Anti-Inflammatory Diet For Dummies - Artemis Morris - E-Book

Anti-Inflammatory Diet For Dummies E-Book

Artemis Morris

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Beschreibung

Practical tips and recipes for avoiding chronic inflammation and maintaining your long-term health

Anti-Inflammatory Diet For Dummies equips you with the latest information on how to avoid chronic inflammation and reduce your risk of associated health conditions. Inflammation is linked to arthritis, stroke, cancer, obesity, and beyond. You can keep inflammation under control by focusing on foods and lifestyle factors that have been shown to help. This accessible and straightforward guide explains how it all works, and offers over 100 tasty and nourishing recipes that can have a real impact on your health—today and into the future. Updated with the latest research and an expanded focus on gut health, this new edition gives you what you need to keep inflammation in check.

  • Find out what causes inflammation, and how reducing inflammation can keep you healthy
  • Discover the basic anti-inflammatory ingredients and great recipes that keep inflammation down
  • Learn what the latest science is saying about inflammation and conditions like breast cancer, Alzheimer's, and dementia
  • Get relief from inflammatory symptoms and keep chronic disease at bay

It's never too early or too late to start shifting to an anti-inflammatory diet and improving your long-term health. Anti-Inflammatory Diet For Dummies makes it easy.

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Veröffentlichungsjahr: 2025

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Anti-Inflammatory Diet For Dummies®

To view this book's Cheat Sheet, simply go to www.dummies.com and search for “Anti-Inflammatory Diet For Dummies Cheat Sheet” in the Search box.

