anti-inflammatory terpenes, including sabinene, terpineol, and pinene. It also is rich in the active ingredient myristicin which has sedative properties to promote sleep. High doses of nutmeg may be toxic to the liver.

Rosemary

Rosemary extract is a rich source of anti-oxidants and anti-inflammatory compounds and is purported to have analgesic, neuro-protective and antidepressant properties. Additionally, it may improve memory and mental fatigue. 

Turmeric

Turmeric, the yellow-orange spice common if Indian and Asian cuisine, is an abundant source of curcumin which is one of the most powerful anti-inflammatory agents available. Of note, however, the curcumin in turmeric is very poorly absorbed from the gut directly.  While piperine, a polyphenol found in black pepper can improve the bioavailablity of curcumin, when seeking to use curcumin as a supplement it is highly recommended to choose a curcumin supplement with features designed to enhance bioavailablity such as liposomal versions.

 

Anti-inflammatory Diet: The Microbiome

The microbiome is the community of microorganisms that live in a person’s gut: the  stomach and intestines that includes a collection of bacteria, fungi, and viruses. One’s diet has an enormous impact on the microbiome, an importance that has only recently been recognized by the medical community and the scope of the microbiome’s impact on health is growing at a huge rate.

In addition to being an important variable in influencing the inflammatory contribution of one’s diet to general health including pain, the microbiome impacts the immune system and vulnerability to infection as well as mental health, significantly playing a role in depression. This list is growing.

Importance
The microbes in the gut are essential for human health.  They support the immune system, protect against pathogens, and facilitate digestion. The microbiome is a key interface between the body and the environment, and can affect health in many ways.

Factors that affect the microbiome
The microbiome is dynamic and changes in response to environmental factors like diet, exercise and medications.

Chemicals that can harm the microbiome
Environmental toxins like alcohol, tobacco smoke, and pollutants can harm the microbiome. Pesticides and antibiotics can also wipe out good bacteria. Medications like acid blockers, can change the pH inside the body and affect the microbiome. 

Foods that promote a healthy microbiome:

• Fibers – whole grains and beans, can help restore gut health.
• Polyphenols –  fruits and vegetables like blueberries, red peppers, and purple cabbage
• Fermented Foods:
  • Kombucha
  • Yogurt
  • Buttermilk.
  • Kvass
  • Kimchi
  • Sauerkraut
  • Fermented vegetables
  • Brined pickles,
  • Kefir – The composition of kefir varies due to geographical location, source, fermentation matrix

For more information on the microbiome and oxidative stress, See: Antioxidants and Oxidative Stress 

Anti-inflammatory Diet: Fiber

High Fiber Foods

See: High Fiber Foods

 

When to not eat a high-fiber diet

Some conditions may argue against high fiber diets, such as Crohn’s disease and ulcerative colitis or during bouts of diverticulitis. Other conditions of potential concern include post-surgical conditions, gastric paresis and those taking GLP-1 agonists such as Ozempic or Mounjaro which slow gastric emptying.

Guidelines for Moving Toward an Anti-inflammatory Diet

• Emphasize plant proteins
• Read food labels – assess fat and sugar content and aim for no added sugar
• Emphasize water, unsweetened teas 
• Emphasize fresh, whole unprocessed fruits
• Healthy food toppings (seeds, nuts)
• Healthy cooking oils (extra virgin olive oil, avocado oil, flax seed oil)
• Avoid deep frying – emphasize baking, air frier
• Consider adding spices

Food – Good Sources of Plant Proteins

• Beans and legumes
• Broccoli
• Chickpeas
• Edamame
• Lentils
• Nut butter
• Nuts and seeds
• Oats 
• Peas
• Quinoa
• Sorghum
• Soy milk
• Spinach
• Tempeh
• Tofu
• Veggie patties

Food – Good Sources of Anti-inflammatory Fruits

While all fruits tend to be rich in disease-protective nutrients, some have particular antioxidant and anti-inflammatory benefits including fiber. However, fruits are high in sugar (fructose)  may be detrimental to some due to its impact on insulin and blood sugar levels. The best measure of a fruits impact on blood sugar is its “glycemic index” or better yet, its “glycemic load.”

 

Glycemic Index and Glycemic Load

The glycemic index (GI) measures how quickly a food raises blood sugar levels compared to pure sugar (glucose), while the glycemic load (GL) takes into account both the GI and the amount of carbohydrates (carbs) in a serving of food, providing a more accurate picture of how a portion of food will impact blood sugar levels because it also takes into account portion size. For more information about carbohydrates and glycemic index/load, See:  Nutrition: Carbohydrates\

 

Glycemic index (GI):

• • A numerical value assigned to a food based on how rapidly it raises blood glucose levels. Pure glucose has the highest GI score of 100.
  • Foods with a low GI raise blood sugar slowly, while high GI foods cause a rapid spike. High GI carbs are useful for acute demands such as during exercise but frequent intake contributes to systemic inflammation, cardiovascular disease and type 2 diabetes risk along with potentially compromising weight management goals.
  • GI ratings of fruits ranging from low (55 or less), medium (56–69) and high (70+).
  • Fresh fruits usually fall into either the low/medium range
  • Canned and processed fruits like dried dates, raisins and pineapple typically have higher GIs due to their concentrated sugars.

 

Glycemic Load

The glycemic index of foods tells only part of the story because it does not indicate how much carbohydrate is in an individual serving.  A separate value called “glycemic load” gives a more accurate portrayal of a food’s impact on blood sugar because it takes into account serving size. The glycemic load is determined by multiplying the grams of a carbohydrate in a serving by the glycemic index, then dividing by 100.

A glycemic load of 10 or below is considered low; 20 or above is considered high. Watermelon, for example, has a high glycemic index (80). But a serving of watermelon which is mostly water with little carbohydrate (6 grams) that its glycemic load is only 5.

 

More about Fructose

Fructose is widely used commercially, added to various beverages such as soda and other foods and condiments including foods not usually thought of as sweet such as salad dressings, ketchup and many other items. Fructose is very different from other sugars because it has a different metabolic pathway and is not a preferred energy source for muscles or the brain. Fructose is only metabolized in the liver and is more lipogenic, or fat-producing, than glucose.

Unlike glucose, fructose does not stimulate release of insulin or stimulate production of leptin, a key hormone for regulating energy intake and expenditure. These properties of fructose raise concerns about chronically high intakes of dietary fructose because it appears to behave more like fat in the body than other carbohydrates. High dietary fructose intake may induce insulin resistance, hyperinsulinemia and hypertriglyceridemia and may contribute to risk for obesity and diabetes. However, a moderate dose (≤ 50 g/day) of added dietary fructose has no detrimental effect on fasting and triglycerides, glucose control, insulin resistance or hypertension.

Fructose is 120-190% sweeter than sucrose. The glycemic index of 25 grams of fructose is 11.

Fructose Content of Different Fruits

High Fructose Corn Syrup (HFCS)

There is some confusion about the difference between fructose and high fructose corn syrup (HFCS). HFCS is produced by enzymatically converting corn starch to glucose, and then adding a second enzyme that converts part of the glucose to fructose. The HFCS usually used in food production is about 55% fructose and 45% glucose. HFCS is more similar to sucrose (50% fructose and 50% glucose) than to pure fructose.

