Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:
Anti-Inflammatory Diet and Lifestyle.
There are over 190 articles on diet, inflammation and disease on this blog
(find topics using search [upper left] or index [lower right]), and
more articles by Prof. Ayers on Suite101 .

Tuesday, July 7, 2009

Flu Susceptibility and Anti-Inflammatory Fish Oil

Omega-3 Oils Reduce Inflammation, but May Increase H1N1 Infection Risk

The goal seems to be to reduce inflammation and reduce disease, but it isn’t that simple. Inflammation is not bad. Chronic inflammation is the problem for degenerative diseases. After all, inflammation is just what we call the mobilization of our immune system to fight infection. The problem is that inflammation needs to be properly controlled to be invoked only when needed, to be kept localized and to be brought to a proper conclusion.

A recent article extended studies of fish oil and various types of infections, to influenza. It used a mouse model that focused on the local, lung aspects of flu infection. Some mice were fed fish oil in a 4:1 ratio to corn oil (fish group) and the controls were just fed corn oil (corn group), as the lipid part of the diets.

Both fish oil and corn oil groups got sick when exposed to flu virus. The lungs of the fish treated group were less inflamed, but there was more virus and an increased death rate. The fish oil effectively reduced inflammation, but the inflammation in the corn oil, inflamed, mouse was useful in controlling the spread of the virus. Does this mean that chronic dietary inflammation is protective?

How close does this mouse system model human H1N1 infections? A lot can be learned from animal models, but not all aspects of the human disease are reflected in this model. There is no single H1N1 strain, for example. Flu viruses mutate thousands of times faster than even the most variable bacteria. Thus, people in various parts of Asia may be experiencing a different H1N1 than people in South America. Some H1N1 infections involve organs other than the lungs and cytokine storms can also be deadly.

If H1N1 is raging, is fish oil a good idea? It would be prudent to reduce other sources of inflammation, by eating an anti-inflammatory diet and getting plenty of exercise. The answer would seem to be to use only enough fish oil to reduce remaining symptoms of chronic inflammation, e.g. aching joints. The mouse model may have reduced the ability to produce an inflammatory response beyond elimination of chronic inflammation.

Most people who eat a high carb diet, with the typical inclusion of vegetable oils, starch and high fructose corn syrup would probably benefit from fish oil supplements, even in the context of influenza risk. It would take a lot of fish oil to compensate for the other inflammatory parts of their diet. Obesity is both a symptom of dietary inflammation and a source of chronic inflammation. Reluctance to engage in physical activity is another indicator of inflammation.

It would be helpful if epidemiologists studying the H1N1 swine flu pandemic would determine if chronic inflammation is a risk or benefit in surviving the disease. It would also be helpful to know what simple dietary or other interventions, e.g. nicotine, caffeine, would be helpful for various symptoms of the disease.

Schwerbrock NM, Karlsson EA, Shi Q, Sheridan PA, Beck MA. Fish Oil-Fed Mice Have Impaired Resistance to Influenza Infection. J Nutr. 2009 Jun 23. [Epub ahead of print]


Jenny said...

This echoes a concern I have about high dose Vitamin D supplementation. Those of us who don't eat high carb diets may not need as much anti-inflammatory intervention as we are getting, especially if we have normal CRP-values.

Dr. Art Ayers said...

Thanks for stopping by. I was appreciate your perspective.

I am beginning to think of immunosuppression as the opposite of inflammation. That means that it is easy to overshoot anti-inflammatory interventions, such as vitamin D and omega-3 oils.

The problem is that we lack good measures of chronic inflammation. CRP is one of the better tools, but it is flawed. Heparin saturation of blood proteins may be better, but it is only a theoretical dream at the moment.

TedHutchinson said...

Regular testing enables people to monitor 25(OH)D status.
The charity
Grassrootshealth D Action
offer twice yearly 25(OH)D testing at cost price as part of a 5yr trial.

