Starving the fire

The anti-inflammatory diet: 5 things to know

Patients with heart disease, diabetes and obesity are among those who may benefit from an eating plan aimed at treating low-grade chronic inflammation.


Chronic inflammation is a risk factor for a host of diseases and health problems plaguing Americans today. Finding ways to help your patients cut down their inflammatory processes can be a crucial component to improving their overall health and well-being.

Diet can be a major contributor to chronic inflammation, says William Welches, DO, PhD, a family physician and biochemist who works at Cleveland Clinic’s Pain Management Clinic.

“If you eat a diet that’s rich in combustibles—which the standard American diet is—you’re going to be in meta-inflammation all the time, always right on the edge and stoked,” says Dr. Welches, who uses an anti-inflammatory diet as part of an integrative approach to treating chronic inflammation in his patients. “You want to starve the fire, not feed it.”

The anti-inflammatory diet is an eating plan aimed at treating low-grade chronic inflammation. Patients with heart disease, diabetes, obesity, asthma and autoimmune diseases such as lupus and rheumatoid arthritis can benefit from the diet, which calls for eating more fresh fruit and vegetables, whole grains, fish, lean meats and low-fat dairy and limiting sugar and processed food.

Here are 5 things to know about inflammation and the benefits of an anti-inflammatory diet:

Anti-inflammatory diet do’s and dont’s. Foods that cause inflammation include refined carbs, added sugars, dairy, fried foods, soda, processed meat, and red meat.

Anti-inflammatory foods include dark, colorful fruits and vegetables such as cherries, raspberries, blackberries, spinach, kale and broccoli; plant-based proteins such as nuts and beans; olive oil, fatty fish and fresh herbs and spices such as ginger, garlic and turmeric.

There is accumulating evidence that vitamin K-rich leafy greens have a protective role against chronic inflammation and chronic age-related conditions, including cardiovascular disease and osteoarthritis, though experts say more research is needed.

To reduce levels of inflammation, aim for an overall healthy diet. If patients are looking for an eating plan that closely follows the tenets of anti-inflammatory eating, they can consider the Mediterranean diet, which is high in fruits, vegetables, nuts, whole grains, fish, and healthy oils with extremely moderate meat consumption, Dr. Welches says.

“The fish component seems to be important, and not just for the Omega 3s,” says Dr. Welches. “Pasta is delicious but not good for you, and I tell patients to stay away from red meat as much as they can.”

How strictly a patient needs to follow an anti-inflammatory diet might depend on their level of inflammation and corresponding pain. Patients with chronic pain conditions who are in constant pain should consider abstaining from all simple carbs like sugar or flour, dairy and red meat, says Dr. Welches. In their place, they should substitute nine servings of vegetables (two to three can be fruit), fish and skinless chicken on occasion.

Inflammation can be a friend or a foe. While inflammation is a critical component in fighting off foreign pathogens and healing injury, a low-grade chronic inflammatory state can contribute to a wide range of chronic conditions, such as Type 2 diabetes, heart disease, and other metabolic disorders.

According to a Johns Hopkins Health Review article, ongoing research is finding more answers about how inflammation contributes to cancer. “Inflammatory cells produce free radicals that destroy genetic material, including DNA, leading to mutations that cause cells to endlessly grow and divide. More immune cells are then called in, creating inflammation that feeds the growth of tumors,” the article states.

The diet supports other methods of curbing inflammation. In Dr. Welches’ pain management practice, the anti-inflammatory diet supports other lifestyle modifications that reduce inflammation, including exercise, stress management, osteopathic manipulative treatment and acupuncture.

Dr. Welches believes that lifestyle modification is the next big revolution in medicine. First, there were the social aspects (clean water and clean air), then the development of antibiotics, he says.

“The next big one I think is lifestyle. It’s something that physicians didn’t pay much attention to, but we’re starting to,” he says. “I remember when the Surgeon General’s report came out that smoking was bad in 1964, and look how long it’s taken us to start seeing the number of smokers go down.”

Adherence can be tough. “I advise patients that lifestyle and dietary changes are going to be difficult and will take effort,” says Dr. Welches. He frequently hears from patients who say they struggle to maintain the anti-inflammatory diet.

“The first thing I suggest people do is increase their vegetable consumption, then work on cutting back on meat and refined carbs. Do it in stages. Keep the wrong food out of the house,” Dr. Welches says. “Each step is a good step all by itself, and if you do enough of them, your diet will change.”

