If you are reading this article, you probably love learning! In fact, you probably love learning about all things health-related. If that is the case, you have also probably encountered many differences of opinion, and scientific research often seems to contradict itself. Plus, there are a lot of self righteous talking heads out there. It’s hard to know what to trust. You are not alone; this confusion exists at every level of health education. This past weekend’s symposium, like most conferences, was no exception.

However, there was a lot of really great information shared too! Some of it was in areas that I don’t focus, like Ayurveda, specialty testing, and restrictive diets. Others dug deep into the physiology of our bodies, how food interacts with our immune system, and common sense eating strategies with proven track records both through research and people’s personal experiences. This second category is what I will be sharing with you. If you are interested in the other topics, I highly encourage you to seek out more information from other practitioners. There are fantastic healers that work in those paradigms, and they are who you want to get that information from - not me!

12 hours of Zoom meetings distilled below:

Main Takeaways:

Two main takeaways came through with most speakers. When looking at nutrition’s influence on mental health, skin health, immune health, and beyond there are two surprisingly easy things to do?

Eat fiber! 35 or more grams daily, when you follow the second recommendation, this is almost difficult to avoid!
Eat 30 or more plants each week. This includes herbs and spices, fruits and vegetables, nuts and seeds, and beans and grains. We aren’t looking for 30 servings, we are looking for 30 different distinct plants. Start counting, this is easier than it sounds!

If you were to start anywhere on your journey into using nutrition as medicine, this is where I would recommend you begin. You can fine tune things for your specific needs and goals later. Just start here, and you should notice a difference within a few weeks. That difference may not be with your primary complaint/goal, but your overall health should shift. If you are already doing this, fantastic! Talk to your healthcare team when you are ready for your next step.

More Specific Content:

The lectures I particularly enjoyed spoke to the role of nutrition in skin diseases and the interplay between food, your microbiome, and your immune system. Dr. Julie Greenberg spoke on skin, and Dr. Heather Zwickey spoke on the connection between immunity and our microbiomes.

Skin inflammation can be life-changing. Anything we can do to treat it needs to be considered. Luckily dietary changes like adding fiber and plants only have positive side effects!

Skin and Diet:

When we look at our skin, we are looking at the barrier between our external world and ourselves. There is a lot of immune activity happening there. However, this pales in comparison to the amount of immune activity happening in our gut. The lining of our digestive tract is another interface between ourselves and the external world, the only difference is we have much more control over what ends up in our digestive system than what lands on our skin - that’s a good thing too!

Equally important to what we put into our digestive system is what lives in there. We will explore this more in the next section, but you may wish to consider that you aren’t just an individual, you are a dynamic and diverse walking, talking ecosystem. There are microbes living on and in every possible surface of our bodies, and without them, we would be in BIG trouble. We need them, they need us, and we can foster a good relationship with them through our food.

Back to the skin. Almost all skin conditions can be linked to issues in our digestive system. These issues range from an inability to digest and absorb nutrients, chronic inflammation, and an imbalance of our gut microbes.

This disruption in our gut shows up on our skin. This is actually a good thing as more people will attend to issues of acne, eczema, or wrinkles than will work hard to regulate their digestive tract. Once we understand that our skin health is a reflection of our health on a deeper level, we can use the state of our skin as one way of tracking our overall wellness.

There are a few specific relationships between specific skin conditions and diet that were explored in Dr. Greenburg’s lecture:

Psoriasis:

There is only one diet-related intervention consistently backed by research for the treatment of psoriasis: weight loss.

That’s not very specific is it? As a doctor, I actually never counsel my patients to lose weight. If they lose weight naturally by incorporating healthy lifestyle choices, great, but I find focusing on weight loss leads to unhealthy and temporary changes more often than not. Chronic dieting and a focus on weight loss also harms people’s relationship with themselves, this is one of the hardest things to heal.

What do people with psoriasis find helpful?

Eliminating alcohol
Cutting out gluten
Avoiding nightshade family plants
Increasing omega 3 fatty acids
Eating more vegetables
Supplementing Vitamin D

Eczema:

In medical school, I was taught to focus on food allergies and elimination to treat the root cause of eczema. While this mode of treatment is effective in about ⅓ of the population, it’s missing things for the other ⅔. Additionally, for many, the inflammation of eczema may actually be triggering food reactions and not the other way around!

What to do?

First, there are foods that do seem to trigger (not cause) eczema in the vast majority of people who are having a food reaction:

Milk
Gluten
Egg
Soy
Peanuts

In severe cases, it makes sense to eliminate these foods for a short period of time to look for a change.

Second, we have to consider the gut and those microbes! Simply eliminating trigger foods isn’t enough if the foods didn’t start the inflammation cycle. There will probably be some relief when removing triggers, but any new exposure could risk starting the inflammation all over again. We need to add things that help rebalance and heal the gut. Enter you guessed it:

Fiber
Organic Produce
Omega 3 fatty acids

Acne:

The link between diet and acne is strong! But it’s not just about avoiding triggers like sugar, chocolate, and fried foods. Again, it’s also what we do eat! Are you seeing a theme here?

