Cómo afecta la dieta a la inflamación y al dolor crónico

We hear about inflammation a lot these days in terms of the role it plays in many chronic disease conditions, including cancer, type II diabetes, and heart disease. Inflammation can play a large role in chronic pain as well, especially when it comes to painful autoimmune conditions like rheumatoid arthritis, fibromyalgia, multiple sclerosis, and ankylosing spondylitis. Inflammation also contributes to osteoarthritis, a painful condition which affects more than 500 million people globally.

Si la inflamación contribuye a su dolor, una de las formas más fáciles de reducirla es a través de la dieta. Puede hacer cambios en su dieta de inmediato y comenzar a notar una reducción de la inflamación en unos pocos días.

Eating an anti-inflammatory diet is so important for people with chronic pain that researchers have made a food pyramid for chronic pain!

In this article, I’ll start with a quick lesson on localized versus systemic inflammation, and how both can contribute to pain. Then I’ll discuss the major food groups that cause inflammation: processed foods, grains, dairy, and processed and factory-farmed animal products. I’ll also discuss the trendy carnivore diet, and finally I’ll answer the question: ¿Cuál es la dieta menos inflamatoria para los humanos?

Cómo la inflamación localizada y sistémica causa dolor

Localized inflammation is the type that I typically talk about in the context of Clinical Somatics. Localized inflammation occurs at the site of an injury or infection. When cells of your body are damaged or attacked, your immune system kicks in to remove the harmful stimuli and begin the healing process. Blood vessels dilate and capillaries become permeable; the increased blood flow to the affected area makes it swollen, red, and warm. The swelling can press on nerves and cause pain. Another cause of pain is the release of inflammatory mediators; these substances activate nociceptors (pain receptors) and contribute to the pain you feel in localized inflammation.

Cuando la inflamación localizada es aguda (dura poco tiempo), es beneficiosa porque facilita el proceso de curación. Sin embargo, cuando la inflamación localizada se vuelve crónica (como en una articulación que está constantemente sometida a demasiada tensión y presión), el desgaste físico y el ataque incesante del sistema inmunológico destruirán gradualmente los tejidos protectores de la articulación y provocarán disfunción y deformidad de la articulación.

Si siente dolor y síntomas de inflamación en una sola parte específica de su cuerpo, entonces, por lo general, se trata de una inflamación crónica y localizada. Para reducir o eliminar este tipo de inflamación, debe liberar la tensión muscular crónica y cambiar la postura habitual y los patrones de movimiento que están causando el daño a su cuerpo.

However, if you feel inflammatory pain in multiple areas of your body, systemic inflammation is likely involved. Systemic inflammation occurs when your immune system produces the inflammatory response throughout your body rather than in just one specific area. When systemic inflammation is chronic, research shows that it can cause pain, autoimmune conditions, destruction and scarring of tissues, buildup of plaques in arteries, changes in gene expression, cancer, type II diabetes, dementia, depression, and other dangerous conditions.

Some proven causes of systemic inflammation are viral and bacterial infections, allergies, smoking, obesity, stress, and alcohol intake. And another major cause of systemic inflammation is the food we eat. Inflammation resulting from diet affects the vast majority of people in the world to some degree, whether they’re aware of it or not.

¿Por qué los alimentos procesados causan inflamación?

All processed foods can cause inflammation, for a number of reasons:

• Los alimentos procesados contienen aditivos y productos químicos no nutritivos, como saborizantes, emulsionantes, edulcorantes y conservantes.
• A menudo tienen un alto contenido de azúcar, grasas saturadas y grasas trans, y son bajos en proteínas y fibra.
• Pueden alterar el equilibrio de las bacterias intestinales, lo que tiene un efecto directo en el nivel de inflamación en todo nuestro cuerpo.
• Están nutricionalmente desequilibrados debido a la eliminación de micronutrientes (vitaminas, minerales y fitoquímicos) durante el procesamiento.
• El embalaje también puede contribuir a la presencia de sustancias químicas en los alimentos procesados.