Please join and encourage your friends and family also. We will have a much better idea of the value of Vit D3 supplementation when we have twice yearly records of 25(OH)D levels of 10,000+ people, matched against supplement intake and medical history over a five year period.

There are other markers of good health such as Vitamin D Status of human breast milk and Incidence of chronic disease that suggest a level higher current average status may be preferable.
40~60ng/ml is the consensus opinion amongst vitamin D experts. I like to keep my 25(OH)D around 55ng/mL.

Angela said...

"I am beginning to think of immunosuppression as the opposite of inflammation. That means that it is easy to overshoot anti-inflammatory interventions, such as vitamin D and omega-3 oils."

And that explains why most inflammatory diseases always to immune suppressants/modulators to some degree...

It is also worth to note that D3 supplementation depletes the liver's reserve of A, so maybe we should ensure correct intake of both A and D.

Maybe that's why two months after I started having plenty of sun I got a bit of rosacea! And then when I started on 6,000 UI D3/day it got worse, sebhorreic dermatitis covered all of my face and got acne perioral.On the top, I reacted very badly to minocycline (depersonalization/derealization symptoms... I thought I'd end up in psych ward!) so now my plan is to supplement with liquid zinc, cod liver oil plus some butter oil to cover K... My immune system is such mess! But at least now that I am on D3 I can laugh at it instead of wanting to hide in a dark corner :D

Daniel said...

Immunosuppression (rapamycin) may delay the aging process too. Interesting stuff. If only we didn't need those immune systems.

Dr. Art Ayers said...


Should have been: I always...

Knowing serum D is very important, especially if inflammation symptoms are present.

The vitamin A depletion is important, an I tend to leave it out.
Did your serum levels of vitamin D show your problems? After vitamin D supplementation, did you still show inflammation by some measure, such as CRP? Are you still on a high carb diet? Celiac (gluten intolerance) is such a common source of chronic inflammation, that it should always be suspected, when carb regulation, vitamin D and omega-3 supplementation don't bring quick results.

I read those rapamycin results with interest. Rapamycin was initially characterized as an antibiotic, because it was effective against fungi. Later, the immunosuppressive qualities were found. I would expect it to also have additional side effects. It is fascinating as a polyketide, because the enzyme complex that makes it can be rearranged in its order within the composite synthesis gene, as the functional groups are then added to the molecule in a new sequence. It is like a molecular construction kit.

Your point about general immunosuppression as life lengthening is insightful, since rapamycin can be added to older mice and extend their lives. It would be interesting to know if rapamycin is effective on the inflammatory chronic diseases such as chronic fatigue, fibromyalgia, chronic lyme, etc.

Thanks for your comments.

Stephan Guyenet said...

Art and Dan,

I wonder if rapamycin extends life in lab rodents because it counteracts the inflammatory effects of their sad little pellets?

ShawneeL said...

Hi, I'm wondering what I can take since I don't eat fish because of sensitivity. Is Flax oil similar and as effective?

Dr. Art Ayers said...

Flax oil is a short chain omega-3. It is anti-inflammatory, but is only converted to the longer, EPA and DHA at very low efficiency. That means that you have to eat at least ten times as much to see the effects that occur with the longer, fish oil. Have you tried krill oil?

You could try some of the highly purified EPA and DHA. If you already have allergies to fish, then you need to follow all of the other guidelines for the anti-inflammatory diet -- use the link at the top of this web page. You may also suspect gluten intolerance. Vitamin D and low carb are the most important. Make sure to eliminate vegetable oils (except olive oil).

Good luck.

Thanks for your comment.

Adolfo David said...


Dr Ayers, I have sent your article to Dr Barry Sears team ( ), and he personally has answered this to me:

"Relative to the swine flu, you have to use dramatic levels of fish oil (probably 10-15 grams of EPA and DHA per day) in humans to lower the AA/EPA to less 1 in which immune function might be compromised."

Mike said...