Acne doesn’t exist outside of Westernized cultures! Researchers who have studied native land-based populations in Japan, New Zealand, and South America found no acne in these populations; the people didn’t even have a word for it! However, when people begin to eat in a more Western fashion, they develop acne. Cause and effect?

There is a specific enzyme named mTOR that is implicated in the development of acne and is more active in those who eat certain foods. The more active mTOR is, the more sebum and skin cell growth there is. The more sebum and skin cells, the easier it is to block pores. Inside those blocked pores skin bacteria feast on the abundant sebum. The chemicals they poop out alert our immune system and this creates inflammation; then we have acne.

This means, the root cause of acne isn’t the bacteria, it's increased mTOR activity. Puberty changes everything in our bodies including the influence of our diet on mTOR. We can treat acne directly by eating an mTOR modulating diet.

A diet that turns the dial down on mTOR includes

Less:

Meat
Dairy
Sugar & starchy foods

More:

Plants and fiber

Wrinkles:

Really, diet affects wrinkles? You betcha! Wrinkles develop as the collagen below our skin changes. This happens with age, sun or other radiation exposure, smoking, pollution, repetitive motions (smiling/frowning), and oxidative damage. What do plants have lots of? Antioxidants!

One key type of oxidative damage occurs with exposure to AGEs (Advanced Glycation End Products). These are created in meat when we cook them with high heat and low water to develop that crunchy crust. This is a recipe that while delicious also produces more skin damage and wrinkles.

What to do to avoid wrinkles?

Avoid smoking
Avoid sun exposure of long duration without sunblock/shade
Avoid meat cooked in a way that increase AGEs - grilling, frying, roasting, broiling
Eat more fruits and vegetables to get their antioxidants and fiber!

Inflammation and Diet:

The pain of inflammation can make one feel trapped in their own body. Don’t let your food cause you pain!

This section is based on a lecture given by Dr. Heather Zwickey.

First, I think you can tell that more fiber and plants will be the summary recommendation of this section. We are also going to talk about an arm of the immune system known as the Th-17 pathway. This pathway turns inflammation down and is often where things go wonky in chronic inflammation. It’s like Lucy in the chocolate factory: no one slows the machine down, and things just keep getting ramped up and going faster and faster and pretty soon chaos ensues. While this is hilarious with a chocolate stuffed and smeared Lucy, it can be painful and debilitating when it occurs in our bodies.

Diet is not the only thing that influences inflammation, but it does play a major role in resolving inflammation, which is why we will focus here.

Before we jump in, here are a few other influences on inflammation that can be targeted for treatment/prevention:

Stress - including personal and generational trauma
Environmental toxins including smoking
Hypersensitivity reactions to common substances
Injury
Genetics
Pharmaceuticals
Obesity

As you can see, there are many factors to consider, but for now, let’s look at how we can soothe our immune systems using food.

Nutrients that increase Th-17 activity:

Back to helping the Th-17 pathway turn the dial down on inflammation. There are a few things that can directly help here:

Vitamin A
A healthy gut microbe ecosystem
Vitamin D

There are other things that increase inflammation besides our immune system. Let’s look at a few of them and return to our microbiome to round things out.

Reduce oxidative damage (free radicals)

Free radicals are basically atoms that run around stealing electrons and causing damage to our tissues. Luckily, we can add in antioxidants to distract those free radicals and render them harmless. A few different classes of antioxidants are:

Vitamins
Allium sulphur, found in garlic and onions
Lycopene, found in tomatoes
Beta carotene, found in carrots and other orange/yellow plants
Indoles, found in broccoli family plants
Flavonoids, found in all plants but especially high in herbs
Catechins, like ECGC (epigallocatechin gallate), found in green tea
Zinc, which is rich in beans, nuts, and meats
Selenium, which is abundant in Brazil nuts
Copper, found abundantly in all plant foods
Isoflavonoids, abundant in flax and soy

Turn down inflammation through our fatty acid metabolism - eicosanoids

I alluded to the eicosanoid system in last week’s article on fat. Here we get to look a bit closer.

When our intake of Omega-6 to Omega-3 fatty acids is out of balance, we get more inflammation! Omega-6 fatty acids are used to make arachidonic acid, which is further broken down into inflammatory chemicals known as leukotrienes and prostaglandins. (3) These chemicals are so potently inflammatory that we use Aspirin and drugs like Celebrex to stop their production. This lowers inflammation and relieves pain.

While we could rely on medications to help us turn down inflammation, they all have side effects that are potentially harmful when used in the long-run. Instead, we can use diet to help turn this activity down either reducing or eliminating the need for medications.

Omega-3 fatty acids break down into EPA and DHA. These chemicals further break down just like arachidonic acid, but they are transformed into potently antioxidant chemicals!

What’s a good balance? That depends on your goals, but if it is to reduce chronic pain and inflammation, a ration of 3 grams of Omega-6 for each gram of Omega-3 is a great place to start. To put this into perspective, the Standard American Diet has a ratio closer to 15:1!