Los alimentos procesados son tan diferentes a los alimentos integrales que los investigadores teorizan que el cuerpo puede percibirlos como una sustancia extraña, lo que desencadena una respuesta inflamatoria conocida como “fiebre de la comida rápida”. Las investigaciones muestran que los efectos negativos de los alimentos procesados no se pueden revertir asegurando una nutrición adecuada, por lo que claramente existen algunas cualidades de los alimentos procesados, además de su bajo valor nutricional, que son perjudiciales para el cuerpo humano.

Food additives, like emulsifiers, thickeners, artificial flavors, and preservatives, are added to processed foods to make them last a long time on the shelf, taste good, and even be addictive. These additives can alter the balance of our gut bacteria, leading to inflammation in the gut and throughout the body. Food additives are linked to inflammatory conditions, including autoimmune diseases and cancer.

The Arthritis Foundation cites mono-sodium glutamate (MSG) as one of eight food ingredients most likely to cause inflammation, making osteoarthritis symptoms worse. MSG can be present in fast food, chips and snack foods, soups and soup mixes, deli meats, frozen meals, condiments, and more. The Arthritis Foundation reports that MSG can affect liver health and trigger two pathways of chronic inflammation.

Trans fat is created when food manufacturers add hydrogen to vegetable oil; this makes the oil solid at room temperature and extends its shelf life. Trans fat has been proven to trigger systemic inflammation, contributing to chronic inflammatory conditions. You should avoid foods with “hydrogenated” and “partially hydrogenated” oils on the label. Ideally, you should avoid trans fat completely. You’ll find trans fat in fast food, margarine, commercial baked goods, and processed snack foods.

Omega-6 and omega-3 fatty acids are essential fatty acids, meaning that they are necessary for physiological functioning but cannot be produced by the body. Humans evolved consuming a roughly equal amount of omega-6s and omega-3s. However, the modern Western diet has ratio of approximately 20 omega-6s to one omega-3.

This excess of omega-6 fatty acids and deficiency of omega-3s increases inflammation and the risk of autoimmune diseases and cancer. Omega-6 fatty acids are found in many oils used in processed food (like corn, vegetable, safflower, sunflower, grapeseed, peanut, and soy). Fried food, salad dressings, and mayonnaise are major sources of omega-6s in the Western diet, and should be limited.

As humans evolved, we ate zero added sugar and very little free sugar (only in the form of honey, when we could find it). The fruits we ate were generally much lower in sugar than the fruits we eat today, which have been selectively bred to have more sugar. The short-term effect of sugar on the body is to raise blood sugar and insulin levels, which increases fat gain and fat retention. Excess body fat increases inflammation, as fat cells release inflammatory substances like leptin and cytokines.

But the inflammatory effects of sugar go beyond just body fat. People who consume diets that are higher in sugar have more inflammatory markers in their blood, including C-reactive protein (CRP). CRP is produced by the liver, and CRP levels rise when inflammation is occurring in the body. When people reduce their sugar intake, their inflammatory markers are reduced.

Research has clearly demonstrated that dietary sugar is a key factor in developing chronic inflammation, neuroinflammation, and painful autoimmune conditions including rheumatoid arthritis and multiple sclerosis. Sugar can increase levels of LDL cholesterol, which increases inflammation and CRP levels. Sugar also stimulates production of free fatty acids in the liver, which then triggers inflammatory processes.

Approximately 75% of packaged foods contain some form of added sugar. There are 60 or more names for added sugar used on food ingredient labels, so be wary and be sure to look at the grams of added sugar per serving.

Refined carbohydrates, which include bread, crackers, white rice, and cereals, have essentially the same effect on our metabolism as pure sugar. While dietary advice in the 1980s and 90s told us to avoid fat and consume carbohydrates at will, researchers now realize that fat was not the culprit they were looking for. Instead, it was refined carbohydrates, which trigger insulin production and stimulate inflammation.