Fructose and Gout

Research also shows that that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men and women. Furthermore, fructose rich fruits and fruit juices may also increase the risk. Diet soft drinks were not associated with the risk of gout.

Fructose and Increased Risk for Cardiovascular Disease

Recently there has been speculation that fructose, especially HFCS, is a causative factor in obesity and/or diabetes. Given the fact that fructose has been an important part of the human diet from prehistoric times, it seems unlikely that fructose alone is the problem, rather overconsumption of carbohydrates is far more likely to be the problem. Of particular concern is the overwhelming use by the food industry of high fructose corn syrup (HFCS). In fact, it is difficult to find commercial food products that don’t have HFCS listed as an ingredient.

What is clear, however, is that too much added sugar of any kind — not just high-fructose corn syrup — can contribute unneeded calories that are linked to health problems, such as weight gain, type 2 diabetes, metabolic syndrome, high triglyceride levels and risk of heart disease. More studies are needed, but current medical literature  indicates that a moderate consumption of fructose (<50 gm/day) does not increase the risk of atherosclerosis, type 2 diabetes, or obesity more than consumption of other sugars.

However, a high intake of fructose (>50 gm/day) may have negative health effects by increasing triglycerides and low density lipids (LDLs), leading to increased systemic inflammation. Remember, each gram of fructose (as with all sugars) has 4 calories, so 50 grams of fructose correlates with an approximate serving of 200 calories.

 

See: Fructose Content of Different Fruits)

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 The American Heart Association recommends that most women get no more than 100 calories a day of added sugar from any source, and that most men get no more than 150 calories a day of added sugar. That’s about 6 teaspoons of added sugar for women and 9 teaspoons for men. A 12-ounce can of Coca Cola contains 140 calories, and the same size Pepsi has 150 calories. The World Health Organization has recommended that people limit their consumption of added sugars to 10% of their caloric intake, but typical consumption of these empty calories in the United States is nearly twice that amount.

Sugar in Sodas

• • 8.3 oz of Red Bull – 27 grams
  • 12 oz of Coca-Cola & Pepsi – 39 grams
  • 20 oz of Mountain Dew – 77 grams

Sugar in Juices

• • 8 oz of Minute Maid Premium Original Orange Juice – 23 grams
  • 20 oz bottle of Minute Maid Lemonade – 67 grams

 

Assessing a fruit’s healthfulness is based on 3 variables:

1. Phytonutrient content such as polyphenols and their antioxidant capacities – higher the better
2. Fiber content- higher the better  (Low- <1gm/cup/fruit;  Medium – 1 -4 gms/cup/fruit;  High – >4 gms/cup/fruit;
3. Glycemic Index/Load- lower the better

The effect of spiking blood sugars with ingestion of higher GI foods can be mitigated by not eating them alone, but by eating them with foods like nuts & seeds that can slow the absorption of carbs to help balance out their impact on insulin response.

Avocados (Low GI, high fiber) A rich source of oil, mostly monounsaturated, and a good source of linoleic acid. It also contains high levels of antioxidants including polyphenols, proanthocyanidins, tocopherols, and carotenoids, Studies show avocados helps to control weight, reduces the risk of diabetes and help normalize blood cholesterol levels.

Berries (Low GI, high fiber). Some berries, like strawberries, blackberries, cranberries and blue­berries, are particularly potent in antioxidant and anti-inflammatory activity. Along with fiber and vitamin C, berries also contain polyphenols that provide health benefits. Research has linked increased berry consumption with lower risks of heart disease, Alzheimer’s disease, and diabetes.

Apples (Low GI, medium fiber). Compounds in apples including fiber, vitamin C, pectin, and polyphenols have anti-inflammatory benefits and increase beneficial microbes in the gut. Consumption of apples along with its relative, pears, is associated with a lower risk of death from heart disease.

Stone fruits (Low GI, medium fiber). Stone fruits such as cherries, peaches, apricots, and plums contain fiber, vitamin C, potassium, and a variety of polyphenols that reduce inflammation. Cherries can reduce pain and soreness after exercise and also may reduce risk of gout attacks.

Citrus (Low GI, medium fiber). Oranges, grapefruit, lemons, and limes are very rich in vitamin C. They also contain fiber, potassium, calcium, B vitamins, copper, and anti-inflammatory polyphenols such as flavonoids and carotenoids.

Pomegranates (Low GI, high fiber).  Pomegranate seeds contain high levelsof vitamins C and K, potassium, fiber, and potent polyphenols such as anthocyanin and resveratrol.

Grapes (Medium GI, low fiber).  Grapes are rich I fiber, vitamins C and K, and powerful polyphenols but how have a higher glycemic index than many other fruits. 

 

LIST OF FRUITS AND THEIR GLYCEMIC INDEX & LOADS

LIST OF FRUITS AND THEIR FIBER CONTENT

 

Brief Summary of Omega Fatty Acids

For more information on Dietary Fats and Oils, See: Omega Fatty Acids

LOC: High

• Omega fatty acids are essential for human health and cannot be synthesized by the body, so they must be ingested in food.
• Omega-3 fatty acids are divided into three different types: Eicosapentaenoic acid (EPA), docosa-hexaenoic acid (DHA), and alpha-linolenic acid (ALA). The EPA and DHA are present in fish and can be used by the body without been changed. ALA, which is present in large quantities in plants, nuts and seeds, must be converted to EPA and DHA.

Benefits:

Omega-3 fatty acids are anti-inflammatory and counter the processes of many chronic diseases:

 Pain

• • Helps reduce joint pain
  • May assist in reducing transition of acute to chronic pain
  • May help suppress evolution of central sensitization that magnifies chronic pain

Arthritis

• • Helps reduce inflammation and joint pain (in osteoarthritis and rheumatoid arthritis) with high dose
  • Improvement in morning stiffness

Cardiovascular Disease

• • Diets rich in Omega-3 fatty acids reduce risk of developing diabetes type 2 and heart disease
  • Evidence suggests EPA alone in a highly-purified, high-dose form (iicosapent ethyl (IPE)), improves cardiovascular outcomes among patients with elevated triglycerides  Current guidelines endorse the use of IPE in statin-treated patients at high cardiovascular risk who have triglycerides >135 mg/dl.

 

Daily Intake:

Although the ideal amount for average daily intake is not firmly established and opinions vary, most expert guidelines recommend total intakes of EPA + DHA ranging from at least 0.5 to 1.8 g per day.

• But, higher intake (>2.7 gm/day of EPA and DHA) may be recommended based on individual lab testing (O3 index)
• A minimum of 3 months of treatment may be necessary to improve levels and joint pain

Best food sources of EPA + DHA 

• Cold-water, oily fish like salmon and tuna, oysters as well as fish oil supplements. EPA & DHA can also be obtained from non-animal sources, such as microalgae

 

 

Fats and Oils in Food

It’s important to learn a bit about fats and oils because of the different health implications associated with the types and amounts of them in one’s diet.

