An anti-inflammatory question
March 14, 2022 5:16 PM   Subscribe

What's the difference between anti-inflammatory foods and NSAID anti-inflammatory pills? Why are the former considered healthy and good for longevity, while you should not take the latter on a regular basis?
posted by musofire to Health & Fitness (18 answers total) 6 users marked this as a favorite
I don't know exactly, but I know that my doctor has told me that I can expect very modest improvements in my inflammation from a dietary change, and I'm not allowed to take Ibuprofen any more because it causes rampant inflammation. I think the idea is that food doesn't react unpredictably with your body chemistry and NSAIDs can.
posted by Pacrand at 5:27 PM on March 14, 2022

NSAIDs have been prescribed for people with inflammation (like osteoarthritis and inflammatory arthritis), but they also have some serious side-effects that are a drawback for long-term use, like stomach problems.

That said, I have been prescribed low-dose aspirin (an NSAID) as a preventative for high blood pressure, and many people with heart conditions are also prescribe it. With a low dose, the benefit outweighs the risk.
posted by jb at 5:37 PM on March 14, 2022

And I think no one can eat enough blueberries to make themselves sick - the chemicals are just not strong enough.

(Are blueberries anti-inflammatory? or something else? I'm very skeptical of "superfood" claims - though I know that kale and other vegetables with lots of vitamin K support blood clotting. This only matters if you are on particular blood-thinners - for the rest of us, you can't eat enough to be a problem).
posted by jb at 5:39 PM on March 14, 2022 [3 favorites]

> And I think no one can eat enough blueberries to make themselves sick - the chemicals are just not strong enough.

Right. There have been people who have injured their livers with green tea extract - something we don't see in just drinking green tea.
posted by sebastienbailard at 5:47 PM on March 14, 2022

One possibility is that whole foods and an anti-inflammatory diet support a healthy gut microbiome, whereas “ibuprofen can wipe out gut bacteria in a fashion similar to antibiotics”.
posted by stellaluna at 5:51 PM on March 14, 2022 [1 favorite]

This link (a government health website) says this about NSAIDS:

NSAIDs can cause serious side effects, some of which may be life-threatening.
NSAIDs may interact with other medicines and cause unwanted effects.
NSAIDs should always be used cautiously, for the shortest time possible and at the lowest effective dose.

Fresh fruits and vegetables, salmon, almonds, whole grains etc do not require such warnings.
posted by lulu68 at 6:02 PM on March 14, 2022

Warning: Probably contains some wellness bs

An inflammatory response is your body mounting a defence against something like a cut or an infection. Sometimes this is really appropriate, like when I broke my leg. Sometimes it's not, like long-term joint point. NSAIDs block specific enzymes to get your body to calm down its response. But how those drugs are processed in your system can cause issues.

An anti-inflammatory diet in my understanding helps your body work more efficiently so that it can both respond to certain things but also calm down. For me personally, when I'm focusing on whole foods that have anti-inflammatory properties, I do have fewer issues.

It is noticeable (whether placebo or not) when I fall off the wagon and have chips and refined carbs etc. in lieu of whole foods. Everything aches more and my peripheral neuropathy gets worse.

But it's not going to stop my hip from throbbing in the night after I overdo it.
posted by warriorqueen at 6:04 PM on March 14, 2022 [8 favorites]

Yeah, you have to be a little wary of the term "inflammation" w/r/t food or supplements or lifestyle behaviors. NSAIDS have proven in studies to reduce literal tissue inflammation. Swollen ankle, less swollen ankle. But they are tough on your stomach lining and the delicate structures inside of your intestines and also brain and circulatory system. That damage - including from injected or intravenous NSAIDS - eventually makes those tissues bleed, which is bad, plus the kidneys can't handle terribly much of it.

But a sufficient number of blueberries come with their own set of risks, including toxicity. (In fact, blueberries specifically are an allergy trigger risk to people allergic to salicylic acid - aspirin.) Nothing is "healthy" without context and considerations. If you only ate allegedly anti-inflammatory foods (we don't actually know much about what is or isn't, in whom, under what circumstances) in volumes large enough to get the same effect as synthesized NSAIDS, you would find yourself suffering a number of other ailments. There are lots of people who do feel they are experiencing an overall reduction in inflammation symptoms with changes in diet - I fall into that category, my partner with an actual auto-immune disease does too - but if you put it to clinical testing it'd be difficult to prove.

