DIET DRAMATICALLY INFLUENCES INFLAMMATORY PROCESSES

enzyme activity involved in tissue repair. Some of these nutrients are discussed below.

Zinc, copper and manganese are

required in sufficient amounts so that we can activate superoxide dismutase (SOD). This is an antioxidant enzyme that may attenuate strain-induced muscle damage and facilitate its regeneration (3). A diet rich in beans, nuts, almonds and whole grains, and pumpkin seeds will help to boost these levels naturally in the body. Bioflavonoids are compounds found in fruit and vegetables. These flavonoids have a wide array of effects including anti-inflammatory, antioxidant and antiviral capacities (4). Three key flavonoids – rutin, hesperidin and quercetin – reduce inflammation through their actions on mast cells. Rutin can be found in grapefruit, lime, lemons and asparagus. Hesperidin is also found in citrus fruits, whereas quercetin is found in apples, green tea and onions. Amino acids help make up collagen fibres – glycine is of specific importance. Vitamin E acts as a major antioxidant within inflammatory conditions. Vitamin C is specifically important for wound healing.

ARE YOUR PATIENTS GETTING ENOUGH SLEEP? Sleep is one of the most essential parts of inflammation management and injury recovery. It is the first thing that I make sure patients understand in treatment. Adults are commonly overworked and under-rested along with inadequate hours of sleep. Disrupted sleep and low sleeping hours can both cause varied neurobehavioural and physiological changes (5). Upregulated inflammatory processes are associated with inadequate sleep,

with the effect of changing baseline

inflammatory markers, such as elevated C-reactive protein. Both the quality and quantity of sleep have been thoroughly researched in relationship to immune, metabolic and cardiovascular function (6). Changes to sleep patterns, by increasing sleep deprivation in one well controlled study, indicated non-specific activation of leukocyte populations and a low level state of systemic inflammation (7). One of the popular conceptions is that one good night’s sleep will go a long way towards managing fatigue, but the same study showed that systemic immune and inflammatory markers did not recover to within normal limits (7), even if there was a positive subjective recovery. It is good guidance to make sure your patients are practising good sleep habits, which includes no TV in bed, no mobile phones, complete black out of light to ensure quality sleep, and making sure that rest is between 8 and 9 hours per night.

DIETARY GUIDELINES Omega-3 vs omega-6. Modern diets are often rich in omega-6 and deficient in omega-3 fatty acids. Patients can be encouraged to eat more omega-3 fatty acids and reduce the intake of omega-6 fatty acids (8). The omega-3 fatty acids are alpha-linoleic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These are all omega-3 polyunsaturated fatty acids. These omega-3 fatty acids are all involved in stimulating a strong anti- inflammatory response in the body. ALA, whose sources include flax seed oil, canola oil as well as green vegetables, cannot easily be converted to EPA and DHA. However, it has been shown to decrease inflammatory prostaglandins (9). Increasing omega-3-rich foods such as mackerel, sardines, salmon and wild game meats gives rise to elevated levels of EPA and DHA. These stimulate production of the prostaglandin-3 (PGE3) and leukotriene-5 (LTB5), which are both anti-inflammatory mediators (10). The omega-6 fatty acids come from food sources such as sunflower oil, safflower oil and canola oil. The omega-6 fatty

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acids are converted to arachidonic acid through metabolic pathways and then converted via the cyclooxygenase enzymes into pro-inflammatory prostaglandins (PGE2) and leukotriene-4 (LTB4). Avoid sugar. An excess of sugar has the capacity to increase levels of C-reactive protein (CRP), which is the major marker of inflammation in the body. Excess sugar can lead to high levels of advanced glycation end products (AGEs). These are classified as toxins and can lead to inflammation in the body. Turmeric. Within turmeric is a fat soluble compound called curcumin, which has been shown to consistently block transcription factors involved in inflammation (11). This compound also helps to mediate the metabolism of arachidonic acid by inhibition of COX2 (12). Ginger. The active phenolic compounds in ginger have anti-inflammatory effects. This process is made possible by inhibiting COX1 and COX2 enzymes (13). Proteolytic compounds. These support the production of various cytokines and slow the clotting process. These enzymes, bromelain and papain, present in pineapple and papaya, have effects that include decreasing the aggregation of blood platelets (14) and increasing fibrinolysis (15). Cayenne. Compounds within cayenne pepper help to inhibit prostaglandin synthesis (16). It also, like bromelain, reduces aggregation of blood platelets and improves circulation (17).

CONCLUSIONS

It is important to understand the impact that simple dietary guidelines and environmental changes, such as sleep patterns, can have on inflammatory processes and tissue repair. This advice stops short of prescriptions that a certified nutritionist would make to patients, but it does educate the patient as to the impact that their choices will have on their treatment and recovery outcomes. This area of sports medicine, when integrated into rehabilitation, allows the practitioner to make positive progress beyond physical protocols. The research surrounding the use of diet, nutrients and botanicals is expanding massively and it is possible to impart simple guidance around this research for our patients.

sportEX dynamics 2012;34(October):7-9