Table of Contents

Cover

Table of Contents

Title Page

Copyright

Introduction

About This Book

Foolish Assumptions

Icons Used in This Book

Beyond This Book

Where to Go from Here

Part 1: Taking the Mystery Out of Inflammation

Chapter 1: Inflammation, Food, and You

Defining What Inflammation Is

Treating Your Symptoms with Nutrition

Supplementing Your Diet with an Anti-Inflammation Lifestyle

Chapter 2: Understanding How Food Can Be Your Body’s Enemy

Finding the Link between Inflammation and the Microbiome

Defining Toxic Foods

Looking at Allergies and Specific Sensitivities

Getting Tested for Allergies and Sensitivities

Working within Your Food Limits to Avoid Inflammation

Understanding the Role of Environmental Toxicity

Eating Clean to Ward Off Inflammation

Chapter 3: Determining Inflammation’s Role in Chronic Diseases

Understanding Chronic Diseases

Connecting Heart Disease, Obesity, and Diabetes to Inflammation

Striking the Brain: Neurodegenerative Disease and Inflammation

Contributing to Cancer

Altering the Mind with Inflammation

Asthma: Inflaming the Lungs

Disrupting Your Digestive System

Knocking Your Immune System Off-Kilter

Chapter 4: Finding the Link: Inflammation and Women’s Health

Looking At Breast Health

Recognizing Issues with Reproductive Health and Infertility

Part 2: Deciphering Anti-Inflammatory Nutrition

Chapter 5: Filling Your Plate to Fight Inflammation

Following Recommendations for Food Categories

Adapting General Food Recommendations for Your Needs

Finding Your Way to Fermented Foods

Implementing the Anti-Inflammation Plan

Chapter 6: Making the Right Diet Choice for You

Perusing Diets and Making Them Work

Fueling with Fats — The Keto Diet

Eating like a Caveman (or Cavewoman) — The Paleo Diet

Giving Up Animal Products — Vegetarian and Vegan Lifestyle

Looking to the East: The Mediterranean and Okinawa Diets

Chapter 7: Feeling the Love (or Hate) in Fats

Getting the Message: Fat, Inflammation, and Cell Signals

Exploring Different Kinds of Fat

Identifying the Best Fat Sources

Chapter 8: Conquering Carbohydrates

Understanding the Role of Carbohydrates

Types of Carbs: Comparing Simple and Complex Carbohydrates

Keeping Carbs in Check to Help Inflammation

Choosing Your Carb Sources

Chapter 9: Getting the Right Kinds of Protein

Looking at Protein’s Role in the Body

Considering Your Protein Sources

Getting the Balance Right

Chapter 10: Indulging in Sweets

Connecting to Inflammation

Eating Less Sugar

Giving In to Your Sweet Tooth

Part 3: Enjoying Recipes for Less Inflammation and Better Health

Chapter 11: Starting the Day: Unbeatable Breakfasts

Simple Starts: Smoothies and Yogurts

Sweetening Toasts, Cereals, and More

Enjoying Savory Egg Breakfasts

Chapter 12: Something on the Side: Appetizers and Snacks

Making Dips Everyone Enjoys

Whipping Up Seafood Starters

Enjoying Stuffed Starters and Wraps

Setting Out Simple Snacks

Chapter 13: Bringing Out the Bowls: Soups

Finding Variety in Vegetarian Soups

Making Soups with an Asian Twist

Cooking Some Hearty Soup

Chapter 14: Eating the Rainbow: Salads

Starring Greens and Other Veggies

Making a Meal of Salads with Meat or Seafood

Fixing Bean Salads

Chapter 15: Making the Main Course: Basic Entrees

Packing Vegetarian Dishes Full of Flavor

Serving Up Poultry and Seafood Entrees

Chapter 16: Cranking Your Entrees Up a Notch

Making Main Dishes Special

Preparing Vegetarian Entrees that Pop

Chapter 17: Topping It Off: Desserts

Refreshing Desserts: Smoothies, Parfaits, and More

Going Traditional with Cookies, Rice Pudding, and Baked Fruit Desserts

Satisfying Your Craving for Chocolate

Part 4: Living an Anti-Inflammatory Lifestyle

Chapter 18: Making Home Cooking Less Inflammatory

Stocking an Anti-Inflammatory Kitchen

Choosing the Right Cooking Methods

Making Favorite Dishes Less Inflammatory

Chapter 19: Keeping Your Cool When Dining Out

Choosing a Restaurant

Planning Your Order

Finding Anti-Inflammatory Foods at Restaurants

Exploring Food Options by Restaurant Type

Keeping Portions Under Control

Chapter 20: Looking at Prescription-Drug Alternatives and Supplements

Treating Inflammation with OTC Medication

Pointing to the Positive Side of Probiotics

Using Dietary Supplements to Fill in the Nutritional Gaps

Choosing Dietary Supplements Wisely

Chapter 21: Making Strides against Inflammation

Fighting Inflammation with Cardiovascular Activity

Finding Stress Relief in Meditation and Yoga

Part 5: The Part of Tens

Chapter 22: Ten (Plus One) Benefits of Stopping Inflammation

Making You Feel Happier

Staying Sharp

Lowering Your Risk of Heart and Cardiovascular Disease

Decreasing Your Cholesterol Levels

Lowering Your Risk of Diabetes and Metabolic Syndrome

Losing Weight

Strengthening Your Bones

Reducing Your Risk of Autoimmune Disorders

Affecting Risk and the Ability to Fight Cancer

Improving Fertility

Chapter 23: Ten Inflammation-Fighting Foods

Wild-Caught Salmon

Flaxseeds

Blueberries

Extra-Virgin Olive Oil

Mushrooms

Broccoli

Quinoa

Brussels Sprouts

Onions

Green Tea

Appendix A: Metric Conversion Guide

Index

About the Authors

Connect with Dummies

End User License Agreement

List of Tables

Chapter 3

TABLE 3-1 Risk Factors for Heart Disease

Chapter 5

TABLE 5-1 Top Recommendations for Each Food Group

Chapter 7

TABLE 7-1 Sources of Good and Bad Fats

Chapter 9

TABLE 9-1 Animal Protein Sources

TABLE 9-2 Fish and Seafood Protein Sources

TABLE 9-3 Beans and Legumes

List of Illustrations

Chapter 1

FIGURE 1-1: With leaky gut syndrome, large particles can escape the digestive t...

Chapter 2

FIGURE 2-1: How food can be toxic to your body.

Chapter 3

FIGURE 3-1: The flow from risk factors to systemic inflammation to chronic dise...

FIGURE 3-2: Insulin resistance is both a cause and an effect of inflammation.

Chapter 5

FIGURE 5-1: The USDA MyPlate.

FIGURE 5-2: The anti-inflammatory food pyramid.

Chapter 12

FIGURE 12-1: Pitting an avocado.

Chapter 13

FIGURE 13-1: Chopping kale.

Chapter 17

FIGURE 17-1: Mincing ginger.

Chapter 21

FIGURE 21-1: Lunge to the left (a), and then to the right (b).

FIGURE 21-2: The stability ball supports your back as you crunch.

FIGURE 21-3: The Downward Dog pose strengthens your shoulders and upper body wh...

FIGURE 21-4: Tree pose requires focus and balance.

FIGURE 21-5: Eagle pose helps you increase balance and strength.

Guide

Cover

Table of Contents

Title Page

Copyright

Begin Reading

Appendix A: Metric Conversion Guide

Index

About the Authors

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Anti-Inflammatory Diet For Dummies®, 3rd Edition

Published by: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774, www.wiley.com

Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies.

Published simultaneously in Canada

No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except as permitted under Sections 107 or 108 of the 1976 United States Copyright Act, without the prior written permission of the Publisher. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011, fax (201) 748-6008, or online at www.wiley.com/go/permissions.

The manufacturer’s authorized representative according to the EU General Product Safety Regulation is Wiley-VCH GmbH, Boschstr. 12, 69469 Weinheim, Germany, e-mail: [email protected].

Trademarks: Wiley, For Dummies, the Dummies Man logo, Dummies.com, Making Everything Easier, and related trade dress are trademarks or registered trademarks of John Wiley & Sons, Inc., and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc., is not associated with any product or vendor mentioned in this book.

LIMIT OF LIABILITY/DISCLAIMER OF WARRANTY: WHILE THE PUBLISHER AND AUTHOR HAVE USED THEIR BEST EFFORTS IN PREPARING THIS BOOK, THEY MAKE NO REPRESENTATIONS OR WARRANTIES WITH RESPECT TO THE ACCURACY OR COMPLETENESS OF THE CONTENTS OF THIS BOOK AND SPECIFICALLY DISCLAIM ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. NO WARRANTY MAY BE CREATED OR EXTENDED BY SALES REPRESENTATIVES OR WRITTEN SALES MATERIALS. THE ADVICE AND STRATEGIES CONTAINED HEREIN MAY NOT BE SUITABLE FOR YOUR SITUATION. YOU SHOULD CONSULT WITH A PROFESSIONAL WHERE APPROPRIATE. NEITHER THE PUBLISHER NOR THE AUTHOR SHALL BE LIABLE FOR DAMAGES ARISING HEREFROM. SOME OF THE EXERCISES AND DIETARY SUGGESTIONS CONTAINED IN THIS WORK MAY NOT BE APPROPRIATE FOR ALL INDIVIDUALS, AND READERS SHOULD CONSULT WITH A PHYSICIAN BEFORE COMMENCING ANY EXERCISE OR DIETARY PROGRAM.

For general information on our other products and services, please contact our Customer Care Department within the U.S. at 877-762-2974, outside the U.S. at 317-572-3993, or fax 317-572-4002. For technical support, please visit https://hub.wiley.com/community/support/dummies.

Wiley publishes in a variety of print and electronic formats and by print-on-demand. Some material included with standard print versions of this book may not be included in e-books or in print-on-demand. For more information about Wiley products, visit www.wiley.com.

Library of Congress Control Number: 2025937869

ISBN: 978-1-394-34083-5 (pbk); ISBN 978-1-394-34085-9 (ebk); ISBN 978-1-394-34084-2 (ebk)

Introduction

There seems to be a diet for everything these days: one for improving heart health, one for detoxifying the body, one for bulking up, and hundreds for slimming down. What if a diet was designed to just make you feel better, relieve painful chronic health conditions, and even prevent the onset of future disease? The anti-inflammatory diet is designed to do just that.

For years researchers have studied the impact certain foods have on people’s digestive systems, but did you know they’ve also been watching the impact foods have on the muscles, bones, liver, kidneys, brain, and other organs? What’s more, physicians and researchers have discovered links between certain foods and chronic illnesses such as diabetes, cancer, rheumatoid arthritis, infertility, Alzheimer’s disease, multiple sclerosis, neurodegenerative disease, depression, and more — links that may be broken with an anti-inflammatory diet. Certain foods and food groups may promote inflammation in your body, just as others — such as fish, nuts, seeds, and organic fruits and vegetables — may help you avoid such diseases.