As to how long a patient should adhere to the diet to see any changes? Dr. Welches suggests 12 weeks to fully test the diet, though patients should have some strong indications within two to three weeks.

“The reality is that oftentimes changing our lifestyle so we live better, healthier lives involves sacrifice,” he says.


  1. Mary M Obermeier

    Sounds good, but are there actually appealing and FILLING menus for this that don’t leave us searching for more?

  2. Claudia Peterson, DO

    Dr. Welches you wrote a great article and there is nothing more I would add to it.
    I have seen it work for those patients that were committed to consuming the suggested foods in the article.
    I kept the process simple, in being creative the patient developed their menu after eliminating those foods that causes inflammation in most people.
    Being an Osteopath you spent 4 years or more gathering evidence.
    The information provided is adequate to bring on a positive change.
    Thank you

  3. William Schindler DO, FACP, FACG

    I am a recently retired Doctor of Osteopathic Medicine. I developed MS in 1985, no meds until fall 94 except steroids. I have been doing a ketogenic or at least low carb diet and have lost 55 lbs. I eat lots of green vegetables but also a lot of bacon and eggs. My HDL has doubled and I’m off my anti hypertension meds

  4. David Walls

    Thank you Dr. Welches! Glad to see this article acknowledging the profound impact diet has on health. We know poor diet is a major contributing factor in chronic diseases. Let’s help keep this information at the forefront of our members minds by supporting policies that take nutrition into account and adhering to these diet recommendations at AOA and state society events.

  5. Joan Orloski, Ph.D., D.O.

    I learned the hard way a long time ago that milk products made my joint inflammation worse.
    I also learned that certain foods contributed to my migraine headaches and as long as I haven’t eaten those foods I haven’t had a headache in years. Avoiding these very common foods has been both difficult and expensive but it is definitely helped me live with a lot less pain and has been worth every minute.

  6. Pratistha Strong

    Thanks Dr. Welches for re-iterating! I give free talks in the St. Louis area at the local health food stores, Fresh Thyme; I’ve done 4 total this year and patients are hungry for this. I break it down into the anti-inflammatory “lifestyle” going into your 5th point of adherence and all. Lifestyle is key to long term adherence; diet is temporary. I’ve added some information on eating fermented foods, meditation/mindfulness eating and activity. For those wanting evidence, there is plenty in the Mediterranean diet, which is essentially the archetype for anti-inflammatory diet. If anyone wants a good read, pick up Dr. Rankles Intergrative Medicine book!

  7. Janice Massie Ryan

    It is all individual, people need to figure out what really works for them not others. Most people are not cut out to be vegetarians as you subtlety insinuate they should. A lot of people don’t like fruit or vegetables are those people supposed to just suffer? It can’t be all or nothing there has to be some leway for picky eaters, allergies, and intestinal upsetments people often deal with having to eat a certain way that you suggest

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  9. Nancy Gray

    I have been on this anti-inflammatory diet starting on my 4ty week. I have followed it to a T. I noticed each week that goes by I’m feeling sicker. I’m eating everything on the list. I’m not sure if it’s a blood issues?? It’s as if I feel my sugar and carbs in take maybe to low for me?
    I feel dizziness, nauseous and weak. I don’t eat fish, hate it. I eat chicken or turkey. Cooking with good healthy oils. Extra virgin olive oil.

    1. Misty, Registered Dietitian

      Hi Nancy! It sounds like you would benefit from seeing your PCP? Have you been testing your blood sugar to see if there is concern here?

  10. Terry

    I am a COVID long hauler with lung issues. When I eat certain foods I feel I can’t breath and even my nose gets stuffy , it’s weird. All this is new to me. I’m gonna start to eliminate as much possible. I did notice when I only ate ground turkey, steam salary, and an apple, I had no chest or lung pressure.
    At the moment I’m also having chest pressure but I’m trying not to let my anxiety hit me cause if I go to hospital again, they only focus on that and not the pain.

    1. laura J schepps

      Hi Terry, Hope you are feeling stronger and stronger. Seems to me you got very vivid feedback about what makes you feel stuffy and congested and what doesn’t. Food is medicine or poison. Believe me I know how hard it is to kick to the curb what i crave but also whats must important to me is that i spend my last years as healthy and feeling good in my body as possible. Good luck to all of us!

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  12. S.

    I just wanted to say that this actually does work in terms of healing issues with chronic gastrointestinal issues, stomachaches, headaches, joint pain acid reflux, chronic fatigue, vomiting, & resistant obesity. There is much sacrifice involved, but it is very much worth it.

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