Fats are important for energy, they help with nutrient absorption, energy storage, and controlling inflammation. Fatty acids are the building blocks of fats. Fats can then be categorized as saturated, polyunsaturated, mono-unsaturated and Trans fats.

Fatty Acids 

Essential fatty acids are fatty acids that the body can’t produce on its own yet they are vital to many bodily functions. acids: There are two categories of essential fatty acids Omega-3 and Omega-6, both are polyunsaturated fatty acids (PUFAs).

Omega-3 and Omega-6 Fatty Acids

Omega-3 and omega-6 fatty acids are necessary because they make compounds called eicosanoids, which are important hormones that control the immune system, nervous system, and other hormones. However, the eicosanoids from omega-3 and omega-6 fatty acids act differently and can produce opposing effects.  As such, a proper dietary balance of them is important.

Some researchers propose that the relative intakes of omega-3s and omega-6s (the omega 3:6 ratio) may have important implications for the pathogenesis of many chronic diseases, such as cardiovascular disease (CVD) and cancer. But the optimal omega 3:6 ratio—if any—has not been definitively identified. Some experts recommend that one should consume one omega-3 for every two omega-6s (a 1:2 ratio) for optimal benefits, but most people ingest about 16 times as many omega-6s than omega-3s.

Others researchers have concluded that such ratios are too non-specific and are insensitive to individual fatty acid levels. Most experts do agree that raising EPA and DHA blood levels is far more important than lowering linoleic acid or arachidonic acid levels.

Omega -3 fatty acids are important for:

• • • Heart health – Reduce risk for cardiovascular disease.
    • Skin health – Maintain the integrity of skin cell membranes and cell hydration.
    • Brain health – Improve cognitive function.
    • Reducing inflammation
    • Easing Joint and muscle pain
    • Bone health
    • Maintaining the reproductive system
    • Regulating metabolism. 

Omega-3 Fatty Acids

High consumption of omega-3 fatty acids has been associated with improved cardiovascular health, decreased anxiety and depression, as well as reduced rates of cancer, Alzheimer’s Disease, type 1 Diabetes, multiple sclerosis, and total mortality.

There are three important types of omega-3 fatty acids which are essential for your body:

• • Alpha-linolenic acid (ALA)
  • Docosa-hexaenoic acid (DHA)
  • Eicosapentaenoic acid (EPA)

Dietary intake of EPA and DHA is emphasized because they provide greater health benefits compared to ALA for improving cardiovascular health and supporting vision, while all three lower inflammation. ALA is present in plant oils whereas EPA and DHA are present only in fish and krill (small, shrimp-like crustaceans).  Therefore, consuming EPA and DHA directly from fish or krill oils and/or dietary supplements is the only practical way to maintain recommended levels of these fatty acids in the body.

Actually, EPA and DHA are originally synthesized by microalgae that are ingested by fish and krill and subsequently accumulate in their tissues.  As such, when it comes to whether farmed fish provide less or more EPA and DHA than wild fish, it depends on the farmed fish’s diet.

 

Alpha-linolenic Acid (ALA)

Alpha-linolenic acid (ALA) is an essential omega-3 fatty acid found in plants such as flaxseed, walnuts, chia seeds, hemp, and many vegetable oils, including canola and soybean oils.  The body can convert ALA into eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are the other essential omega-3 fatty acids found almost exclusively in fish.  However, while EPA and DHA can be used directly by the body, ALA must be converted by the liver into EPA and then to DHA. This conversion is very limited, with rates of less than 15%.

ALA is a precursor to important anti-inflammatory compounds produced by the body that help modulate inflammatory responses and reduce inflammation in joints and tissues, so it is important to include ALA-rich foods in one’s diet. ALA may also contribute to lower blood triglyceride levels, and reduce the risk of heart disease.

Benefits of ALA

• • ALA has anti-inflammatory benefits
  • ALA has cardiovascular-protective,, anti-cancer, neuro-protective, and anti-osteoporotic effects
  • ALA may help reduce total cholesterol, LDL cholesterol, triglycerides, and blood pressure
  • ALA may help reduce the risk of diabetes
  • ALA may help counteract cognitive impairment

 

Docosahexaenoic acid (DHA)

Docosahexaenoic acid (DHA) is an essential omega-3 fatty acid that’s essential for brain development and function. Plentiful DHA in the diet improves learning ability, whereas deficiencies of DHA are associated with deficits in learning. DHA is taken up by the brain in preference to other fatty acids but the turnover of DHA in the brain is very fast.

DHA deficiencies are associated with fetal alcohol syndrome, attention deficit hyperactivity disorder, cystic fibrosis, unipolar depression and aggressive hostility. Decreases in DHA in the brain are associated with cognitive decline during aging and with onset of sporadic Alzheimer disease.

Benefits of DHA

DHA has a positive effect on diseases such as hypertension, arthritis, atherosclerosis, depression, adult-onset diabetes mellitus, myocardial infarction, thrombosis, and some cancers. DHA may help improve attention and behavior in children and adults with ADHD

Sources of DHA

• • Fatty fish: Cold-water fish like salmon, tuna, and mackerel are rich in DHA
  • Fish oil: DHA is found in fish oil supplements, along with eicosapentaenoic acid (EPA)
  • Seaweed: Seaweed is a vegetarian source of DHA
  • Breast milk: DHA is a normal component of breast milk
  • Infant formula: Some infant formulas contain DHA

 

Eicosapentaenoic acid (EPA)

Eicosapentaenoic acid (EPA)  has anti-inflammatory and anti-oxidative properties. It can help lower the risk of heart disease, high blood pressure and high triglycerides. Appropriate dietary intake of EPA is a very important aspect of maintaining an anti-inflammatory diet.

EPA is also available as a prescription drug to reduce triglyceride levels and as a supplement, it is commonly used for heart disease, depression, and preventing heart attack.

 

Beneficial roles for omega-3 fatty acids

Osteoarthritis

A 2024 study demonstrates that the consumption of omega-3 PUFAs significantly reduces the risk of all-cause mortality in patients with OA. This effect is likely due to the anti-inflammatory, antioxidant, gut microbiota regulatory, and immune-modulating properties of omega-3 PUFAs.

Reduces Chronic Inflammation and Oxidative Stress

Aging is the most significant risk factor for OA. During aging, cells produce various inflammatory factors (chemokines and and other factors) that lead to chronic inflammation. This chronic inflammation accelerates aging and increases mortality risk by causing oxidative damage (oxidative stress), DNA telomere attrition, loss of protein balance, and stem cell depletion. Omega-3 fatty acids can effectively stabilize these inflammatory responses and reduce the risk of severe inflammatory reactions by inhibiting inflammation-related activity, disrupting the production of pro-inflammatory mediators and enhancing mitochondrial antioxidant capacity that reduces oxidative stress and inflammation.

Improvement of the Gut Microbiota

Disruption of the gut microbiota (dysbiosis) is an important factor in the development of OA by inducing immune activity and activating the “gut-joint axis,” that worsens OA progression. Omega-3 PUFAs can improve gut dysbiosis by regulating the gut microbiota and restoring the healthy ratio of Bacteroidetes to Firmicutes, which reduce intestinal inflammation by increasing short-chain fatty acid synthesis.