It is increasingly possible to test for various systemic inflammation markers in bloodwork - this is often part of the diagnostic or differential process in auto-immune conditions - and people appear to experience a reduction in related symptoms when they do or don't eat certain things. We know the inflammation is important, it is science that it is meaningful when it is elevated, but we do not really know a ton about it in an immune sense. Not nearly as much as people with smoothies want to say we do. It's kind of in the same arena as "gut health", which we know is not only important for digestion but for neurochemical production and endocrinological function, but we still know very very little about how and what and why and what it all means.
posted by Lyn Never at 6:38 PM on March 14, 2022 [13 favorites]

I suspect avoiding inflammatory foods, especially sugar, and, in my case, dairy, really helps, and that salmon and blueberries optimize nutrtion, but have moderate effect on inflammation.
posted by theora55 at 8:28 PM on March 14, 2022 [1 favorite]

It's remarkably difficult to get clear information on it, but I believe that "anti inflammatory foods" use a completely different mechanism and different substances to reduce inflammation, than "anti inflammatory drugs" do.

I would love to have this confirmed but it seems that the anti inflammatory term refers to the effect produced, rather than the actual substances involved, much like drinking water can help ward off a headache, but water doesn't contain the same substances as a headache pill.
posted by Zumbador at 8:47 PM on March 14, 2022 [3 favorites]

NSAIDs block the cyclooxygenase enzyme used to make prostaglandins. (You might have heard of "Cox2 inhibitors." That's cyclooxygenase.) Prostaglandins cause localized pain and also cause a localized inflammatory response.

Foods that are supposedly anti-inflammatory act through different biochemical pathways. They might work through interleukins and C-Reactive Protein, or other factors. The science on this isn't completely in.
posted by Knowyournuts at 8:50 PM on March 14, 2022 [4 favorites]

Oh, and the problem with taking NSAIDs and gastrointestinal bleeding - the same biochemical pathway I mentioned above interferes with the platelet response that would slow down bleeding.
posted by Knowyournuts at 8:53 PM on March 14, 2022

The term "inflammatory" has been misappropriated.

In traditional Chinese medicine, there's the concept of yin (cool) and yang (hot) and it applied to a lot of herbal medicines and food. In my personal experience, I nod and smile. The concept of yin and yang when it comes to food, in my personal experience, is the balance of flavours and textures in a particular dish/ across dishes that makes up an incredibly balanced and satisfying meal.

It's gotten to the point where "inflammatory" foods is basically the same as the British-ism that "eating carrots improves your eyesight."

Inflammation, in the context of mammalian immunology, is the recognition of potentially dangerous microbes by your innate immune system and the recognition of previously determined-as-dangerous-microbes by your adaptive immune system.

Inflammation - in the oldschool Western sense - comes from the Roman idea that calor (heat), dolor (pain), rubor (redness), and tumor (swelling) are associated with microbial infection.

Not bad.

Modern understanding of inflammation is that there are immune and immune adjacent cells that can recognize the presence of potentially- and previously-known-to-be microbobes and send complex signals to each other through cytokines - the release of small signalling peptides - that cause the message recipients to do stuff that leads to the heat, pain, redness, and swelling as a response/ side-effects of trying to kill/ get-rid-of those microbes.

Cytokines are generally classified as pro-inflammatory and "modulating" (note: not "anti-"inflammatory).

In the case of NSAIDs - they work on the COX receptor. There are two major types in humans; COX1 and COX2; aspirin hits both of these more-or-less equally. COX1 receptors mediate inflammatory communication and tamping it down helps relieve symptoms of inflammation.

COX2 are expressed in the gastrointestinal tract; inhibiting these can cause gastrointestinal distress, and in severe cases bleeding. There is new data indicating that the pathways are more complex than originally thought, though and inhibition of COX2 isn't necessarily sufficient to cause the bad side effects.

Newer NSAIDs like Ibuprofen are more selective at inhibiting COX1 and COX2, and indeed there are fewer GI side effects compared to aspirin.


(sorry folks) "anti-inflammatory" foods is mostly BS. I'd be wary of "experts" who use the term.

There's some hand-wavy stuff about anti-oxidants, but that's also pretty sketchy these days.

Eating pizza/ animal fats/ oily foods doesn't cause/ exacerbate acne either.
posted by porpoise at 8:53 PM on March 14, 2022 [12 favorites]

Anti - inflammatory foods are foods that do not cause, or are least likely to cause inflammation.

NSAIDS are drugs that help alleviate inflammation once it is already present in the body.
posted by itsflyable at 10:43 PM on March 14, 2022 [3 favorites]

People have done a decent job of getting at details and how little we really understand and how inflammation is used to refer to a whole range of phenomena.

But I want to offer one analogy that came to me reading your question: What's the difference between a deep massage and getting hit with a hammer?
posted by Lady Li at 12:46 AM on March 15, 2022 [1 favorite]

Do you get drunk off one slightly fermented grape? Maybe, but not noticeably. Much like grapes are fermented and distilled and into brandy that concentrates the active ingredient, NSAIDs are processed medicine with concentrated active ingredient.

