What is Inflammation?
Most individuals have heard of the word inflammation at some point or another. Whether that be on TV or from a physician. Typically, the term is used to explain the triggering of the immune system in response to an insult. This insult is generally an injury or an infection. When the immune system gets triggered, it releases inflammatory chemicals and white blood cells that travel to the site of injury or infection and fix that problem. Inflammation is the body trying to protect itself.
Any term that ends in -itis is referring to inflammation. For example, arthritis is inflammation of joints. Colitis is inflammation of the colon. You can see how many conditions are considered inflammatory!
Types of Inflammation: Acute vs Chronic
The most common example of acute inflammation is when you break your ankle. Cells travel to the ankle and cause swelling and redness but ultimately this is to heal the problem. This is a short-term problem and therefore referred to as acute inflammation. When the foreign insult or injury is removed, the inflammation stops.
On the other hand, chronic inflammation refers to the uncontrolled, long-term infiltration of inflammatory mediators. Think of an autoimmune disease like rheumatoid arthritis. This is when your body incorrectly releases inflammatory cells that attack the joints causing inflammation. Chronic inflammation is known to play a role in most conditions such as cardiovascular disease, autoimmune diseases, cancer, Alzheimer’s, multiple sclerosis, obesity, fibromyalgia, and more. (1)
How To Reduce Inflammation?
Diet has long been thought to play a large role in inflammation. Anti-inflammatory foods are vital in chronic inflammation, which is why dietitians are so integral in health care! Examples of anti-inflammatory foods are your deep, dark colored fruits and vegetables (think kale instead of iceberg), nuts and seeds, particularly walnuts, and herbs such as turmeric and ginger. The list is much longer than this but just to give you an idea, most of these are going to be plant-based foods. (2)
Diet first is always my suggestion. Try and eat a rainbow of colors on a daily basis to get these anti-inflammatory nutrients. But what about supplements? I field this question often during sessions with my clients. Long story short, you cannot out-supplement a poor diet or cure an inflammatory disease. However, if diet falls short, this is where supplementation can come in.
How to Choose a Supplement?
First and foremost: Look for 3rd party testing
Because vitamins, minerals, and herbs are not regulated by the FDA, these 3rd party organizations test the quality, strength, safety, and purity of the product and provide their stamp of approval, which is commonly stated on the supplement bottle! If not, you can always check the supplements website. Supplement producers are also required to produce supplements in line with GMP, which is Good Manufacturing Practices set by the FDA.
Well-known third-party testing organizations are the NSF (National Sanitation Foundation), USP (US Pharmacopeia) and Consumer Lab, but many additional companies exist depending on what type of product you are testing.
Practitioners usually have brands that they like so speak to your health care provider if you have questions! Below are some of my favorite general supplement options. Please be advised, supplements are not for everyone nor do I recommend them to everyone.
Anti-inflammatory Supplements I Use in Practice
Alpha Lipoic Acid
Alpha lipoic acid (ALA) is a supplement that has powerful antioxidant and anti-inflammatory properties. It is naturally made by our body’s mitochondria (which you may remember as the powerhouse of the cell from school). It helps to regenerate other major antioxidants, such as vitamin C and E in a downstream way. Research indicates it can decrease the most well-known inflammatory measurement: c reactive protein (CRP). Because CRP is elevated in many cardiometabolic conditions such as type 2 diabetes and atherosclerosis, it is logical that the anti-inflammatory impacts of ALA can improve disease outcomes. The way in which ALA can improve diabetes and polycystic ovarian syndrome (PCOS) is by improving Insulin sensitivity. Lastly, ALA can improve diabetic neuropathy. (3)
The dosages of ALA are between 600-1200 mg/day, which have been proven safe and tolerable in the clinical trials that have been conducted. It is best taken 30 minutes before or 2 hours after a meal for optimal absorption.
I am hopeful that more studies will come out about the use of ALA, especially in the realm of reducing cognitive decline in conditions like dementia/Alzheimer’s. There have only been a handful of studies, but what a discovery that would be!
Curcumin is the active chemical form of turmeric derived from the root curcuma long. Turmeric is a well-known spice in Indian cuisine and carries a deep orange color. However, turmeric is poorly absorbed in the human body (only about 4% is absorbed), so it’s best to supplement it in the form of curcumin.
Curcumin is an antioxidant with strong anti-inflammatory properties. It has been proven useful in many conditions such as metabolic conditions, diabetes, cancer, and numerous autoimmune/ inflammatory conditions specifically arthritic conditions and inflammatory bowel diseases. (4)
Despite curcumin being the more absorbable form, it does require some help from things like black pepper, essential oils, extracts, or phospholipids for optimal use in the body. My personal favorite product contains curcumin extracts in the form of BCM-95 as it has a very high absorption rate. I don’t use black pepper bound curcumin as much because many of my clients have gastro-esophageal reflux disease (GERD) and have complained of irritation with these products. Commonly studied dosages are between 500-1000mg/day and it is best to take with a food that contains fat as it is fat-soluble.
Curcumin is contraindicated with blood thinning medications, and active gallbladder disease/gallstone history.
Vitamin C/Vitamin E
Vitamin C is a water-soluble vitamin that is well known for its ability to support your immune system during sickness. What individuals don’t know it how useful it can be in other conditions. Vitamin C is a powerful antioxidant that can reduce inflammation by controlling something called oxidative stress. Oxidative stress is a fancy name for the imbalance between pro-inflammatory byproducts and anti-inflammatory byproducts. This can cause damage to organs and tissues. (5)
Vitamin E also plays a role in reducing oxidative stress, which is why I will sometimes supplement them together. Vitamin E is an abundant fat-soluble vitamin that has anti-inflammatory properties. Vitamin E and C actually enhance the impact of each other!