Por lo tanto, es importante limitar la ingesta de azúcar y carbohidratos refinados. En su lugar, elija fuentes de carbohidratos de alimentos integrales, como verduras, frutas, papas, batatas, legumbres, nueces y semillas. Si consume cereales, asegúrese de hacerlo en su forma integral, sin procesar, no cereales integrales que hayan sido procesados para hacer pan integral, pastas, galletas, etc.

¿Por qué los cereales causan inflamación?

Grains, along with other plant foods, contain lectins. Lectins are proteins that plants produce as a self-defense mechanism, so that predators like us won’t eat them. In our digestive system, lectins can prevent absorption of nutrients, damage the walls of our intestines, and contribute to painful autoimmune conditions.

El gluten es la lectina más problemática porque estamos sobreexpuestos a ella. Además de estar presente en todos los productos de trigo, que constituyen una gran parte de la dieta occidental, el gluten se agrega a muchos alimentos procesados, productos de belleza, medicamentos y suplementos. Si bien las estadísticas varían, algunos estudios sugieren que hasta el 30% de la población es sensible al gluten en la actualidad, y que entre el 50-99% de las personas con enfermedad celíaca o sensibilidad al gluten nunca son diagnosticadas.

When gluten reaches our gut, it’s broken down into the proteins gliadin and glutenin. In people who are gluten sensitive or who have celiac disease, the immune system sees gliadin as dangerous and produces antibodies to attack it. Gliadin also increases the release of zonulin, a protein that modulates the permeability of junctions between cells of the intestinal walls. Increased presence of zonulin causes intestinal permeability (leaky gut), which allows toxins, microbes, food particles, and the anti-gliadin antibodies to leak out of the intestines and travel through the body.

Anti-gliadin antibodies often attack other things in the body besides just gliadin, and can trigger the immune system to attack its own tissues; this is how autoimmune conditions result from gluten sensitivity and celiac disease. Gluten sensitivity is associated with many painful inflammatory and autoimmune conditions including rheumatoid arthritis, fibromyalgia, multiple sclerosis, ankylosing spondylitis, and migraine headaches. Research shows that when gluten is taken out of the diet, pain and other inflammatory symptoms of these conditions improve.

Algunas personas con sensibilidad al gluten pueden ser sensibles a todas las lectinas, por lo que puede ser útil hacer una dieta de eliminación durante un período de tiempo en el que eliminen todos los productos a base de cereales. Si bien los cereales no son la única fuente alimentaria de lectinas (las legumbres son otra fuente importante), tienden a ser la fuente más frecuente y problemática en la dieta occidental. Además, dado que las lectinas se unen a los carbohidratos en el cuerpo, reducir la ingesta de carbohidratos puede ayudar a reducir los efectos negativos de las lectinas.

¿Por qué los productos lácteos de vaca causan inflamación?

Like gluten, research consistently shows that dairy consumption leads to to an increase in inflammatory symptoms. Dairy consumption has been linked to a number of autoimmune conditions, including rheumatoid arthritis, multiple sclerosis, ankylosing spondylitis, type 1 diabetes, inflammatory bowel disease, thyroid disorders, and others. Dairy consumption is also linked to other inflammatory conditions, such as osteoarthritis and Parkinson’s disease.

There are several reasons why cow dairy products cause inflammation when consumed by humans. The first is lactose, a naturally occurring sugar in dairy products. Approximately 68% of the world’s population is lactose intolerant.

Las personas intolerantes a la lactosa no producen lactasa, la enzima necesaria para descomponer la lactosa. La lactosa no digerida se fermenta en el intestino, lo que produce gases y provoca síntomas como hinchazón, náuseas, vómitos, diarrea o estreñimiento. Si eres intolerante a la lactosa, el consumo continuo de productos lácteos puede provocar daños en el revestimiento intestinal, una afección conocida como permeabilidad intestinal o "intestino permeable". Como se explicó en la sección anterior, la permeabilidad intestinal provoca reacciones inflamatorias asociadas con enfermedades autoinmunes dolorosas.