For more information on Omega-3 and Omega-6 fatty acids, give last week’s article a review.

Break down inflammatory histamine by increasing DAO (Diamine Oxidase)

Histamine creates problems and solutions throughout the body. It helps us produce stomach acid, but it also causes the itchy eyes of allergy season. When histamine activity is balanced, we function well. When it is out of balance, we experience symptoms like acid reflux, anxiety, muscle spasms, nausea, hives, and our traditional allergy symptoms.

The good news is, you can increase the breakdown of histamine by eating more foods that contain DAO!

Fresh meat and fish - not canned, dried, smoked, or pickled
Berries
Eggs
Gluten free grains
Coconut
Almonds
Olive oil

Feeding your microbiome

Now we get back to our gut bugs. Did you know that 80% of our immune activity takes place in our guts - 80%! And, our gut bugs play a major role in this. They prevent infectious microbes from moving in, they make vitamins from the food we eat like vitamin K and some of the B vitamins, and they make chemicals that calm our immune system and our nervous system!

These chemicals are called short chain fatty acids. They increase our secretory IgA - an antibody that lines all the openings to our body and blocks entry by infectious agents. They decrease neuroinflammation and increase the activity of the helper cells (microglia) in our brains! They also increase our Th-17 activity letting our immune system calm back down.

How do we get our gut tenants to make more short chain fatty acids? We feed them fiber-rich foods: plants!

As an aside, did you know that 90% of the serotonin in our bodies is made by our gut bugs? Serotonin is sometimes called the happy hormone. In fact, many antidepressants are designed to help you keep your serotonin levels higher for longer periods of time. Eating a high fiber diet may be a great way to prevent depression and treat milder cases.

It’s time we live in harmony with our microbiome and make sure they have what they need to keep on providing us such wonderful services!

Applications:

Eat 30 or more plants a week. Aim for 35 or more grams of fiber from whole plants daily.

This week’s applications are pretty short and sweet. If you need a nutrition tracker to check your fiber intake, my favorite is cronometer, but there are many others out there. I don’t advise using a nutrition tracker long term as this can lead to disordered eating, but they are great tools for getting your bearings when you make nutritional changes.

Also, there is no upper limit on daily fiber intake, so enjoy! Just be sure to get plenty of water in with your fiber to avoid constipation.

Lastly, there can be a transition period when you add extra fiber. This looks like increased intestinal gas with flatulence and a general increase in bowel movement frequency and volume. This does calm down as your body and the ecology of your gut shifts. Carminative herbs like chamomile, ginger, fennel, cardamom, or peppermint as a tea with your meals can help dispel some of that gas and reduce any associated odor.

There is more than enough to go around if we help each other!

Parting Thoughts:

If you have read this far, thank you. Now it’s time to bring this all together and include the idea of social justice in our health.

The deeper I dig deep into nutrition research, the simpler healthy eating truly becomes! We can get so caught up in the details and the competing opinions that everything seems hopeless driving us back to our Standard American Diet for comfort. This conflict and confusion has been created artificially, and in my opinion, the sole purpose has been to sell products and create a sense that we must supplement our way to good health. It creates the illusion that our health is a commodity to be bought and sold to the highest bidder.

The wellness industrial complex would have us believe that focusing on our own individual health is more important than the health of our communities. Who cares if you have a fancy water filtration system? Fix the public water supply - Flint, Michigan anyone? Who cares if you have access to multiple health food stores with ample parking minutes from your house when people live in food deserts and do not have access to local organic produce let alone the money to buy it?

If this wasn’t an article for the general public, this is where I would insert expletives! Instead, I’ll just say, forget that! No one who promotes health for the privileged few over our communities deserves our dollars.

There is good news. There are many grassroots community organizations working to change things!

If you are looking for ways to work toward social justice in your community, I encourage you to seek out the organizations who are doing just that and partner with them, and there are so many ways to help.

Here in my area of East Multnomah county, we have SnowCap food pantries, Equitable Giving Circle, Mudbone Grown, NAYA, and many others including CSAs who have scholarships for those with financial barriers.

With all that said, I’ll wrap this up with my usual sentiment:

To our health!

Next Week:

Next week, we dive back into our exploration of macronutrients with Protein.

References:

This week’s references come from the NUNM Food as Medicine Symposium. Unfortunately, access to the lecture notes is behind a paywall, and I cannot provide those notes directly to you (that would be stealing).

Greenberg, J., Diet and Dermatology: The Role of Diet in Skin Disease, NUNM 2021 Food as Medicine Symposium - Professional Track, February 20, 2021
Zwickey, H., Food, Microbiome, and Inflammation, NUNM 2021 Food as Medicine Symposium - Professional Track, February 21, 2021
Ferrier, D. Lippincott Illustrated Reviews: Biochemistry: Seventh Edition, Wolters Kluwer, 2017

Food and Inflammation - Takeaways from the 2021 Food As Medicine Symposium

Main Takeaways:

More Specific Content: