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August 18, 2021 | 7 minute read

Can an Anti-Inflammatory Diet Reduce Cancer Risk?

A diet to help you fight off the chronic inflammation that can play havoc with your health is not a one-and-done choice . . . it’s the sum of many small choices you make each day. Ongoing low-grade inflammation increases your risk of cancer, heart disease and other chronic diseases. Despite the headlines you see about this or that anti-inflammatory food, nutrient or phytochemical, fighting inflammation—just like fighting cancer—is not a solo act.

Identifying an Anti-Inflammatory Diet

The Dietary Inflammatory Index (DII) is a single score pulling together evidence on how food-related components affect six different biomarkers of inflammation. DII scores encompass 45 individual nutrients and other components that have either pro- or anti-inflammatory potential. For example :

  • Nutrients, such as folate (a B vitamin), magnesium, selenium and vitamin C are categorized as anti-inflammatory.
  • Nutrients, such as saturated fat, trans fat and iron are categorized as pro-inflammatory.
  • Phytochemicals, such as beta-carotene and several different flavonoid polyphenol compounds are categorized as anti-inflammatory.
  • Food ingredients, such as ginger, garlic, thyme and oregano are categorized as anti-inflammatory.

The influence of a food is based on the components it contains. And no single food choice can make a diet inflammatory or anti-inflammatory. The balance of the number and portion sizes of different food choices determine the influence of overall eating habits. And indeed, when the diets of people in large observational studies were scored, higher DII scores (more pro-inflammatory) were associated with higher levels of several markers of inflammation.

What Makes an Anti-Inflammatory Diet?

The DII is one way, but not the only way, to look at how food choices can come together to create eating habits that are likely to reduce inflammation.

  • The Empirical Dietary Inflammatory Pattern is a scoring system created by examining how 39 pre-defined food groups predicted three major inflammatory markers in large U.S. population studies. For example, processed meat, red meat, refined grains and high-calorie beverages were identified as pro-inflammatory choices; dark yellow/orange vegetables, leafy green vegetables, tea and coffee were identified as anti-inflammatory choices.
  • Mediterranean diet scores applied to large population studies show that diets more consistent with traditional Mediterranean-style eating are linked with lower levels of blood tests of inflammatory markers. The inflammation-fighting potential of these eating patterns seems associated with their rich use of fruits and vegetables and with extra-virgin olive oil, which is rich in polyphenol compounds.
  • Healthy Plant-Based Diet Index scoring, reflecting more healthy choices within a plant-based diet, applied to a large population study of U.S. women found that higher scores were associated with biomarkers showing less inflammation. And when plant-based diets became less healthy over a decade of follow-up, biomarkers of inflammation rose. This scoring supplies important insights, clarifying that simply being plant-based does not automatically mean a diet is healthy.

Differences between scoring systems are important in choosing a tool for a research study. But for identifying the kinds of food choices that are most likely to have anti-inflammatory influence, they provide very similar answers.

Implications for Your Food Choices

Combining results of research using all these scoring systems, for a diet most likely to be anti-inflammatory:

  • Focus on abundance and variety of vegetables and fruits, including deep orange and dark green choices, cruciferous vegetables (like broccoli and cauliflower), onion/garlic family choices, berries and citrus fruits.
  • Choose mainly whole grains, keep enriched “staple” type refined grains like white bread and rice to modest amounts and limit sweet grain products (like cookies and cake) to occasional treats only.
  • Expand your use of plant-based protein sources like pulses (such as, dried beans and lentils), soy foods, nuts and seeds. Limit red meat and processed meat.
  • In addition to water, enjoy coffee and tea as beverages of choice rather than sugar-sweetened soft drinks, lemonade and sweetened juice “cocktails.”
  • Enjoy delicious food that’s flavored with herbs and spices and prepared with extra-virgin olive oil and other unsaturated plant oils, rather than ultra-processed foods’ reliance on loads of added sugars, unhealthy fats and salt for flavor.

Is an Anti-Inflammatory Diet an Anti-Cancer Diet?

Inflammation is identified in the AICR Third Expert Report as one of the key “enabling characteristics” that contribute to cells acquiring hallmarks of cancer. In contrast to short-term inflammation that’s essential for wound-healing and recovery from infections, chronic low-grade inflammation contributes to all stages of cancer development.

