The first anti-inflammatory diet was proposed in the book, The Zone, published 20 years ago [19]. The central focus of this anti-inflammatory diet was one that was based on a bell-shaped curve of the protein-to-glycemic load described in Fig. 14.1. In addition there was a strong emphasis to reduce the levels of omega-6 and saturated fats with most of the fats in the diet coming from noninflammatory monounsaturated fats.

The midpoint of the protein-to-glycemic load for this anti-inflammatory diet had a slight excess of carbohydrates to low-fat protein. When the overall fat content was factored in the overall composition of the anti-inflammatory diet, it would be approximately 40 % low-glycemic-load carbohydrates, 30 % low-fat protein, and 30 % fat high in monounsaturated fats and low in omega-6 and saturated fatty acids. However, this proposed anti-inflammatory diet was also a calorie-restricted one to prevent the inflammatory effect of excess calories. Thus, the absolute levels of the various macronutrients of the proposed anti-inflammatory diet are shown in Table 14.1 at various total caloric intakes. The usual recommendation for females would be 1,200 cal per day and 1,500 cal per day for males.

It can be seen from Table 14.1 that at these caloric levels, the absolute levels of protein are adequate, the absolute levels of low-glycemic-load carbohydrates are moderate (although the volume on the plate would be significant), and the absolute levels of fats would be considered low. The macronutrient composition on a gram basis is 1 g of fat (primarily monounsaturated fats) for every 2 g of low-fat protein and 3 g of low-glycemic-load carbohydrates (primarily non-starchy vegetables and fruits).

The first clinical trial to support such a macronutrient ratio in treating diabetics was reported in 1998 [27]. In this study, it was demonstrated that insulin resistance was significantly reduced within 4 days and before any weight loss. Carefully controlled clinical trials at Harvard Medical School in 1999 gave further support to the rapid hormonal changes and improvement in satiety using such the same macronutrient ratio in overweight children [28]. Researchers at Harvard Medical School confirmed these findings in satiety in 2000 in overweight adults [29]. More recent studies at Harvard Medical School have demonstrated that this macronutrient ratio is superior in reducing inflammation compared to isocaloric high-carbohydrate diets, even though the weight loss is identical [30].

In 2007, the Joslin Diabetes Center at Harvard Medical School announced their new dietary guidelines for treating obesity, metabolic syndrome, and diabetes [31]. These guidelines in terms of macronutrient composition and calorie content were virtually identical to those proposed more than a decade earlier [19]. Subsequent studies and other publications from the Joslin Diabetes Research Foundation have supported this anti-inflammatory diet concept [32, 33].

Numerous other clinical studies of this anti-inflammatory diet having 40 % of calories as carbohydrates, 30 % the calories as protein, and 30 % of calories as fat have demonstrated superior weight loss, fat loss, improved insulin levels, increased fat loss, increased satiety, and most importantly reduction of cellular inflammation [34–39].

From a visual standpoint, the composition of the plate for each meal is shown in Fig. 14.2.

At every meal, the plate should be divided into three equal sections. On one section should contain low-fat protein approximately the size and thickness of the palm of the hand. Appropriate protein choices would be chicken, fish, or protein-rich vegetarian sources. The other two-thirds of the plate should be filled with colorful carbohydrates (primarily non-starchy vegetables and limited amounts of fruits). This will simultaneously maintain a low glycemic load as well as provide adequate levels of polyphenols. Finally, the ideal added fat would be a dash of extra virgin olive oil (approximately 5 ml). The hormonal success of this dietary balance will be indicated by the lack of hunger and maintenance of mental acuity for the next 5 h.

There are three clinical markers that are important to achieve for an anti-inflammatory diet to be considered successful. Each of these markers relates to a different component of the inflammatory response, and all three markers should be within appropriate ranges to truly ensure that cellular inflammation is being managed.

Often even a strict anti-inflammatory diet sometimes will not be sufficient to reach the desired ranges of the clinical markers described above. Under these circumstances, there are two additional anti-inflammatory supplements to consider.

Reducing the potential problems during pregnancy is best accomplished by first identifying high-risk populations with existing metabolic dysfunction caused by diet-induced inflammation and then working with such populations to reduce cellular inflammation by the use of an anti-inflammatory diet as described above. There are various time points at which such dietary interventions might be contemplated.