Anti-Inflammatory Diet For Dummies, 3rd Edition, serves as an introduction to the foods you should avoid and those that you should pile up, explains how you can change your lifestyle into one that’s inflammation-free, and provides approximately 110 recipes you can incorporate into your new anti-inflammatory lifestyle.

About This Book

This book is for anyone who is suffering from one of a multitude of chronic health conditions, for those who know someone who is suffering, and for people who simply want to avoid pain and discomfort in the future.

Diet plays a key role in how you feel, well beyond the fullness you feel after a big meal. Certain foods — refined sugars, foods high in saturated fats, and some meats — can actually work against your body and contribute to diabetes, heart disease, cancer, and all other chronic health conditions.

This book also is a starter guide, an introduction to signs and symptoms of a variety of chronic health conditions and conditions related to inflammation. We introduce you to the healthiest foods, herbs, and supplements, and we steer you away from foods that can — and do — cause problems. We don’t simply say, “This is bad;” we tell you why something is inflammatory, why it’s healthy, how it can help, or how it can further damage your tissues and cells.

We also assist you in putting the anti-inflammatory diet into practice. Not only does this book give you a list of the foods that help to reduce inflammation, but it also features approximately 110 easy-to-moderate recipes for almost any occasion, all geared toward stopping inflammation in its tracks. In addition, this book offers simple exercises and yoga positions to help you further move inflammation out of your life.

This book is a reference book, so you don’t have to read everything or read everything in order. We designed it so you can jump in and read about whichever topics most interest you — or the ones that can offer you the most relief.

Most of the recipes in Part 3 aren’t only anti-inflammatory but also designed for people suffering from lactose intolerance or gluten sensitivity. In recipes not designed for those people, we suggest substitutions you can make.

Furthermore, here are a few other guidelines to keep in mind about the recipes in this book (unless otherwise stated in the recipe):

All butter is unsalted unless otherwise stated. Margarine isn’t a suitable substitute for butter.

All eggs are large, organic, and pasture-raised.

All dry ingredient measurements are level.

All temperatures are Fahrenheit (see the appendix to convert Fahrenheit temperatures to Celsius).

All sea salt is unrefined.

All ingredients are organic unless otherwise noted.

All canned beans are no-salt-added and organic.

All lemon and lime juice is freshly squeezed.

All Greek yogurt is full-fat yogurt.

If you need or want vegetarian recipes, scan the list of “Recipes in This Chapter” on the first page of each chapter in

Part 3

. A little tomato, rather than a triangle, in front of the name of a recipe marks that recipe as vegetarian. (See the tomato to the left of this paragraph.)

The exercises and yoga positions in Part 4 are good starter exercises for people who are just getting started. If you already subscribe to a workout regimen, step up the moves or push yourself just a little harder by taking a class, trying a tougher workout, or simply extending the time of your own workout.

Foolish Assumptions

In writing this book, we made some assumptions about you, the reader:

You aren’t a healthcare provider, so you don’t need highly technical information. You’re using this book as a guide to better, healthier living.

You or someone close to you suffers from inflammation and you’re interested in knowing ways to curb the pain and discomfort without the need for an arsenal of medication. Or you don’t want to suffer from arthritis, diabetes, multiple sclerosis, or cancer later on in life and are looking for something to keep chronic conditions at bay.

You’re interested in changing your diet, whether it’s a complete overhaul or just substituting some healthier options for some of the not-so-healthy foods in your diet now.

Icons Used in This Book

Icons are the little signposts in the margins of this book. Here’s a guide to what they signify:

This icon gives you hints and suggestions, usually to make a good thing even better.

Here we draw your attention to key ideas you should remember even after you close the book.

Whenever you change your diet or start looking at medications and supplements, you should consult your doctor for precautions. This icon serves as a reminder in cases where you should exercise extra caution and/or get a medical opinion.

You see this icon attached to information that, although interesting, isn’t vital to your understanding of the topic.

This icon marks text (from Artemis) with medical information about the choices you can make to handle inflammation.

Beyond This Book

For a quick reference point, you can check out the Cheat Sheet at www.dummies.com. Just search for “Anti-Inflammatory Diet For Dummies Cheat Sheet” for helpful information you can refer to again and again.

You can also check out a bonus chapter that identifies ten anti-inflammatory supplements and herbs at www.dummies.com/go/anti-inflammatorydietfd3e.

For more information, check out www.drartemis.com.

Where to Go from Here

You don’t have to read this book from cover to cover. Flip through the Table of Contents or Index to find a topic that interests you and start reading. Or, if you want, you can skip right to the recipes and find out later why they’re good for you. Want to see how your dietary supplement compares to others? Skip straight to Chapter 20. Need some good exercises to go along with your healthy habits? See Chapter 21. Want to know how inflammation can impact women’s health, from breast cancer to infertility? Turn to Chapter 4. Trying to figure out how many servings of something you should eat on a daily or weekly basis? Check out Chapter 5.

The great thing about this book is that order doesn’t matter. If you need information in one chapter to better understand another, you can jump back and forth, and we include cross-references where appropriate to help you get the whole picture, no matter where you start.

Part 1

Taking the Mystery Out of Inflammation

IN THIS PART …

Understand the difference between acute and chronic inflammation and how what you eat can affect how you feel.

Identify where toxic foods come from and how food toxicity can affect your health.

Dig into different food allergies and sensitivities and how your body may be affected without knowing it.

Understand how chronic inflammation can impact women’s health, from breast cancer to infertility and menopause.

Examine the health benefits of different foods to create a diet that suits your needs.

Make sense of the connection between food and chronic diseases like cancer, heart disease, and neurodegenerative disease.

Chapter 1

Inflammation, Food, and You

IN THIS CHAPTER

Understanding how inflammation fits into the immune system

Using nutrition to decrease inflammation

Making lifestyle changes

If you ever fell off your bike or out of a tree, you’re familiar with inflammation surrounding an injury. In most cases, inflammation surrounds minor cuts and bruises in the form of swelling and protects the injured area until it heals. Since the late 1980s, however, research has also linked inflammation to outside sources, such as diet and internal imbalances. These inflammatory responses may become so severe and long-lasting that they lead to chronic illness, such as diabetes, arthritis, heart disease, and cancer, as well as neurological and cognitive issues, such as Alzheimer’s, dementia, depression, and stress.