Cardiovascular disease 

The totality of evidence suggests EPA alone, administered in a highly-purified, high-dose form (in the form of icosapent ethyl (IPE)), improves cardiovascular outcomes among patients with elevated triglycerides at high cardiovascular risk, but EPA and DHA together does not. Current guidelines endorse the use of IPE in statin-treated patients at high cardiovascular risk who have triglycerides >135 mg/dl.

 

Omegas-3 Dietary Needs

Omega-3 index (O3i) – Assessing an Individual’s Omega-3 Intake

In order to determine the status of an individual’s intake of omega-3s, specifically EPA and DHA, one can measure their omega-3 index (O3i) (defined as the ratio of EPA and DHA to total fatty acids measured in erythrocyte (red blood cell) membranes), which is indicative of overall omega-3 status. The O3i was first validated as a risk factor for cardiovascular disease in 2004 and remains a generally accepted measure for determining omega-3 status.

O3i has been shown to reflect tissue omega-3 distribution and is more representative of long-term omega-3 dietary intake than other assessment methods. It can be measured via a quick and non-invasive blood test.

Individuals with O3i >8% have a lower risk of cardiovascular disease vs. those with <4%. Further evidence supports health benefits for maintaining O3i >8%.

Population Analysis

A 2023 scoping review article concluded that the majority of the population does not consume adequate omega-3 fatty acids, leading to global deficiencies and subsequent increased risk of cardiovascular disease among other chronic ailments. The majority of the world population has O3i levels well below the recommended target of ≥8% with most mean baseline O3i ranging from 3 to 6%, suggesting that most individuals would benefit from improved omega intake.

Population studies suggest that even those who consume fish regularly have a low O3i. The Food and Drug Administration (FDA) has established a Daily Value (DV) of 65 gm for total fat intake but not for omega-3s. Dietary Guidelines for Americans (DGA) and the American Heart Association recommend consuming two servings of fish per week (3.5–4-oz per serving), to reach an intake of 250 mg/day of EPA and DHA. However, his targeted daily dose is lower than other expert recommendations.

The majority of the American population consumes approximately half of the recommended 7–8 oz. fish per week. NHANES data have estimated the mean fish intake among adults to be 4 oz. per week and only 1 oz. per week if limiting intake to oily fish high in omega-3. This amount of fish intake translates to dietary omega-3 to be far short of the recommended 250 mg/day, with an estimated mean consumption of 63 mg/day DHA (72 mg/day when including supplements) and 23 mg/day EPA (41 mg/day when including supplements).

Recommendations for Dietary Intake of Omega-3 Fatty Acids 

Although the ideal amount of omega-3 fatty acids for one’s diet is not firmly established, in the absence of O3i measurements, most expert guidelines recommend a total intake of EPA + DHA ranging from 0.5 to 1.8 gm per day (either as fatty fish or supplements) should be ingested to significantly reduce the number of deaths from heart disease.

• But, higher intake (>2.7 gm/day of EPA + DHA) may be recommended based on individual lab testing (O3 index)
• A minimum of 3 months of treatment may be necessary to improve levels

 

Improving an Individual’s Omega-3 Intake.

Since few individuals meet the recommended amount of fish intake or meet the target O3i of 8%, improving O3i by recommending an increase intake of fish alone is neither realistic nor sustainable. Only two means of achieving healthier omega-3 intake are available if an individual’s intake  of food sources is insufficient: fortifying foods with omega-3s and/or encouraging dietary supplements of omega-3s.

Food sources of omega-3 fatty acids

This table provides the amounts of omega-3 fatty acids in grams per serving:

See: Food Sources of Omega 3 Fatty Acids

 

Plant-based food sources of ALA

Plant-based foods may contain large quantities of ALA but they have little to no EPA and DHA. Because ALA allows only limited conversion to EPA and DHA, plant sources of omega-3s are insufficient to provide recommended amounts of these omega-3s.

Plant-based foods that contain large quantities of ALA include:

• • Chia seeds
  • Flaxseed seeds and oil (linseed)
  • Walnuts
  • Hemp seeds, and oil
  • Soybeans
  • Canola oil

Seafood and fish sources of EPA and DHA

The omega-3 (EPA and DHA) content of fish varies widely. Cold-water fatty fish contain the highest amounts of omega-3s, whereas fish with a lower fat content—such as bass, tilapia, and cod—as well as shellfish, contain significantly lower levels than oily fish.

Fish with the highest content of EPA and DHA include:

• • Salmon
  • Tuna
  • Mackerel,
  • Herring
  • Anchovies
  • Sardines
  • Oysters

The omega-3 content of fish also depends on the composition of the food that the fish consumes. Farmed fish such as salmon may have higher levels of EPA and DHA than wild-caught fish, but it depends on the food they are fed.

See: Omega-3 Fatty Acid Content of Fish and Seafood

Salmon vs Salmon

While all salmon is highly nutritious, some salmon have a slightly better profile of omega-3 fatty acids (noted here, per 100 gms): :

• • • Atlantic Salmon (Wild): ALA (0.2), EPA (0.3 gm), DHA (0.9 gm), Total: 1.4 gm
    • Atlantic Salmon (Farm): May be higher or lower c/w Wild, depending on diet
    • Sockeye Salmon: ALA (0.1), EPA (0.5 gm), DHA (0.7 gm), Total: 1.3 gm
    • Chinook Salmon: ALA (0.1), EPA (0.8 gm), DHA (0.6 gm), Total: 1.5 gm
    • Chum Salmon: ALA (0.1), EPA (0.4 gm), DHA (0.6 gm), Total: 1.1 gm
    • Coho Salmon: ALA (0.2), EPA (0.3 gm), DHA (0.5 gm), Total: 1 gm

Tuna vs Salmon

Tuna and salmon are both highly nutritious sources of fish.

Tuna and salmon are both highly nutritious fatty fish and they have plenty of similarities. Both are high in omega-3 fatty acids (though wild and farmed salmon both outrank tuna, with over 1.5 gm of these fats per serving versus tuna’s 1,000 to 1,500 mg). Neither salmon nor tuna contains any carbohydrates, which means they have no fiber or sugar. Their sodium content is also nearly identical at a low 37 mg per serving for salmon and 38 gm for tuna and both provide plenty of protein.

Despite their similarities, these fish differ in significant ways. Ounce for ounce, salmon contains about one-third more calories than tuna because it has more fat content,  at 5 gm per serving versus 1 gm per serving in tuna (but remember, dietary fat can be beneficial. Fat helps to promote feeling full and they help with absorption of fat-soluble vitamins.

Salmon has more vitamin D and vitamin B12 than tuna, while tuna has more niacin (the high amounts of niacin in tuna can lower cholesterol) and selenium than salmon. Tuna is among the highest dietary sources of the important mineral, selenium. Selenium is a trace mineral that provides a number of health benefits.  It is an antioxidant which protects against DNA damage by free radicals and it plays a role in cancer prevention. Selenium also plays an essential role in thyroid health.