Too much grapes, you probably won’t feel much except the poops. Too much brandy? Bad time. Same with NSAIDs.
posted by Geckwoistmeinauto at 1:27 PM on March 15, 2022

Oof there's a lot of nonsense in here. NSAIDs are anti-inflammatory drugs. The idea that food might have some relationship to something kind of akin to inflammation that might somehow both screw up your microbiome and make your body larger is essentially an untested hypothesis at best even in animals; dietary recommendations based on this interesting supposition are free of any support whatsoever. Foods are not anti-inflammatory in any meaningful sense. Eating blueberries or kale or whatever isn't going to help your tendinitis or your headache or cause stomach problems or do any of the things that NSAIDs definitely, demonstrably do.
posted by shadygrove at 2:08 PM on March 15, 2022 [1 favorite]

Best answer: Hmm, I think this is the paper you want to read:

Low-grade inflammation, diet composition and health: current research evidence and its translation, The British Journal of Nutrition, Oct 14, 2015.

If you're not used to reading scientific and medical type papers, it might be a bit of tough going (google all the acronyms - that's the main difficulty). But it addresses all the questions you have and also discusses various approaches to addressing the systemic low-grade inflammation issue - such as different dietary interventions - and talks about the evidence there, including where it is contradictory, shaky, or just lacking.
Inflammation is a central component of innate (non-specific) immunity. In generic terms, inflammation is a local response to cellular injury that is marked by increased blood flow, capillary dilatation, leucocyte infiltration, and the localised production of a host of chemical mediators, which serves to initiate the elimination of toxic agents and the repair of damaged tissue. It is now clear that the termination (alternatively known as resolution) of inflammation is an active process involving cytokines and other anti-inflammatory mediators, particularly lipids, rather than simply being the switching off of pro-inflammatory pathways.

Inflammation acts as both a ‘friend and foe’: it is an essential component of immunosurveillance and host defence, yet a chronic low-grade inflammatory state is a pathological feature of a wide range of chronic conditions, such as the metabolic syndrome (MetS), non-alcoholic fatty liver disease (NAFLD), type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Although the association between inflammation and chronic conditions is widely recognised, the issue of causality and the degree to which inflammation contributes and serves as a risk factor for the development of disease remain unresolved.
Later on, they say "There is a substantial amount of evidence to suggest that many foods, nutrients and non-nutrient food components modulate inflammation both acutely and chronically." However, they go straight on to emphasize that various factors put a "significant limitation to our understanding of diet/nutrient–inflammation interactions."

In short, the association between low grade, systemic inflammation and a bunch of different conditions (cardiovascular disease, Type 2 diabetes, fatty liver disease, metabolic syndrome) is well established.

But WHY that association exists, and what causes it, are less established. A logical assumption would be that the inflammation causes the disease and if you could slow or stop that inflammation you would slow or stop the progress of that disease. However, that is an unproven assumption for now! Perhaps the condition causes the inflammation, perhaps the condition and inflammation cause each other in a sort of vicious cycle, or perhaps some third factor(s) cause both of them simultaneously.

All those (and more) are possibilities that we can't, as yet, narrow down to just one.

There is also some evidence, but not complete or the highest quality evidence, to think that diet may affect these inflammatory responses.

So this is an exciting area of research yet it also has a lot of loose ends and unproven ideas - especially including, what treatments and dietary interventions might be helpful and why.

As you're reading the paper, note how many times words like these are used: "possibly," "unresolved," "unknown," "contradictory evidence," "may affect," "limits," "limitations," "not all of it consistent," "there is evidence emerging," and so on.

These are all ways of conveying various degrees of uncertainty, and there are piles and piles of thus uncertainty flagged in the article. This is an active area of inquiry many, many questions are far from settled. Undoubtedly many ideas outlined there will prove out in different ways than expected now.

This is a review and summary type article, and as far as I know a fairly decent one. But it is summarizing the current state of the field at that time, including what is known, what is speculated, what is being worked on that may or may not pan out, what is believed with some (incomplete) evidence, that questions are under investigation and what is known and not known about them, what is the quality of evidence for various theories and ideas, what further types of investigation are needed to answer various questions, and so on.

So you can imagine why this sort of environment produces a lot of books and diets and ideas and products that are designed to appeal to the layperson and that have some degree of actual research behind them. There are still so many missing links there though that pretty much all of it must be considered on the cutting edge and experimental - far from completely proven.

So just keep that in mind when evaluating any particular diet, book, product, etc. Big picture this approach is likely onto something really exciting and groundbreaking, but quacks (and over-enthusiastic scientists and doctors) do rush in to fill in those areas of uncertainty with their high-priced products, bring things to market based on one or two shaky, low-quality research studies, and so on.

That goes double when the books/diets/products fit right into an area of people's health where many of us are concerned or anxious.

Buyer beware.
posted by flug at 6:46 PM on March 15, 2022 [6 favorites]

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