In this chapter, you get a better idea of just what inflammation is — both the good and the bad — as well as how it’s defined and what to look for. Throughout the remainder of this book, you discover foods that may contribute to the problem as well as those foods, vitamins, and supplements that may lessen the effects of inflammation.

Defining What Inflammation Is

Keep in mind that not all inflammation is bad; in fact, inflammation plays a vital role in keeping you healthy. Inflammation is the body’s way of protecting itself from harmful bacteria, viruses, and injury. This short-term inflammatory response was helpful when people were living and eating in the wild; however, in modern day, more often than not, inflammation becomes a long-term, or chronic, issue that your body may need help to resolve. In some cases inflammation causes the body to turn on itself, attacking healthy cells and organs. In this section, we take a look at the various kinds of inflammation and identify how things can go wrong.

Understanding how the immune system works

The immune system is a complicated association of organs, tissues, and cells that work together to protect the body. The immune system uses inflammation as a protective mechanism when it feels the body is in danger of infection or injury.

There are three kinds of immunity:

Passive:

Passive immunity

is a temporary immunity that comes from another body, such as from the mother to a fetus through the placenta or to an infant through breast milk. Passive immunity typically disappears 6 to 12 months after birth.

Innate:

Innate immunity

is the immunity you were born with and your first line of defense against potentially harmful invaders. Innate immunity includes barriers that keep invaders from entering your body, as well as inflammatory responses — coughing; producing tears, sweat, mucus, and additional stomach acid; swelling; and so on.

Acquired:

Acquired immunity,

also known as

adaptive immunity,

develops in the presence of certain antigens. It develops as your body builds defenses against specific invaders, such as viruses that cause chicken pox and the common cold. Acquired immunity can develop naturally, such as by catching a cold and recovering, or artificially, by receiving a vaccine.

In this section, we cover innate and acquired immunity, the two immune systems that stick around through adulthood. We discuss inflammation as part of the innate immune system, and we cover the invader-specific defenses of the acquired immune system.

Innate immunity: Providing general protection with inflammation

Inflammation is part of your body’s innate response to invaders. The inflammatory response takes over when harmful bacteria, viruses, toxins, or other elements make their way into your tissues and cause damage. Those damaged cells release chemicals called prostaglandins and histamines, which cause blood vessels to leak fluid into the tissues and create swelling.

The resulting inflammation — characterized by redness, swelling, heat, and pain — serves as a physical barrier against the spread of infection (in the case of illness) or against further injury (which would delay the healing process). Chemical factors released during inflammation ward off or sensitize pain signals, creating a more suitable environment for healing.

Meanwhile, the immune system, sensing danger, sends backup. Various parts of the immune system respond by directing traffic, isolating and killing the invaders, and destroying and clearing out infected cells. The cells communicate with each other through a variety of substances or proteins, including cytokines, C-reactive protein (CRP), acute-phase proteins, prostaglandins, and more. Understanding this response is helpful for healthcare providers because these inflammatory markers — CRP, acute-phase proteins, and prostaglandins, for instance — indicate where the problem is and how severe it may be. Researchers examine the immune system’s response to determine what triggers inflammation and find ways to control it — such as through diet — when things go wrong or get out of control, creating a cytokine storm. A cytokine storm happens when your immune system produces too many pro-inflammatory cytokines in response to an infection or attack, leading to uncontrolled inflammation.

Acquired immunity: Attacking specific invaders from past encounters

The acquired, or adaptive, immune system is the one you develop based on what you do, where you go, and what you’re exposed to. The more bugs and viruses you come in contact with, the more complex your acquired immune system becomes and potentially the more protected you are.

Through a process called immune response, the immune system calls upon its network — cells, tissues, and organs — to combat illness and infection. Leukocytes, or white blood cells, seek out and destroy infectious organisms and substances. There are two kinds of leukocytes:

Phagocytes,

which are the hungry leukocytes that eat the invaders

Lymphocytes,

which help the body identify and recognize attackers so it knows what to watch for later

Here’s what happens: When your body detects antigens (the foreign substances), a group of cells get together and form a type of cell army to attack the invader. Some of these cells produce antibodies that can lock onto the specific antigens. The antibodies serve as tags, identifying the invader as an enemy and targeting it for destruction.

Some of the antibodies continue to live in your body so they can immediately attack if the same antigen is detected. The next time the antibodies encounter that antigen, they lock on and initiate an inflammatory response.

Seeing where inflammation goes wrong

When inflammation works right, it attacks the irritant — the virus, harmful bacteria, or damaged cells. Sometimes, however, the body kicks into overdrive and launches an offensive on normal, healthy tissue. For example, if you have the autoimmune disorder rheumatoid arthritis, you may experience some redness and some swelling in the joints, with joint pain and stiffness. This reaction is a sign that your body is trying to attack your joint tissue, which your body mistakenly perceives as unfriendly.

Say your house is being overtaken by mosquitoes. You get some mosquito spray, light a citronella candle, and keep a rolled-up newspaper handy. You’re handling the irritant and the irritant only. Now say you’ve gone a little bit overboard. Instead of a rolled-up newspaper, you take a baseball bat and try to kill that mosquito on the wall. The problem is that the mosquito wasn’t a mosquito at all; it was just a shadow, and now you have a hole in the wall. In the same way, the immune system can overreact to perceived threats and damage the body.

The way your body responds to inflammation partially depends on your genetics and environmental factors. Most generally healthy people respond to a cut or bruise in the same way, but how the immune system responds to a virus, a bacteria, or different foods can differ from person to person. The differences in the way your immune system responds depends on several factors, including:

Your genes

Factors influencing your gene expression, called

epigenetics

Your general physical and emotional state of health

The health of major organs of immune function, such as the gastrointestinal tract

Your nutrient status of vitamins, phytonutrients, antioxidants, and minerals

Dietary influences on health, including nutrients and toxins in food

Environmental toxins, such as pesticides

Blood sugar and insulin dysregulation

Stress factors (stress weakens the immune system)

A major underlying factor in the different ways people are affected by inflammation is an imbalance in their acquired immune systems. In a healthy immune system, the helper T cells (those that are part of the immune response and attack) are in balance working against various threats — one cell to attack blood-borne parasites, the other to attack invaders such as bacteria. As the immune system becomes overstimulated, the helper cells find themselves in a self-perpetuating imbalance, causing the helper cells to attack the body. As long as whatever is causing the inflammation is still present, the imbalance remains.

Inflammation can also go on too long. The innate and the acquired immune systems communicate with each other through sensors and signals, which tell the body when to release certain chemicals and proteins to activate the inflammation guard. The signals are supposed to tell the inflammation when to stop as well. That doesn’t always happen. Some people have elevated levels of C-reactive protein, an inflammatory marker that leaves the body in defensive mode, always ready to attack. When that happens, your body begins a steady downward spiral leading to disease.

Inflammation doesn’t just happen — it takes energy, which causes fatigue and creates free radicals, molecules that cause cell damage and make you feel unwell. Thanks to all the things you’re exposed to, cells related to the inflammatory response have to become pretty strong, which means that when they attack, they do so with force. That force can cause damage the longer those cells are active.

Eating foods high in anti-inflammatory antioxidants and phytochemicals clean up the free radical damage that is associated with the immune systems’ battle. These antioxidants also help your body to detoxify and are associated with improved health and longevity.

Inflammation also causes oxidative stress and mitochondrial damage. Mitochondria are the powerhouse of a person’s cells that are needed for energy and for the system to function at its best. Besides free radical damage, inflammation can cause advanced glycation end products (AGEs) and uric acid crystals and can oxidize your bad cholesterol and other effects that unchecked can lead to chronic disease and inflammaging.

Differentiating between acute and chronic inflammation

Inflammation may be acute or chronic. The biggest difference between the two is time:

Acute

:

Acute inflammation

occurs almost immediately after tissue damage and lasts for a short time, from a few seconds to several days. It’s what causes bruising and swelling when you fall or sprain something.

Chronic:

Although usually not as painful as acute inflammation,

chronic inflammation

lasts much longer, sometimes for several months. Chronic inflammation can be caused by physical factors (viruses, bacteria, blood sugar imbalances, extreme heat or cold, toxins) or emotional factors (chronic daily stress). Over time, chronic inflammation can contribute to chronic disease by throwing off the body’s immune system and creating a lot more inflammation in the process.

Some researchers describe inflammation as high-grade or low-grade, depending on the severity of inflammation and the levels of inflammatory markers such as high sensitivity C-reactive protein (hs-CRP), fibrinogen, globulins (like IgG and IgA), and pro-inflammatory cytokines:

High-grade inflammation

is severe and easily noticeable, with swelling, redness, or pain. It can result in conditions like rheumatoid arthritis, inflammatory bowel disease (IBD), and lupus.

Low-grade inflammation,

on the other hand, refers to chronic, subtle inflammation with little to no noticeable symptoms. It often leads to chronic disease, such as atherosclerosis (hardened arteries), diabetes, cancer, arthritis, multiple sclerosis, and lung diseases, such as chronic obstructive pulmonary disease (COPD). It’s also been linked to neurodegenerative disorders and

inflammaging

, impacting the way people age by increasing the risk of disability, the likelihood or severity of becoming frail, or even premature death in older people. We talk about inflammaging more in

Chapter 3

.

Many of the factors leading to low-grade inflammation are lifestyle-related: smoking, stress, obesity, inactivity, and diet. Diet is a powerful and delicious way to decrease the risk of inflammation wreaking havoc on your body.

Low-grade inflammation often goes undetected, but here are common symptoms:

Chronic fatigue and difficulty sleeping

Chronic low-grade fever and flu-like symptoms

Depression, anxiety, and mood disorders and memory problems

Difficulty concentrating

Difficulty losing weight

Dry eyes and skin

Frequent infections

Gastrointestinal issues, like indigestion, diarrhea, chronic constipation, or irritable bowel syndrome symptoms

Hormone and endocrine issues

Muscle stiffness, body aches and pains

Respiratory symptoms like nasal congestion, itchy eyes, chronic sinus infections, chronic cough, and shortness of breath

Skin rashes, chronic itching, and mouth sores

Weight gain or weight loss

One of the first and best ways to determine whether you’re experiencing low-grade inflammation is to have some bloodwork done. A healthcare professional can test your hs-CRP levels, along with other specific tests for inflammatory markers and cytokines, such as lipoprotein A2 (LPA2) and immunoglobulins (IgA). According to the American Heart Association, an hs-CRP test can help determine a person’s risk for heart disease, stroke, and other cardiac issues.

Gut reactions: Linking food, digestion, and the immune system

For you to remain healthy, your immune system must remain healthy and in balance. Getting the right kinds and amounts of proteins, fats, carbohydrates, vitamins, minerals, and other nutrients is key to getting and staying healthy. Eating a balanced diet positively affects every bodily function, from your digestive system to your immune system and everything in between.

Breaking down food and dealing with the pieces

Digestion involves mechanical actions — the chewing and grinding of the food and the consumption of liquids — as well as chemical processes, in which enzymes break down the food into tiny molecules. Your body puts these molecules through a selection process, keeping the useful molecules as raw materials for energy and building, and filters out what it can’t use as waste.

Consuming nutritious foods in the right amounts ensures that your body has the raw materials it needs. For example, eating the beneficial fats, such as omega-3 fatty acids, keeps your cells flexible and can strengthen your immune system and help you fight off inflammation. On the other hand, consuming less nutritious fats, such as processed omega-6 fatty acids, may result in excessive eicosanoid production. Eicosanoids, or chemicals derived from fatty acids, regulate inflammation and may contribute to an immune response. We discuss fats in Chapter 7.

Recognizing the digestive tract as part of the immune system

A major forgotten part of the immune system is the digestive tract. In fact, 80 percent of your immune system is found there. The digestive tract contains the gut associated lymphoid tissue (GALT), a type of tissue that monitors and protects the body against pathogens (germs). There is a high concentration of GALT in the small intestine, where your food gets absorbed.

Due to oral tolerance (or the immune system’s ability to recognize and ignore subtances you eat, such as food proteins or friendly bacteria), the GALT doesn’t respond to most foods you eat as foreign invaders. That’s why you don’t mount an immune system response to everything you eat. However, in people with food allergies, the GALT generally identifies certain foods as invaders, then overreacts to food and mediates the hyperreactive immune response in food allergies, where the food is seen as an invader.