  • Inflammation leads to the production of free radicals that damage DNA, potentially creating cancer-causing mutations.
  • Signaling by cytokine proteins produced by inflammatory cells seem to dial up expression of oncogenes (which increase cancer cell growth) and dial down tumor suppressor genes.
  • Inflammation may also be involved in cancer metastasis and in resistance to treatment, based on emerging research.

Recognizing the potential importance of inflammation—and a diet that reduces inflammation—in cancer, AICR funding provided some of the support for research on anti-inflammatory diets and cancer.

→ One analysis combining 44 observational studies found that each unit increase in the DII score (a more inflammatory diet) was associated with an 8.3% increase in overall cancer risk.

→ So far, the strongest association relates to risk of colorectal cancer. For each unit increase in the DII score (a more inflammatory diet), the risk of colorectal cancer increased 6 to 7 percent in analyses that combined multiple studies.

→ An anti-inflammatory diet also shows potential association with risk of several other cancers, including prostate, lung, breast, ovarian and others. So far, studies involving these cancers are limited in number, and many are a type of study that can be particularly vulnerable to other factors affecting results.

However, while results of many types of research suggest that an anti-inflammatory diet is likely an anti-cancer diet, reducing cancer risk involves more than an anti-inflammatory diet.

  • Plant foods rich in phytochemicals may work in other cancer-preventive pathways like carcinogen deactivation, cell signaling and destruction of abnormal cells.
  • A diet to reduce cancer risk should help you reach and maintain a healthy weight. Excess body fat not only affects cancer risk by promoting inflammation, it also affects levels of insulin and related growth factors and hormone levels tied to cancer risk.
  • Physical activity as a part of everyday life goes hand-in-hand with eating habits, reducing cancer risk through many pathways.

Five Top Take-Aways for Today

  • An anti-inflammatory diet holds strong potential to reduce cancer risk.
  • Reducing cancer risk encompasses more than reducing inflammation. For example, alcohol is categorized in some scores as anti-inflammatory. However, alcohol is metabolized to a compound that is a known human carcinogen. And even low levels of alcohol consumption pose some risk of cancer. Researchers suggest this may explain some of the mixed findings relating anti-inflammatory diet scores and risk of breast cancer, one of the cancers that is particularly alcohol-related.
  • An anti-inflammatory diet is built based on the overall pattern of food choices you make. There’s no need to jump back and forth based on hype about loading up on or avoiding any single food or nutrient.
  • An anti-inflammatory diet is not all-or-nothing. Analyses show that perfection is not needed, and each step closer to more anti-inflammatory choices may help lower risk of cancer.
  • The association of an anti-inflammatory diet with lower cancer risk provides an example of how you can reduce risk of both heart disease and cancer. Diet scoring systems link a more anti-inflammatory diet with lower levels of heart disease risk factors and risk of heart disease. And an anti-inflammatory diet is compatible with the AICR Recommendations that are based on today’s best evidence on eating to lower cancer risk.

 

4 comments on “Can an Anti-Inflammatory Diet Reduce Cancer Risk?

  1. Thierry Ludwig on

    Dear Mrs Collins,

    Allow me to introduce myself: My name is Thierry Ludwig and I am the communication manager at Cancer Foundation Luxembourg, a non-profit organization.

    Our director saw your article ‘Can an Anti-Inflammatory Diet Reduce Cancer Risk?’ and she loved it: extremely interesting, easy to read and well written.

    Healthy diet is a very important topic in cancer prevention which is one of our three missions (along with supporting cancer patients and promoting cancer research).

    That is the reason why we wanted to ask you the permission to translate your article into French and German, both official languages in our country.

    We plan to publish the text on our website (www.cancer.lu) and in our magazine info cancer (https://www.cancer.lu/fr/nos-publications). We would of course acknowledge your copyright.

    If you have any questions, please contact me at Thierry.ludwig@cancer.lu .