The nutrition information for 3 ounces (85g) of yellowfin tuna and 3 ounces (85 gm) of wild Atlantic Salmon is provided here.

Note, however, that not all tuna is the same. The amount of omega-3s in raw tuna varies by type, but tuna is generally a good source of these fatty acids (noted here, per 100 gms):  

• • • Albacore tuna: ALA (0.2), EPA (0.3 gm), DHA (1.0 gm), Total: 1.5 gm
    • Bluefin tuna: ALA (0), EPA (0.4 gm), DHA (1.2 gm), Total: 1.6 gm
    • Skipjack tuna: ALA (0), EPA (0.1 gm), DHA (0.3 gm), Total: 0.4 gm

 

Other food sources of omega-3s

Beef is very low in omega-3s, but beef from grass-fed cows contains somewhat higher levels of omega-3s, mainly as ALA, than that from grain-fed cows.

Some foods, such as certain brands of eggs, yogurt, juices, milk, and soy beverages, are fortified with DHA and other omega-3s. Since 2002, manufacturers have added DHA and arachidonic acid (the two most prevalent PUFAs in the brain) to most infant formulas.

Foods Fortified with Omega-3s

Some food is available that is fortified with omega-3s and research shows that fortified foods may significantly improve O3i by 1–2% with lower doses than dietary supplements. Nevertheless,  it is unlikely that fortified foods will provide enough EPA and DHA to raise O3i to >8%, so it is recommended that one still obtain the bulk of their omega-3s by ingesting natural foods and/or supplements rich in  omega-3s.

Some brands of the following foods are fortified with omega-3s: 

• Eggs
• Dairy: milk, yogurt, and butter
• Breads
• Spreads: margarine and spreads
• Juices
• Baby food
• Protein powders
• Peanut butter
• Soy milk
• Weight-loss drinks

 

Supplementing Dietary Omega-3

Despite the definitive need, surveys indicate that only 7.8% of U.S. adults and 1.1% of U.S. children use supplements containing fish oil, omega-3s, and/or DHA or EPA. Generally, it may require up to 12 weeks or more of taking omega-3 supplements to be effective in raising O3i to recommended levels of >8%. Dietary supplements vary in chemical composition but the most common are triglycerides (TAG) or ethyl esters (EE). Supplements composed of TAG are more bioavailable and thus more effective than other formulas so lower doses can be employed.

Recent research suggests that DHA is more effective at raising O3i than EPA, compared to studies which supplemented equal or greater amounts of EPA vs DHA. This is because DHA is more efficiently incorporated into erythrocyte membranes. EPA and DHA both improve the O3i to a greater extent than ALA and other omega 3s such as SDA (from soybeans), which both show minimal effect on O3i.

 

Recommended omega-3 supplement doses to raise O3i to recommended levels of >8%:

(1). Those individuals with unknown O3i levels but poor dietary intake of fish: Consume at least 2,250 mg/day of EPA and DHA (as TAGs) or 2,250–3,250 mg/day (EE’s) for at least 12 weeks to reach 8%.

(2). Those individuals with unknown O3i levels but dietary intake of fish low to moderate: Consume at least 1,000–1,500 mg/day EPA and DHA (as TAGs) for at least 12 weeks to improve levels. Those with baseline O3i <4% will likely need longer time periods of supplementation and/or higher doses.

(3). Those individuals with an O3i of 2–4%: Consume 1,500–2,250 mg/day of EPA and DHA (as TAG’s) or 2,250–3,250 mg/day (EE’s) to reach 8%.

(4). Those individuals with an O3i of 4 to 6%: Consume 1,000–1,500 mg/day of EPA and DHA (as TAG’s) or 1,500–2,250 mg/day (as EE’s).

• • Ultimately, one’s choice of fish consumption, fortified foods, or dietary supplements will depend on their baseline O3i, their food tolerance, and availability.
  • The research supporting the recommendations above was directed towards improving O3i rather than maintaining healthy levels, so the appropriate dose for maintenance is an area for future research.

 

Omega-3 Dietary Supplements

Because the only practical way to obtain recommended amounts of EPA and DHA in one’s diet is by eating fish,  dietary supplements provide the only alternative source for those who do not eat enough fish. There are many different dietary supplement formulations of Omega-3s available. Formulations of omega-3 dietary supplements vary widely, so it is important to check product labels to determine the types and amounts of omega-3s in them. Omega-3 dietary supplements can be fish oil-based or plant-based (vegan). In some cases, fortified foods (above) may offer additional options for supplementing one’s diet.

Some formulations include fish oil, krill oil, or cod liver oil and some are vegetarian only products that contain algal oil made from microalgae. Some formulations also include other nutriceutical compounds in addition to omega-3s including vitamin A and vitamin D (cod liver oil) or curcumin, and black seed oil (Bio-Avail Omega+).

Omega-3 dietary supplements vary in omega-3s chemical composition; a recent review identified the most common are triglycerides (TAG) or ethyl esters (EE).  Supplements composed of TAG are more bioavailable and thus more effective than other formulas so lower doses can be employed.

The review found the lowest supplement intervention dose was formulated to supply only 100 mg/day EPA + DHA, while the highest was formulated to supply 4,400 mg/day EPA + DHA.

Krill Oil

Krill oil contains omega-3s primarily as phospholipids. Some studies suggest that these phospholipids have somewhat higher bioavailability than the omega-3s in fish oil, whereas other studies do not.

Plant-based Omega-3 Supplements

Plant-based sources of omega-3s are made from algal oil (derived from algae). Algal oil is a good direct source of DHA and in some cases, EPA. It provides the same benefits as fish oil but is a better choice for those choosing to follow a plant-based diet or for those who can’t tolerate the taste or after-effects of fish oil. Plant-based sources of omega-3s usually provide doses around 100–300 mg of DHA and some contain EPA as well. These supplements typically contain omega-3s in the triglyceride form (TAG) . According to a small study, the bioavailability of DHA from algal oil is equivalent to that from cooked salmon.

While certain types of seaweed and algae contain small amounts of omega-3s, the amounts may vary and not all types are good sources. So, if opting for vegetarian Omega 3 supplements, check for the amounts and sources.

Adverse Effects of Omega-3 Fatty Acid Supplements

Studies with omega-3 fatty acid supplements have reported no serious adverse reactions. The more common adverse effects of fish oil supplements, particularly in higher dosages, include nausea, fishy belching, and loose stools. Although seafood contains varying amounts of mercury, omega-3 supplements generally have not been found to contain mercury because it is removed during processing and purification. That being said, one should check the label before purchasing.

The Dietary Supplement Label Database (http://www.dsld.nlm.nih.gov/dsld/) from the National Institutes of Health contains label information from many dietary supplements on the market that contain omega-3s.

 

Omega-6 Fatty Acids

Omega-6 fatty acids are a family of fats that are essential for human health. They are polyunsaturated fatty acids (PUFAs) that are found in plant oils and seeds.