The intestines also offer a safe haven for beneficial bacteria, called the gut microbiome, which aid in digestion and occupy prime real estate so other, harmful microorganisms can’t move in. Dysbiosis is an imbalance of good and bad bacteria in the gut. Because many of its symptoms (gas, bloating, constipation, indigestion, skin issues, brain fog, fatigue, anxiety or depression, and difficulty sleeping) seem to be normal reactions to some foods, many people shrug off the condition. But if left untreated, it can turn into leaky gut syndrome, a major cause of disease.

Leaky gut syndrome, also known as increased intestinal permeability, is a condition that’s part of the mechanism that contributes to inflammation in the gastrointestinal (GI) tract and thus, the rest of the body. Inflammation in the intestines disrupts the tight junctions, the glue that holds the cells of the intestines together in a self-contained tube. Most molecules are too big to fit through these junctions, so the only way for them to escape the intestines and enter the blood is to be ferried through the intestinal cells, from one side to the other. With inflammation, the junctions become too leaky and let things such as large food particles and bacteria out into the rest of the body, where the immune system can attack them (see Figure 1-1). In this way, leaky gut syndrome, also known as intestinal hyperpermeability, contributes to autoimmune disorders, joint pains, food allergies and sensitivities, neurodegenerative disease, and most chronic diseases.

© John Wiley & Sons, Inc.

FIGURE 1-1: With leaky gut syndrome, large particles can escape the digestive tract.

Treating Your Symptoms with Nutrition

In recent years research has really honed in on the relationship between what people eat and how it affects their inflammation levels. Nutritionists now know that the highly processed foods present in many kitchens promote inflammation, whereas whole foods have a noticeable diminishing effect on inflammation and may prevent it altogether. Being mindful of what you keep in your kitchen is important; some of the inflammation from your diet is tied to the quality of your food and how it was grown.

In this section, we look at foods that can cause discomfort and how they’re linked to inflammation. We tell you how to restructure your diet long-term to maintain good health and help you avoid sometimes-hidden internal inflammation.

Creating a diet that works for you

Creating an anti-inflammatory diet based on the foods that don’t cause discomfort or sensitivity helps you stay in good health while maintaining — or retaining — energy levels and ensuring you get an ample supply of macronutrients (proteins, fats, and carbohydrates) as well as micronutrients (vitamins and minerals).

Sometimes you may feel gassy or bloated or get a headache after eating, but have you ever stopped to think that it’s a specific food that’s causing those symptoms, and it very likely causes the same symptoms every time you eat it?

No one eating pattern diet or menu works for everyone. Your needs are different from your neighbor’s and even people you live with. If you’re allergic to dairy products, it’s a safe bet that foods made with cow’s milk aren’t going to top your list of foods to eat. People with celiac disease or gluten sensitivities aren’t going to be eating a lot of gluten-containing breads or baked goods.

The first step in tailoring an anti-inflammatory diet is to determine which foods are good for you — which ones don’t cause you pain, bloating, gas, or other feelings of discomfort. Read the list of potentially inflammatory foods (see Chapter 2) to determine which foods to avoid and create a menu that helps your body and also tastes good.

Eating right for long-term benefits

Inflammatory foods can create instant symptoms as well as long-term effects. What’s the damage in the long term? Inflammatory foods can speed the aging process, contribute to rheumatoid arthritis and other joint problems, and stimulate inflammation in a variety of ways (see Chapter 3).

Knowing which foods are inflammatory can be as simple as keeping a few general rules in mind. The less it looks like it did originally, and if you don’t know how it was produced, the more inflammatory it likely is. You’ve likely heard of people following a “whole foods” diet — this is what they’re talking about, a diet that emphasizes eating foods that are close to their original form without a lot of processing. Whole grains such as bulgur, brown rice, and oats that haven’t been massively genetically modified, especially when complete with the germ and the entire grain kernel, look most like they do prior to harvest, are likely to be okay if prepared in a traditional manner.

Sometimes you can’t tell if your whole food has been processed or sprayed, which is the case with many foods that aren’t organic or come from the supermarket rather than a local farm or your own backyard. For example, you may have an inflammatory reaction to a food because it was sprayed with a glyphosate or another toxic chemical to prepare it for harvest and prevent bugs from attacking it, such as is the case with some forms of wheat and other products.

Glyphosates, a commonly used chemical in nonorganic agricultural production, can contribute to low-level inflammation and leaky gut in an otherwise nutritious food. For example, glyphosate can be used to spray apple trees to control weeds. That whole, nonorganic apple that you purchase as the “less inflammatory” option may contain a small amount of this potentially hazardous material. That said, it’s likely better for you to consume whole foods in their state closest to nature instead of highly processed options to prevent potential disease. Selecting organic, non-GMO (genetically modified) glyphosate-free produce is the easiest way to eliminate these concerns.

Splurging — or treating yourself — is okay now and then if you don’t have a chronic inflammatory disorder, but you should avoid certain inflammatory foods (see Chapter 5). Foods to avoid include high-omega-6 oils, such as those made from corn, safflower, sunflower, and cottonseed; inflammatory saturated fats from animal sources, as found in processed meats like bologna and hot dogs; trans fats; and refined sugars.

Striking the right nutritional balance is just as important as knowing which foods to eat. Make sure you’re getting the right amount of proteins, carbohydrates, healthy fats, vitamins and minerals, and other nutrients.

Supplementing Your Diet with an Anti-Inflammation Lifestyle

Creating an anti-inflammatory diet is more than changing the foods you eat; it’s committing to a change in lifestyle to give you a healthier life. Here are a few areas of change that go hand-in-hand with the anti-inflammation diet:

Exercise at least 45 minutes three times a week.

Reduce stress and practice mindfulness. Check out

Mindfulness For Dummies

by Shamash Alidina (John Wiley & Sons, Inc.).

Opt for healthier cooking methods, such as steaming, boiling, roasting, baking, and grilling. Avoid deep-frying and swap for air frying or baking.

Restock your kitchen with anti-inflammatory foods.

Sleep well (at least seven to eight hours a night).

Take time to eat and chew your food thoroughly.

Practice portion control.

Look at some of your habits or vices. Do you smoke? Drink alcohol? How much exercise do you get each day? Those are three big areas in which change — giving up smoking, reducing how much alcohol you drink (and how frequently), and increasing how much you exercise — can make a world of difference.