    Best regards Thierry

    Reply
  2. Fred Tabung on

    Dear Karen,
    Thank you for a very comprehensive analysis of anti-inflammatory diets and cancer risk. Alcohol is intriguing as an anti-inflammatory food (beverage). The Mediterranean dietary pattern that is recommended by the DGA is scored with moderate alcohol intake as good. Three of the 4 dietary indices for assessing dietary inflammatory potential has alcohol intake as a favorable component (including the DII). I don’t think that this is simply a coincidence because as you have also mentioned, these dietary indices with alcohol in them (including the MEd diet) are significantly associated with health outcomes (cancer risk and survival, CVD risk, total mortality and disease-specific mortality)
    I understand the concern about some cancers in which alcohol has been unfavorably associated with risk but I feel strongly that there is a disconnect in the way alcohol is studied in relation to health outcomes – mainly alcohol as a single food/beverage versus alcohol as part of a dietary pattern. Important questions are: 1) does alcohol have the same effect when consumed as part of the dietary pattern versus when consumed alone as a beverage? 2) when alcohol is studied as a single beverage, how do you account for the context in which it is consumed, e.g., binge drinking.
    Until careful thought in put into the research methodology for alcohol and until most funding agencies can allow alcohol to be studied in humans, the evidence will continue to be confusing and inconsistent – mainly that when alcohol is consumed as part of dietary pattern, the overall pattern is good for health and when consumed/studied in isolation, it shows up as bad for health.

    Reply
    • Sheena on

      Thank you, Dr. Tabung, for raising these interesting and important issues. You offer valuable perspective as a scientist recognized for your groundbreaking contributions to research developing both the DII and EDIP scoring systems to evaluate how a dietary pattern is likely to promote or inhibit the chronic inflammation.

      Indeed, as you indicate, our understanding of alcohol’s place in the big picture of how lifestyle choices affect chronic diseases risk and outcomes remains incomplete. In addition to the examples that you raise regarding the context of consumption, with or separate from meals, and spread across a week versus in binge drinking, we may also question what other factors might affect people’s disease susceptibility related to their alcohol consumption choices.

      Human nutrition research has increasingly transitioned from analyses of individual nutrients and foods towards whole foods and dietary patterns, partly because the contributions of individual dietary components to disease risk were typically weak and inconsistent. From a research perspective, dietary patterns are an appealing approach for assessing a complex aspect of lifestyle, but limitations remain. Indeed, for cancer risk, the AICR/WCRF Third Expert Report graded evidence for dietary patterns as limited suggestive – more research is needed (https://www.wcrf.org/wp-content/uploads/2021/02/Other-dietary-exposures.pdf). By contrast, the evidence for alcohol is strong for 6 types of cancer (breast, esophageal, head & neck, colorectal, stomach, liver) (https://www.wcrf.org/wp-content/uploads/2021/02/Alcoholic-Drinks.pdf).

      Analysis to understand which components of a dietary pattern are most strongly tied to health outcomes has limitations and has produced inconsistent outcomes. For example, although the Mediterranean dietary pattern is related to lower risk of cardiovascular disease, association with cancer risk is seen in some, but not all population studies. And although the Dietary Guidelines Advisory Committee identified this dietary pattern as one option for healthy eating, statements about alcohol don’t support alcohol as an essential component. The committee report notes “Although alcohol can be consumed at low levels with relatively low risk, for those who choose to consume alcohol, evidence points to a general rule that drinking less is better for health than drinking more…”

      While research on these and other questions continues, healthcare professionals like me are faced with questions by people eager to know what choices they can make to reduce their risk of cancer. To answer those questions, health professionals consider recommendations like those from the AICR/WCRF Expert Report that are based on evaluation of best available population studies using specific grading criteria, including whether there is evidence of biological mechanisms at typical levels of exposure. In the case of alcohol, there is clear and widely accepted evidence that alcohol is metabolized to a compound (acetaldehyde) that is a human carcinogen and that alcohol influences levels of hormones (such as estrogen) that are related to cancer risk.

      For example, in addressing questions about breast cancer — one of our most commonly occurring cancers – we have strong evidence of a mechanism of risk and evidence from longer-term studies that show a dose-response relationship between alcohol consumption and risk of breast cancer that begins even at low levels of consumption (less than one drink per day).

      This article about the intersection and overlap of anti-inflammatory diets and eating patterns to reduce cancer risk was not intended as a finalized summary of research conclusions, but as an aid to lend perspective for people — and for the health professionals that advise them — about what choices they make based on today’s best evidence. And the article clarifies that as important as inflammation is as enabling characteristic in cancer development, it is not the only factor that warrants our attention as we identify risk-reducing diet and lifestyle choices.

      This will be a great topic for discussion during the AICR Research Conference in November, which will include a session dedicated to dietary patterns in cancer research. I look forward to the presentations by Dr. Tabung and other leading researchers.

      Karen Collins, MS, RDN, CDN, FAND

      Reply

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