The second reason why dairy leads to inflammation is the proteins found in cow’s milk, casein and whey. Casein in particular is difficult for many people to digest, and often leads to an inflammatory autoimmune response. However, there are two types of casein found in dairy, A1 and A2, which have slightly different chemical structures.

La caseína A1 parece ser el desencadenante de las reacciones autoinmunes, mientras que la A2 es mucho menos problemática. La caseína A1 puede actuar como una lectina en el cuerpo. Debido a un proceso conocido como “mimetismo molecular”, las moléculas de caseína A1 pueden ser confundidas por el cuerpo con lectinas (como el gluten), y el sistema inmunológico puede responder de la misma manera: con inflamación.

Lamentablemente, la mayoría de los productos lácteos estadounidenses provienen de vacas que producen caseína A1. Algunos productos lácteos de fuentes alternativas, como cabras, ovejas, búfalos y razas específicas de vacas, contienen predominantemente proteínas A2. Estas pueden ser mucho más fáciles de digerir y tienen menos probabilidades de causar síntomas inflamatorios dolorosos.

In addition to naturally occurring lactose, casein, and whey, synthetic substances are given to cows during the dairy production process and are present in the milk they produce. These include hormones to increase milk production and antibiotics to prevent infection. Pesticides, heavy metals, and other toxins are also present in cow’s milk, likely due to being consumed in animal feed. All of these synthetic, toxic substances are known to contribute to inflammation and chronic disease in humans.

Por qué los productos animales procesados y criados en granjas industriales causan inflamación

When it comes to consuming animal products, quality is of utmost importance. Processed meat and factory-farmed animal products are low-quality and increase inflammation, while unprocessed, pasture-raised, grass-fed animal products can be part of an anti-inflammatory diet.

All processed foods contribute to inflammation, as discussed earlier in this article. When it comes to processed meat in particular, the curing and preserving process includes dangerous additives like sodium phosphate and sodium nitrite. Additives like these are so bad for human health that in 2015 the World Health Organization classified processed meats as a “class 1 carcinogen.” This means that research has proven conclusively that processed meats contribute to cancer, a highly inflammatory condition. If you are going to eat processed meat, be sure to choose those that are labeled “uncured,” and read the list of ingredients.

Factory-farmed animal products are inflammatory as well, especially when consumed in excess. The main reason why factory-farmed animal products cause inflammation is due to the animals’ unnatural diet: grains. In contrast, pasture-raised animals eat grass, nuts, and seeds, which are high in alpha-linolenic acid, an essential omega-3 fatty acid.

Grain-fed animals result in meat and eggs with an unnatural ratio of omega-6 to omega-3 fatty acids. Humans evolved eating a diet with a roughly equal (1:1) ratio of omega-6s to omega-3s. Sadly, the typical Western diet is around 20:1 or higher. This excess of omega-6 fatty acids and deficiency of omega-3s increases inflammation and the risk of autoimmune diseases and cancer.

La proporción de omega-6:3 para la carne de res alimentada con pasto es de aproximadamente 2:1, mientras que la proporción para la carne de res alimentada con granos es de aproximadamente 9:1. Es importante tener en cuenta que todos los tipos de carne alimentada con granos, incluidos el cerdo, el pollo, el pavo y el cordero, tienen desequilibrios de omega similares.

Eggs from pasture-raised hens have three times the omega-3s than conventionally raised eggs, resulting in a favorable 2:1 ratio of omega-6:3. Pasture-raised meat and eggs also contain more antioxidants, micronutrients, and trace minerals than conventionally raised meat and eggs.

Conventionally raised animal products also contain toxic substances that can increase inflammation and weaken our immune system. These include antibiotics to prevent disease, hormones to increase animal growth, and pesticides, which are present in animal feed.

Al comprar productos animales no procesados, las etiquetas que debe buscar son “criado en pastura” y “alimentado con pasto”. Otras etiquetas que suenan saludables, como “sin jaulas” y “de corral”, no significan que los animales hayan comido pasto. También debe buscar la etiqueta “orgánico”, que significa que los animales comieron alimento orgánico (sin pesticidas) y no se les administraron hormonas ni antibióticos innecesarios.

¿Qué pasa con la dieta carnívora?

Acabamos de enterarnos de que las carnes procesadas y de granjas industriales aumentan la inflamación, especialmente cuando se consumen con regularidad. Pero, ¿qué pasa con la dieta carnívora de moda? Esta dieta se ha vuelto popular últimamente por dos razones: puede ser muy eficaz para perder peso y elimina todos los alérgenos potenciales de la dieta.

The carnivore diet can allow for weight loss because it doesn’t include any carbohydrates, which elevate insulin levels and tell the body to store fat. Simply having excess weight on the body increases inflammation, as fat cells release inflammatory molecules like leptin and cytokines. So, losing weight reduces inflammation. If you decide to use the carnivore as a short-term means to lose weight, quality is key. You should consume meat and eggs from pasture-raised animals only, preferably those who have consumed organic feed and are antibiotic- and hormone-free.

La dieta carnívora también puede ser muy beneficiosa para las personas que padecen enfermedades autoinmunes y otras enfermedades inflamatorias. Si bien los alimentos vegetales son muy saludables debido a sus nutrientes, antioxidantes y fibra, ciertos alimentos vegetales pueden causar inflamación en algunas personas.

Por este motivo, algunas personas con enfermedades inflamatorias dolorosas afirman sentirse muy bien cuando adoptan una dieta en la que comen predominantemente productos animales enteros y sin procesar. Esto se debe a que han eliminado los alimentos vegetales que podrían desencadenar su inflamación. Además, este tipo de dieta reduce o elimina los alimentos procesados y el azúcar añadido.

The danger in following a carnivore diet long-term is the vast reduction of fiber intake. Research clearly shows that our gut microbiota needs a large amount of fiber from diverse plant sources in order to be most healthy and keep our immune system strong. So, a carnivore diet could be used short-term as a type of elimination diet, but it is likely not the most healthful long-term solution for most people.

Quiero reiterar que si decides seguir una dieta carnívora, la calidad de los productos animales que consumes es de suma importancia. Debes consumir carne y huevos de animales criados en pasturas únicamente, preferiblemente de aquellos que hayan consumido alimentos orgánicos y que estén libres de antibióticos y hormonas.

¿Cuál es la dieta menos inflamatoria para los humanos?

La dieta menos inflamatoria para los humanos es la que se asemeja lo más posible a la que comíamos a medida que evolucionábamos. En general, la inflamación es resultado del consumo o la exposición a sustancias o factores estresantes a los que los humanos no están adaptados. Cuanto más podamos adoptar una dieta y un estilo de vida similares a los de nuestros antepasados cazadores-recolectores, menos inflamación tendremos.

This means eating a diet based on whole, unprocessed foods that were able to be hunted or gathered: meat, fish, eggs, vegetables, fruits, nuts, and seeds. This whole-food “primal” diet does not include foods that became widely available as a result of farming, like grains and dairy. And of course, it does not include processed foods or added sugar.

Research on the effect of diet on various inflammatory chronic pain conditions is so abundant that scientists have created a food pyramid for chronic pain. The pyramid is new and will hopefully be refined as time goes on, but it’s a step in the right direction. And it should be noted that we all have different dietary triggers of inflammation, so each person needs to explore their own diet and find out which foods are inflammatory for them.

The best way to do this is with an elimination diet like the Whole30 diet. The Whole30 diet removes all potentially inflammatory foods from your diet for 30 days. Then, you’ll reintroduce certain types of foods one at a time so you can see how each inflammatory food (like sugar, gluten, dairy, etc.) affects you. This is done in a systematic way, returning to a complete elimination diet for several days in between each food reintroduction.

Si bien puede resultar difícil, este tipo de dieta de eliminación es esencial para determinar qué alimentos desencadenan la inflamación en usted. Modificar su dieta es la forma más sencilla de reducir la inflamación. Una vez que se acostumbre, es posible que se sienta tan bien con esta dieta que seguirá comiendo de forma "primaria" todo el tiempo.