Physical activity supports with weight loss and maintenance, makes your heart work more efficiently, keeps your blood pressure in normal ranges, and reduces stress, a major factor in inflammation. Chronic stress depletes your body of the nutrients you need for your immune system to function properly. Get started with some meditation or yoga and take up a cardio workout, such as walking, to slow the aging of the brain and build up your muscles and nerves. We discuss exercise and meditation in Chapter 21.

Chapter 2

Understanding How Food Can Be Your Body’s Enemy

IN THIS CHAPTER

Identifying links between food, inflammation, and your microbiome

Knowing the difference between allergy, sensitivity, and intolerance

Living with allergies and sensitivities

Allow us to go ahead and get this out of the way right now: Yes, some foods really are your enemy. And the hard truth is that many of them are foods you enjoy or that are a regular part of your soon-to-be former diet. Not all food is working against you, of course. But much of the food you consider safe, the foods that you may be eating regularly, may show up on your new do-not-eat list. After you identify your food allergies, sensitivities, and intolerances, keep them in mind as you select recipes and ingredients in later chapters. And keep in mind that things may change for your body in terms of what it can and can’t tolerate. Working with a healthcare provider can help determine what your sensitivities may be with appropriate blood and skin testing. Food sensitivities may become less sensitive when you avoid them and start to heal your gut.

Researchers have been working for years to determine how certain types of foods react with the human body and stir up inflammatory responses. It’s no secret that fried foods, highly processed foods high in saturated and hydrogenated fats, and those high in refined and artificial sugars are bad for you. What’s surprising to many people, however, is the discovery that many of the foods that seem safe can really be hazardous to one’s health, creating a slow drip of inflammation that leads to sensitivities or allergies or even contributing to cancer, heart disease, or diabetes.

Finding the Link between Inflammation and the Microbiome

Your gut has a microscopic world inside your intestines, called your gut microbiome, made up of trillions of microbiota, microorganisms found on and in the human body, like bacteria, fungi, and viruses. These microorganisms outnumber human cells ten to one, but because of their small size, they make up only 1 to 3 percent of the body’s mass (that’s 2 to 6 pounds of bacteria in a 200-pound adult) but play an important role in human health. The gut microbiota comprises the largest group of microorganisms and is responsible for keeping the gut healthy — some studies even consider it a virtual endocrine organ, producing hormones that influence other organs. But why is keeping your gut healthy important for overall health?

The following sections outline how your microbiota works, what happens when it doesn’t work properly, and how probiotics and prebiotics can help keep the system in check.

Recognizing how your microbiota benefits you

These microbiota are beneficial to your well-being; these microorganisms have a symbiotic relationship with your body and are associated with your immunity against pathogens. Some ways they support good health include

Protecting the gastrointestinal tract from harmful bacteria

Producing vitamins the body can’t make on its own

Aiding in the digestion of food and the extraction of nutrients

Regulating the immune system and inflammatory response

According to a 2024 report from the Mayo Clinic, when your gut microbiota is out of sync — when the bad bacteria outnumber the good — you’re more susceptible to a list of chronic health conditions, such as irritable bowel syndrome, inflammatory bowel disease, allergies, mental health issues, and others.

Connecting prebiotics and probiotics

One way to keep your gut health in check is to incorporate prebiotics and probiotics into your diet on a regular basis (we talk more about probiotics in Chapter 20).

Prebiotics are foods that help feed your gut microorganisms. Most prebiotics are high-fiber and resistant starches, which can’t be digested by your body but instead pass through the stomach and produce vitamins, nutrients, and other beneficial byproducts. Polyphenols found in foods like extra-virgin olive oil (EVOO) and red grapes have a prebiotic effect with their antioxidant-like work neutralizing free radicals (unstable molecules that can damage cells and DNA and potentially lead to chronic disease).

Some examples of prebiotic foods include

Fibrous vegetables like garlic, leeks, onions, and dandelion greens

Whole grains

Legumes, like beans and lentils

Probiotics are live microorganisms inside your body that produce the good bacteria that ward off the bad bacteria — they keep your health in check. Your body does produce some probiotics naturally, but it’s a good idea to give those natural probiotics a boost with supplements. There are a variety of supplemental probiotics available — as food, drinks, or, well, supplements — and they’re all meant to bolster the effects of your natural probiotics.

The best boost you can give your body is to eat prebiotic foods as well as supplementing your diet with probiotics. The bigger your gut microbiota’s army, the better, especially when battling toxic foods.

There’s also a class of probiotics called psychobiotics, which help mental health. Psychobiotics support the gut-brain connection and positively influence the gut microbiome, which can help improve mood, alleviate depression, and reduce stress.

Defining Toxic Foods

Food, by definition, is what you eat or drink for sustenance. When you eat food, it becomes energy for your body through the process of digestion. The foods and drinks you take in aren’t in a form that your bodies can use just yet; the food has to be transformed into much smaller pieces, nutrient-filled molecules, which can be absorbed by your blood and carried throughout the body. Digestion starts in the mouth as you chew food into smaller pieces; then it continues through the body with the help of digestive fluids until it’s broken down as far as possible. Most of these molecules are absorbed into the small intestine and eventually become energy for various parts of the body.

Your gut microbiota is designed to help your body digest food, but when it isn’t healthy that balance between good and bad microorganisms is disrupted and can cause serious problems.

Sometimes the foods people often think are helping them be healthy and maintain a nutritious lifestyle are working against them. Foods that are seemingly harmless can become toxic, leading to inflammation and serving as triggers for chronic illnesses such as diabetes, cancer, arthritis, and heart disease.

We define toxic foods as any foods that can become harmful over time and in sufficient amounts can increate chronic or acute inflammation, increasing your risk for chronic disease. For some people, the nightshade family of fruits and vegetables — tomatoes, potatoes, peppers, eggplant — can be inflammatory in that they contain alkaloids, which can affect muscle function. Dairy products or wheat products can cause digestion problems for some people, and refined sugars can promote diabetes, obesity, and hypertension.