Some types of omega-6 fatty acids:

• • Linoleic acid: A type of omega-6 fatty acid that is found in sunflower seeds
  • Arachidonic acid: A polyunsaturated omega-6 fatty acid that is a precursor in the formation of leukotrienes, prostaglandins, and thromboxanes
  • Gamma linolenic acid: A type of omega-6 fatty acid that may help reduce inflammation

Benefits of omega-6 fatty acids:

• • Brain function: Important for brain function, along with omega-3s
  • Growth and development
  • Stimulation of skin and hair growth:
  • Maintain bone health
  • Regulate metabolism
  • Maintain the reproductive system

 

Types of Fat: Saturated, Polyunsaturated, Monounsaturated and Trans

The Nutrition Facts label on each bottle of oil lists the content of four different types of fat: saturated, polyunsaturated, monounsaturated and trans fats.  Because of the links between saturated fats and heart disease and stroke, the American Heart Association recommends that most saturated fat in the diet be replaced with mono- and polyunsaturated fat and that trans fats be avoided altogether.

Saturated Fat

Saturated fat can come from meat, lard, and dairy, as well as some plant sources like coconut and palm. Saturated fat is solid at room temperature. Recent research is showing a role for saturated fat in a healthy lifestyle, but it should still be used sparingly because of its link to poor health.  It is recommended to limit or avoid animal-based saturated fats completely.

Polyunsaturated Fat

Polyunsaturated fat tends to be higher in omega-6 than omega-3 fatty acids, which is linked to inflammation in the body. Healthier polyunsaturated oil choices contain more omega-3s and less omega-6s. Polyunsaturated oil is less stable than monounsaturated or saturated fat. Polyunsaturated fat can degrade in the body, leading to oxidation and cell damage. These types of fat are not typically used for cooking — especially not at higher temperatures.

Mono-unsaturated Fat

Oil that’s high in monounsaturated fatty acids is a staple of the Mediterranean diet, which has been shown to extend length and quality of life. Monounsaturated fats tend to be higher in omega-3s than other types of oil and usually solidify when refrigerated. Oils high in monounsaturated fats include avocado, sunflower, safflower and peanut oils.

Trans fats

Trans fats are unsaturated fatty acids found in both natural and industrial sources. They can be harmful to your health and increase the risk of heart disease and death. Trans fats can be found in many commercial foods, including baked goods, fried foods, frozen pizza, microwave popcorn, and margarine. Eggs are low in both saturated and trans fats and commercial peanut butters do not contain trans fats.
.

• • Trans fats in fried foods
    Even though restaurants and bakeries have reduced or eliminated the use of trans fats, trans fats can still develop during the frying process. 
  • FDA regulations
    In 2015, the FDA banned the use of partially hydrogenated oils (PHOs) in the United States. PHOs are oils that are turned into solid fats, like shortening or margarine. The FDA also requires that trans fats be listed on Nutrition Facts labels.
  • World Health Organization (WHO) goals
    The WHO has set a goal to eliminate industrially produced trans fats by the end of 2023. As of the end of 2021, 40 countries had implemented policies to eliminate industrial trans fats.

 

Cooking Oils

The choice of what oil to cook with is important relative to health considerations, as some oils are definitively more healthy than others. The Nutrition Facts label on each bottle of oil lists the content of three different types of fat: saturated, polyunsaturated, and monounsaturated. Some of each kind are beneficial in the diet, but because of the links between saturated fats and trans fats with heart disease and stroke, the American Heart Association recommends that most saturated fat in the diet be replaced with mono- and polyunsaturated fat and that trans fats be eliminated.

Most cooking oils contains about 120 calories and 14 grams of fat per tablespoon.

Choosing a Cooking Oil

When choosing a cooking oil from a health perspective, the most important consideration in choosing a cooking oil is the content of its fats. As noted above,  monounsaturated and polyunsaturated fats are emphasized.

One should also be aware of an oil’s smoke point, which is the temperature at which an oil begins to smoke and burn. Smoke points of oils typically range from 225 – 510 degrees Fahrenheit. When oil is overheated, its taste and nutritional value may be altered. When it starts to burn and smoke, it releases toxic free radicals into the food and toxic compounds into the air in the kitchen.

Always look for organic oils and avoid dangerous, “partially hydrogenated” (trans) fats. Many conventional cooking oils are extracted from plants with industrial chemicals such as hexane. Cold-pressed oil, extracted mechanically from the plant or seed using pressure, is typically healthier. Some oils are refined so they can better withstand heat, but refinement reduces nutritional value. Some experts recommend avoiding genetically modified oils (GMO-free) – See below.

The Healthiest Cooking Oils

Most cooking oils contain all three types of fat, or at least two, but sometimes people classify them by the type they contain the most of. Here are some recommended oils:

Extra Virgin Olive Oil

Extra virgin olive oil (EVOO) comes from olives with a rich, distinctive flavor and contains mostly monounsaturated fat. “Extra virgin” means it’s an unrefined oil in a natural state, not treated with chemicals or heated. EVOO and a relatively low smoke point of 375 degrees Fahrenheit so, while one can cook with EVOO on the stovetop, other oils may be a better choice for frying or high-heat cooking. Extra virgin olive oil contains the highest amount of health-protecting monounsaturated fatty acids of any oil, along with vitamins A, D, E, K, and beta-carotene and is rich in polyphenolst.

Refined olive oil is lower quality and loses some of its antioxidants and other nutrients in processing, so stick with EVOO.

Best Uses: EVOO is great for sautéing garlic and other veggies at low heat, and it makes a delicious oil and vinegar dressing for salads. You can also use it in recipes such as pesto and ratatouille.

Avocado Oil

Avocado oil is a monounsaturated fat extracted from the fruit of the avocado tree. It has a mild, buttery taste and a smoke point of 520 degrees Fahrenheit. One study showed that avocado oil helped reduce LDL (bad) cholesterol and triglyceride levels while increasing HDL (good) cholesterol in people with high cholesterol.

Best Uses: Because of its very high smoke point, it is good for highest-heat cooking and frying but can also be used cold in dips or recipes. The low-carbohydrate FODMAP diet, which helps reduce symptoms of irritable bowel syndrome (IBS), makes extensive use of avocado oil.

Grape Seed Oil

Organic grape seed oil is a healthy cooking oil, high in vitamin E and antioxidants and is known to deter harmful organisms. Cold-pressed or expeller-pressed is the best choices because other options involve chemical processing which introduces harmful polyaromatic hydrocarbons into the oil. Don’t confuse it with rapeseed, a similarly named oil that comes from another plant entirely, but is not a healthy option.

Best Uses: Grape seed oil has a smoke point of 390 to 420 degrees, so one can use it for sauteeing and other high-heat cooking, but it also works well in a homemade salad dressing recipe.

Flaxseed Oil

Flaxseed oil comes from the seeds of the flax plant. It is a neutral-tasting oil with a very low smoke point of only 225 degrees Fahrenheit, which means one should not use it for high-temperature cooking. Flaxseed oil has the highest alpha-linolenic acid (ALA) omega-3 content of all oils, plus some fiber. Studies have shown the omega-3s in flaxseed oil are associated with nearly a 10 percent lower risk of fatal heart attacks.