Dr. Ayers,

Phenomenal blog; I always look forward to your topics.

This one hits home quite accurately with me, as of late; Since the beginning of June, I have had 3 concurrent episodes of flu-like symptoms, The most recent coming yesterday, along with URI symptoms. Symptoms seem to last for 3-5 days, with the URI not clearing since June.

Some vitals, for interest's sake:

-I have not had the flu in 3 years
-I did NOT receive a flu shot this year
-I take 5.4g EPA/DHA daily
-I take between 10,000iu and 5000iu of D3 daily, with my last levels testing at 73ng/mL
-I take a tumeric/bromelain 3x daily; unsure on mg per cap, as I'm at work (which i shouldn't be!)
-I eat a 90% strict Paleo diet
-I Crossfit and mountain bike for exercise; I deadlift 405lbs, and run 5km in 23 minutes.
I work shiftwork as a firefighter, which affects my immunity

My point in all this is that a light bulb went on in my head today, as I am potentially suppressing my immune system with my supplementation,dietary, and lifestyle habits.

Comments? Insight?

Once again, thank you for the excellent blog and topics.

Dr. Art Ayers said...

As you indicate, you don't tend to get sick, so I wouldn't expect suppression. Your intense exercise should also purge your body of pathogens.

Biking and URIs would seem to go together -- ureter trauma and dehydration. URIs can produce all of the symptoms that you discussed, because the bacteria can release endotoxins. Have you tried cranberry juice? You might stay away from the bike seat for a while. Some of the antibiotics for URIs don't hit the gut flora, so that is another option.

Also note that prostatitis can get started from URIs.

A castor oil pack may also provide anti-inflammatory relief for your bladder. It seems kind of strange, but castor oil applied to the belly helps a variety of obstetric problems, so I would extend that to bladder and prostate as well. Vicks may work even quicker.

Thanks for protecting people. I have military and police in my family, so I know that your work can produce intense stress. Your diet, exercise and health awareness should be providing lots of support.

Thanks for your comments, it makes the writing rewarding.

Mike said...

Dr Ayers,

Thanks for the reply. Just some clarification, though:
URI = Upper respiratory infection.
UTI = Urinary Tract Infection.

Water works are fine for me. :) Lungs, on the other hand, and sinuses, not so much. Regularly stuffed sinuses and productive hacking cough since June, waxing and waning in severity.

The longer LSD training(1-2h, sometimes 3-4h) of mountain biking, which I have increased in frequency with the warmer weather here in Alberta, may have a strong contribution.

Dr. Art Ayers said...

I wish I had a good excuse. At least I had an answer for UTI. This is a useful indicator that I am not an MD.

URI - I don't have much to say about these. If you have sinuses with bacterial infections, then I would recommend humming. It breaks up the surface layers and gives access of sinus vessels to the nitric oxide in the respired air. The net result is useful dilation of the vessels and increased access of your immune system to any pathogens in the sinuses. It is more effective than antibiotics. So, hum as you ride. (It can make you dizzy, so use care.)

I still doubt that your illness is due to anti-inflammatory suppression. It may be due to old allergies that you developed prior to your current anti-inflammatory diet/lifestyle. But, you indicated no prior occurrance.

I would try the humming.

Anonymous said...

I noticed you mentioned heparin sites in your post re H1N1. I am 18 weeks pregnant & on Fragmin 5000 units bid. To your knowledge is there any theoretical risk related to fragment use & h1n1 vaccine? I noticed thrombocitopinia is a AE of vaccine and also of fragmin.

Anonymous said...

I noticed you mentioned heparin sites in your post re H1N1. I am 18 weeks pregnant & on Fragmin 5000 units bid. To your knowledge is there any theoretical risk related to fragment use & h1n1 vaccine? I noticed thrombocitopinia is a AE of vaccine and also of fragmin.

Vinyasa paris said...

what is the symptoms of H1n1...How to avoid ??