You can put toxic foods into three categories:

Foods that increase inflammation in everyone, such as trans fats, refined sugars, highly or ultraprocessed foods, and artificial foods

Foods that are toxic to some individuals and not to others, such as wheat, corn, and dairy

Foods that contain chemicals, toxins, and other harmful substances that cause inflammation and endocrine changes in the body; they may accumulate in the fat cells and liver and can be associated with cancer and chronic disease

Over time, toxic foods offer more harmful effects than healthy benefits. Refined sugar, trans fats, and bleached or enriched flour are the top three toxic foods for people seeking anti-aging strategies. Following is a sampling of some of the toxic foods found in everyday diets (We discuss these foods in detail in Chapter 5):

Highly processed foods:

Cookies, doughnuts, pastries

Prepared salad dressings and condiments

White bread

Pasta

Flavored oatmeal or cereal

Soda and fruit punch

Cereal bars

Trans fats:

French fries

Margarine

Packaged baked goods

Potato and corn chips

Fried foods

Creamy salad dressings and condiments

Bleached or enriched flour:

Bread

Crackers

Cereal

Cookies

Pasta

Pancakes and waffles

Looking at Allergies and Specific Sensitivities

For many people, creating a menu isn’t as simple as going with whatever they like to eat. People who have food allergies, sensitivities, or intolerances have to avoid foods and food products that many people take for granted (see the following list):

Food allergies

are caused by an overreaction of the immune system toward a food or drink. Allergic reactions tend to show up almost immediately, from a rash or watery eyes to a more serious anaphylactic reaction that could be fatal.

Food sensitivities

appear in the form of a more delayed, sometimes chronic onset of symptoms, such as fatigue, skin issues, headaches, digestive issues, or even nasal congestion days after consumption. Food sensitivities are often caused by

leaky gut syndrome,

or inflammation in the gastrointestinal system

Food intolerance

is an adverse reaction to a food because something necessary for digestion is missing. For example, if your body is missing lactase, the enzyme needed to break down lactose, you’re likely intolerant of milk and dairy products.

Distinguishing between a hypersensitivity and an allergy to a food can sometimes be difficult, as seen in Figure 2-1. Many of the same symptoms may appear with both hypersensitivity and allergies, but the chronic effects may differ. Consult a healthcare professional to determine if you have food allergies, sensitivities, or intolerances.

© John Wiley & Sons, Inc.

FIGURE 2-1: How food can be toxic to your body.

In this section, we take a look at various allergies, sensitivities, and intolerances; note some foods that commonly cause problems; and discuss how those food reactions can lead to chronic inflammation.

Understanding food allergies and sensitivities

Food allergies and sensitivities aren’t all that uncommon. In fact, you may have an allergy and not even realize it. Allergies of all kinds occur when a body’s immune system kicks in, attacking the irritant that it views as an invader.

Most of the time, your body doesn’t attack the food you eat because of food tolerance, which is regulated by the immune system, your microbiome, and your gastrointestinal tract. But as you age and practice more inflammatory habits, you can develop intolerances, sensitivities, or even life-threatening allergies to specific foods. Your immune system starts attacking either because too much of a particular component of that food is present or because there’s something wrong with the way that food affects your body due to your genetic predisposition.

After the body first identifies — or rather, misidentifies — a particular food particle as an invader, the body starts mass-producing antibodies. When you eat something you’re allergic to, antibodies lock onto an antigen (the offending food particle) and trigger an inflammatory response. In most cases, the inflammation quiets down again; however, if you have a genetic predisposition to food allergies, high levels of toxicity, digestive system imbalances, or a weakened immune system, this normal immune response can kick into high gear and wreak inflammatory havoc in your body in varying degrees.

Think of a bee sting. Everyone has some level of irritation or sensitivity to the stinger, even if it’s not a full allergy. When the bee stings you, there’s a small red bump where your antibodies immediately attack the area and work to protect the rest of the body. The same thing happens with food allergies and sensitivities, only the inflammation comes in the form of arthritis, irritable bowel syndrome, or other issues.

Food sensitivities and intolerances typically cause discomfort but not life-threatening issues, such as gas or bloating, headaches, or skin rashes. These symptoms may be easily dismissed as “normal” symptoms of being tired and achey. These symptoms typically mean your gut is sensitive to certain foods, or certain parts of the food: Some people may love to eat tomatoes, for instance, but the high acid levels may cause heartburn or stomach discomfort. It can, however, create a chronic slow drip of low-level inflammation that compromises your gut integrity and increases your risk of chronic disease.

Food allergies, on the other hand, can be lethal. Some people must avoid not only the product itself but also anything that may contain that product in its ingredients list. People allergic to peanuts, for example, have to avoid anything made with peanut oil. In extreme cases, people must even avoid foods that have come into contact with their allergen, which may mean avoiding foods that are manufactured or packaged in the same area as foods containing the allergen.

Addressing lactose intolerance

Most people have some degree of sensitivity to dairy, although the majority don’t even realize it. About 65 percent of people worldwide suffer from lactose intolerance, the inability to digest lactose, which is the main sugar found in milk. Your genes influence your ability to break down lactose, with as much as 90 percent of some of the world’s ethnic groups not able to digest milk beyond infancy.

To be digested properly, the sugar lactose must be split into the smaller pieces glucose and galactose. When the lactase enzyme is either absent or inactive in the body, you can’t break down lactose, and you have lactose intolerance. The body produces less lactase as you age, and in Asian, Native American, and African American populations, lactase production drops anywhere from 70 to 100 percent from childhood.

That’s not to say everyone with a lactase deficiency is lactose intolerant; many people may go years without having any symptoms, or there may be just certain dairy products that trigger symptoms while others don’t have any affect at all. But whenever you eat or drink something your body doesn’t like, it sends out warning signals, usually in some form of inflammation. The most common symptoms of dairy sensitivity are gastrointestinal issues, but other symptoms with a potential relationship to dairy include

Abnormal cravings for sweets

Achy joints and muscles

Acne

Anxiety

Dark circles under the eyes

Chest congestion

Chronic fatigue

Dizziness or faintness

Excessive sweating

Headaches

Mood swings

Ulcers

Symptoms generally appear anywhere from 20 minutes to two hours after eating or drinking dairy products. Consume too much dairy, and symptoms can worsen, leading to abdominal distention and diarrhea as well as many other stomach problems.

If you suspect you may have lactose intolerance because you’re experiencing any of the symptoms listed, look for the word “lactose” listed in the ingredients of some of your favorite foods — even those you may not think have any dairy. Be sure to get a proper diagnosis so you can rule out any other conditions that may be present.