Best Uses: Use at room temperature in recipes for dips and dressings. Add a teaspoon to a fruit smoothie to boost your nutrition without changing its flavor. Many people take flaxseed oil as a supplement.

Sesame Oil

Made from sesame seeds, this oil has equal amounts of polyunsaturated and monounsaturated fats. Its nutty, fragrant flavor best complements South Asian, Middle Eastern, and African cuisine. It has a smoke point of 350 (unrefined) or 450 (refined) degrees Fahrenheit. Sesame oil has an extremely high antioxidant capacity, making it good at fighting free radicals. Although it has anti-inflammatory properties, it’s also higher omega-6 content than some other oils, so use it in moderation.

Best Uses: With its distinctive taste, a little sesame oil goes a long way. It can be a good oil for high temperature cooking and for people who are allergic to peanuts.

Walnut Oil

Pressed from walnuts, this oil has a rich, nutty taste. Its smoke point is 320 degrees Fahrenheit. It’s high in the essential fatty acid ALA and contains an antioxidant called ellagic acid, which research suggests may be an important nutrient in the fight against cancer.  Walnut oil is a good source of  other important nutrients including B vitamins, vitamin E, selenium, iron, and calcium.

Best Uses: Walnut oil’s flavor and texture make it good for low heat uses such as baking, marinades, dressings, or atop whole-grain pasta.

Coconut Oil  – Encouraged or Avoided?

An integral part of tropical cuisine, coconut oil is extracted from coconut flesh. One can buy unrefined extra virgin coconut oil or refined coconut oil for a more neutral flavor. Its smoke point is 350 (unrefined) and 450 (refined) degrees Fahrenheit. Unlike olive oil, the terms “virgin” and “extra virgin” are not regulated and should be considered interchangeable.

Coconut oil is 92 percent saturated fat, The predominant type is lauric acid (47%), with myristic and palmitic acids present in smaller amounts, which have been shown to raise harmful LDL levels. Coconut oil raises “bad” LDL cholesterol more than unsaturated oils but less than butter.

Researchers have concluded that because of coconut oil’s effects on raising blood cholesterol including harmful LDL and in some cases triglycerides, and because its cholesterol-raising effects were comparable to other saturated fats, coconut oil should not be viewed as a heart-healthy food and should be limited in the diet. (Source)

Coconut  MCT Oil vs Coconut Oil

Many of the health claims for coconut oil refer to research that used a special formulation of coconut oil made of 100% medium-chain triglycerides (MCTs), not the commercial coconut oil most available on supermarket shelves. MCTs have a shorter chemical structure than other fats, and so are quickly absorbed and used by the body. After digestion, MCTs travel to the liver where they are immediately used for energy. The theory is that this quickly absorbed form promotes satiety and prevents fat storage.

Coconut oil however contains mostly lauric acid, which is not an MCT. Lauric acid is absorbed more slowly and metabolized like other long-chain fatty acids. So, the health benefits reported from a specially constructed MCT coconut oil that contains medium-chain triglycerides other than lauric acid cannot be applied directly to commercial coconut oils.

Best Uses: Coconut oil is extremely versatile. When making Thai or Indian food, use the unrefined oil which retains the coconut flavor more than refined coconut oil. One can use coconut oil for frying, sautéing, baking, to grease pans or add it to coffee.

 

When to Limit or Avoid a Cooking Oil 

The arguments against using specific cooking oils are based largely on their fat profiles (monounsaturated fats  preferred over saturated fats and to some degree polyunsaturated fats and mostly to avoid trans fats). Additional arguments against some oils are the presence of genetically modified (GM) compounds and the potential for an oil to be contaminated with toxic solvents such as hexane during processing.

Genetically Modified (GM) Foods

Genetic modification alters the genetic machinery of living organisms including animals, plants and microorganisms. Combining genes from different organisms is known as recombinant DNA technology and the resulting organism is said to be ‘Genetically Modified (GM)’, ‘genetically engineered’ or ‘transgenic’.

There a variety of motivations for genetic modification including enhancing resistance to viruses, pests and inclement weather environments as well as improving the taste or nutritional values of a food. The principal transgenic crops grown commercially are herbicide and insecticide resistant soybeans, corn, cotton and canola. GM foods are often reported to be higher in nutrients and contain more minerals and vitamins than those found in traditional foods and they often taste better. GM foods can have increased shelf lives with less concerns for spoiling quickly. Some transgenic foods now available in the market include cotton, soybean, canola, potatoes, eggplant, strawberries, corn, tomatoes, lettuce, cantaloupe, and carrots.

The technology of gene manipulation raises questions as to the risks of “tampering with Mother Nature.” The biggest threat of GM foods is that they can have harmful effects on health and on the environment. Since not much is known about their long term effects, many people prefer to simply avoid GM foods.

Health risks associated with GM foods are concerned with toxins, allergens, or genetic hazards. With regards to genetic hazards, it is not the transferred gene itself that necessarily poses a health risk, it is the expression of the gene and the affects of the gene product. Fore example, new proteins can be synthesized that may produce unpredictable allergenic effects.

Early research suggested that GM foods could have toxic effects on the liver, pancreas, kidneys or reproductive organs and that they may alter hematological, biochemical, and immunologic parameters. However, many years of research with animals and clinical trials are still required for this assessment. For now, the decision to ingest GM foods remains controversial and left to the individual.

 

Cooking Oils to Limit or Avoid

Based on potential health risks, including the presence of GM foods, the following oils should be avoided or limited in their use:

Soybean Oil

Soybean oil is is too high in omega- 6 fatty acids, which increases the risk of obesity, inflammation, cardiovascular disease, cancer, and autoimmune diseases. Unless organic, it also comes from GM soybeans and is extracted with the neurotoxin hexane, a toxic chemical solvent that may end up in the final product. GMO soybean oil is commonly found in packaged foods, so read product labels.

Corn Oil

More than 50% of corn oil is polyunsaturated fat, and it also contains a high proportion of omega-6 fatty acids. Most corn oil is extracted with hexane, a toxic chemical solvent that may end up in the final product and most corn oil comes from genetically modified corn.

Canola Oil

Although it is polyunsaturated, most canola oil is genetically modified. Canola is also heavily processed and extracted with hexane, which may contaminate the cooking oil. High heat is used during canola oil processing, which turns polyunsaturated fats rancid — or into dangerous trans fats. One study found that 0.5 to 4 percent of the oil in soybean and canola oil being sold had turned to trans fats.

Palm Oil

Palm oil may have more grams of fat per serving than other oils (22 grams vs. 14 grams), and it also consists almost entirely of saturated fat. Like soybean oil, palm oil is found extensively in packaged foods.

Cottonseed Oil

Made from seeds of the cotton plant, which aren’t edible, this polyunsaturated oil can contain residue of chemical fertilizers and pesticides used to grow the cotton. More than half of the fatty acids it contains are omega-6, and it’s higher in saturated fat than most polyunsaturated oils.