Vitamin C and E may reduce inflammation seen in diabetes/obesity, viral illnesses (COVID-19), gout, nonalcoholic fatty liver disease, and coronary heart disease. A unique recent finding was the potential lowered risk in developing Alzheimer’s disease and macular degeneration. (6)
Vitamin C (ascorbic acid) dosages are between 500-1000 mg/day. Monitor your stools as too much vitamin C can cause diarrhea in sensitive individuals!
The typical dosage of vitamin E (alpha tocopherol) is 600-800 IU/day and it should be supplemented in the form of mixed tocopherols and from natural sources. To locate these, look for “d” or “RRR” before the compound name to ensure it comes from natural sources! Because vitamin E has a blood thinning effect, it is counterintuitive to take in large dosages with blot clot conditions.
Vitamin D is one of the most important vitamins for immune and inflammatory responses to protect us. Low or suboptimal Vitamin D levels have been associated with chronic conditions spanning every bodily system such as musculoskeletal, autoimmune, cardiometabolic, and gastrointestinal. Considering how many chronic conditions have roots in inflammation, you can see why it is tested at most doctors’ visits! (7)
As a dietitian specializing in gastrointestinal disorders, it is extremely common for me to see vitamin D deficiencies in inflammatory bowel diseases and malabsorptive conditions such as celiac and pancreatic insufficiency. This is why it is one of my most recommended supplements! (8)
Vitamin D is achieved through sunlight, nutrition (milk, eggs, liver), and of course supplements. I prefer my clients have vitamin D levels above 50 ug/dl for optimal health outcomes, which is consistent with the Institute for Functional medicine. Getting 15 minutes of direct sunlight a day can be an easy method to get enough vitamin D but if supplementation is required, my favorite form is vitamin D3, cholecalciferol. Dosages vary based on condition and current serum vitamin D levels. Regardless of the dosage, I suggested taking it in the morning with a fat containing food since Vitamin D requires fat to be absorbed.
Fish oil has long been recognized as a big name when talking about inflammation. Hence the name, fish oil comes from the tissues of the fish that contain the anti-inflammatory fats and oils. Fish oil is rich in omega 3 fatty acids, which encompasses 3 main types– EPA, DHA, and ALA. You will commonly see these names on the label of fish oil supplements. The research on this supplement is conflicting, but recent studies have shown improvements in many inflammatory-driven conditions, dementia, and also in cardiovascular conditions. Plus, the risk of trialing this product is typically low, so I see many clients supplementing on their own.
The convenience of fish oil supplements is what is most attractive because many people are unable to consume, afford, or even enjoy fish and other foods rich in omega 3’s such as chia seeds, flax seeds, nuts, and avocados. When choosing a supplement, choose one that has been tested for contaminants. The organizations mentioned above are good options to check the safety of a product. (9)
Dosages can vary, but most studies use between 500 mg-2 grams total omega 3’s/fish oil daily depending on desired outcomes, and how much you are already getting in your diet. One complaint I typically hear from my clients is burping or the taste of fish. This can be due to a poor-quality product, taking too much at once, or consuming on an empty stomach. Just like vitamin D and curcumin, it is best to take with a meal that contains fat to improve absorption. It is not recommended to take high doses of fish oil if you are on a blood thinning medication as it can increase bleeding.
If you are vegan or vegetarian and avoid fish, algae oil is a great plant-based option that is also environmentally conscious.
When it comes to gut-driven inflammation, probiotics reign supreme! Because 2/3 of the immune system is located in the gut, it is not surprising that these bacterial bugs can decrease inflammation.
Probiotics can be anti-inflammatory for a few reasons:
- They help to balance the immune system and produce antibodies that protect the gut.
- They compete with potentially pathogenic species that may cause disease.
- They secrete compounds that have anti-inflammatory properties and help to quench body wide inflammation and oxidative stress (remember that word I use above?)
- They strengthen the intestinal barrier, which helps to keep nutrients in, but also pathogenic nutrients out.
Most of the conditions that probiotics are seen to improve are gut-related such as irritable bowel syndrome (IBS) constipation/diarrhea predominant, gastrointestinal infections, and Inflammatory bowel disease. Additional conditions where probiotics are useful are autoimmune conditions and eczema. Of particular interest in recent years are preclinical studies that show benefits in anxiety and depression. However, this has yet to be confirmed in enough human studies. More research is needed on probiotics and their effects, but so far, the outcomes are very promising!
Choosing a Probiotic
With the abundance of probiotics on the market, it can be difficult as a client to choose a product on their own. Marketing can also cause confusion but my two most important tips for when choosing a probiotic are:
- Choose based on the strain designation. A lot of popular products will leave this out and typically that is a red flag. There are multiple different strains for each species, but they all do not have the same mechanism of action. Therefore, you match the strain to the condition or outcome you are looking for. In this photo below for the popular Culturelle Probiotic, the strain is the “GG” designation. This strain is one of the most studied strains and is useful in cases of antibiotic associated diarrhea, gastroenteritis, IBS, and ulcerative colitis.
- Ensure each probiotic strain contains at least 1 billion CFU. This is the dosage that most probiotic research shows efficacy for. Different conditions may require higher dosages so be sure to ask your healthcare practitioner about this! More CFU’s are not always better!
The supplement world is extremely large and also extremely confusing when it comes to navigating the options. It’s best to look at scientific studies rather than trusting everything you read online from sources that may not be reputable. Supplements cannot “cure, treat, or prevent diseases” but they can have certain health benefits such as in the case of inflammation. When it doubt, ask your healthcare practitioner!
Looking for more information on supplements?
As a certified LEAP therapist, Dietitian Kathleen can help you solve your digestive difficulties with cutting edge research and state of the art protocols. Co-author of Cooking with Food Sensitivities Survival Guide.