Peanut Oil

Peanuts often contain aflatoxins, substances responsible for severe allergic reactions in some people. The oil contains high levels of omega-6 fatty acids, which contributes to inflammation in the body. While peanut oil is high in healthy monounsaturated fats, it is also his in unhealthy saturated fats, making its fat profile less healthy than other oils like olive and avocado oils.  Peanut oil is also prone to oxidation, which means the fat goes bad on the shelf — often without one realizing it. Peanut oil also has been linked to high rates of atherosclerosis (hardening of the arteries), possibly due to its high levels of lectins.

 

Crisco

Crisco shortening is gluten free and contains ALA omega-3 fatty acid, but no EPA or DHA. It is used for baking and frying, substituting for butter or margarine. While the latest version of Crisco is considered less harmful than older versions due to the removal of trans fats, it is still a processed fat that is high in saturated fat and should be avoided or consumed in very limited amounts.

Crisco contains the following (unrecommended) oils:

• • Soybean oil
  • Fully hydrogenated palm oil
  • Palm oil

Crisco shortening contains the following nutrients per tablespoon: 

• • Calories: 110
  • Total fat: 12 grams
  • Saturated fat: 3.5 grams
  • Trans fat: 0 grams
  • Polyunsaturated fat: 6 grams
  • Monounsaturated fat: 2.5 grams
  • Cholesterol: 0 milligrams
  • Sodium: 0 milligrams
  • Total sugars: 0 grams
  • Protein: 0 grams

“Vegetable Oil”

Products are sometimes simply labeled as “vegetable oil” and generally contain a mixture of different cheaper but unrecommended oils, usually soybean, canola, corn, cottonseed and other oils that are high in omega-6 fatty acids. While it may be cheaper, avoid anything labeled only as “vegetable oil” because it is, inevitably, also processed with toxic solvents like hexane and is simply not the healthiest choice.

 

Points to Remember

The best cooking oils are fresh, organic, and cold-pressed. They’re rich in omega-3 fatty acids and stand up to the level of heat you plan to use. Olive and avocado oil, with the most monounsaturated fat, are the most healthful choices. Sesame and walnut oil are also excellent choices for cooking. Flaxseed oil, which is high in omega-3 fatty acids, is a good option for low-temperature uses, like salad dressing.

Coconut oil contains mostly saturated fat so its use should be limited, but coconut MCT oil, if available, may offer unique advantages.

Stay clear of hydrogenated oils (usually found in margarine and packaged foods) because they contain dangerous trans fats.  Avoid soybean, corn, palm kernel, cottonseed, canola, and grapeseed oil as they  are extracted with harsh chemical solvents (hexane). Additionally, they likely contain GM compounds.

 

Purchasing Supplements

To purchase supplements reviewed on this web site or discussed with Dr. Ehlenberger, a discount can be applied to usual commercial pricing by purchasing from Accurate Clinic’s online Supplement Store after acquiring the discount code from Accurate Clinic. Please note that Dr. Ehlenberger does not receive any financial rewards from sales through this store, it has been set up as a means to allow purchase of quality supplements more accessible and more affordable for his patients.

Accurate Clinic’s Supplement Store or, call Toll-Free: 877-846-7122 (Option 1)

 

Resources:

Online Resources for Nutritional Information

MyFoodData.com

MyFoodData.com provides nutrition data tools and articles to empower you to create a better diet. All data is sourced from the USDA Food Data Central.This site includes many tools related to nutrition including one that allows you to look up any food for a nutritional analysis, including commercial products,

 The Nutrition Source

www.Nutrition.gov
Nutrition.gov provides easy access to vetted food and nutrition information from across the federal government. It serves as a gateway to reliable information on nutrition, healthy eating, physical activity, and food safety for consumers. Since dietary needs change throughout the lifespan, specialized nutrition information is provided about infants, children, teens, adult women and men, and seniors. Users can find practical information on healthy eating, dietary supplements, fitness and how to keep food safe. The site is kept fresh with the latest news and features links to interesting sites.

 

 National Association to Advance Fat Acceptance
Founded in 1969, the National Association to Advance Fat Acceptance (NAAFA) is a non-profit, all volunteer, civil rights organization dedicated to protecting the rights and improving the quality of life for fat people. NAAFA works to eliminate discrimination based on body size and provide fat people with the tools for self-empowerment through advocacy, public education, and support.

 

Journals & Newsletters

 

Books

“Dopamine for Dinner”

by Joan Borsten, 2014
Available online at Amazon.com: Kindle subscriber: free;  Kindle book: $9.95  Paperback: $149.00

 

“Dopamine for Dinner,” is the first Malibu Beach Recovery Diet Cookbook, based on their famous low-glycemic diet. The recipes developed by four accomplished chefs are both pleasant eating as well as healthy. Based on the use of low glycemic index foods, the recipes emphasize nutritious eating in a manner that promotes maintaining high brain levels of dopamine and serotonin as a means of supporting healthy brain chemistry.

 

Educational Resources:

Genetically Modified Food

• Genetically Engineered Crops- Experiences and Prospects – 2016
• Genetically modified foods- safety, risks and public concerns—a review – 2012

 

Misc.

1. Simopoulos AP. The importance of the ratio of omega 6/omega 3 essential fatty acids. Biomed Pharmacother. 2002 Oct;56(8):365-379.
2. LeGendre O, et al. (-)-Oleocanthal rapidly and selectively induces cancer cell death via lysosomal membrane permeabilization. Mol Cell Oncol. 2015 Jan; 2(4):e1006077.
3. Carvajal-Zarrabal O, et al. Effect of dietary intake of avocado oil and olive oil on biochemical markers of liver function in sucrose-fed rats. Biomed Res Int. 2014;2014:595479.
4. Unlu NZ, et al. Carotenoid absorption from salad and salsa by humans is enhanced by the addition of avocado or avocado oil. J Nutr. 2005 Mar;135(3):431-436.
5. Irandoost P, et al. Does grape seed oil improve inflammation and insulin resistance in overweight or obese women?. Int J Food Sci Nutr. 2013 Sep;64(6):706-710
6. Del Gobbo LC, et al. ω-3 ω-3 polyunsaturated fatty acid biomarkers and coronary heart disease pooling project of 19 cohort studies. JAMA Intern Med. 2016 Aug; 176(8):1155-66.
7. Carvalho M, et al. Human cancer cell antiproliferative and antioxidant activities of Juglans regia L. Food ChemToxicol. 2010 Jan; 48(1):441-447.
8. Deol P, et al. Soybean oil is more obesogenic and diabetogenic than coconut oil and fructose in mouse: Potential role for the liver. PLOS One. 2015 June.
9. O’Keefe S, et al. Levels of trans geometrical isomers of essential fatty acids in some unhydrogenated U. S. vegetable oils. J Food Lipid. 1(3):165-176.
10. Kritchevsky D, et al. Lectin may contribute to the atherogenicity of peanut oil. Lipids. 1998 Aug;33(8):821-3.

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

Supplements recommended by Dr. Ehlenberger may be purchased commercially online

Please read about our statement regarding the sale of products recommended by Dr. Ehlenberger.

 

 

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