A Gastroenterologist Explains What We’re Getting Wrong About Inflammation

Inflammation is at the root of many chronic diseases, from heart disease and Type 2 diabetes to autoimmune disorders, and it can even contribute to certain types of cancer. Yet, despite its profound impact on health, inflammation remains widely misunderstood. Shilpa Ravella, M.D., a gastroenterologist and author of A Silent Fire, is working to change that. “We know today that one of the most important factors in creating an anti-inflammatory gut microbiome is to consume an adequate quantity and diversity of plants, but misconceptions about inflammation persist in pop culture,” Ravella says. Through her clinical practice, research, and writing, she sheds light on the intricate connections between inflammation, diet, and disease—challenging long-held myths and offering practical, evidence-based solutions for reducing inflammation through diet. We caught up with Ravella about how she became interested in the science of inflammation, how the standard American diet fuels disease, and what you can do to prevent inflammation from lingering in your body.

Shilpa Ravella, M.D.: At the core of practicing medicine is this idea that you’re helping people with their most valuable possession, their health. No matter how small a part we play in that, it was something that I felt compelled to do. … And as the years went on, everything I was interested in learning about nutrition and lifestyle and the gut microbiome was so directly relevant to gastroenterology. I just fell in love with the field.

SR: As I went through my fellowship, I saw a lot of patients who struggled with inflammatory gastrointestinal disorders. They were coming into the clinic and asking, “Is there something I can do with my diet and lifestyle to decrease inflammation?” At that time, folks in Western medicine would think of [an anti-inflammatory diet] as a hoax. I had a lot of questions: Is there a true anti- inflammatory diet? Moreover, what is low-level inflammation, and can it be a root cause of disease? … During the early years of my fellowship, someone very close to me was diagnosed with a devastating autoimmune disorder, and that also compelled me to want to know more about this topic.

SR: Ultraprocessed foods are truly insidious. They’re made in laboratories by companies who want to make them addictive. So you don’t just eat one chip— you’re eating bag after bag after bag and bypassing your body’s regulatory systems. They’re mostly made of whole-food derivatives and additives that we are finding more and more problematic, including artificial sweeteners and some oils that are very inflammatory. So the first step is going back to real foods. Even if you can’t make the shift to a [completely] plant-based diet, make the shift to whole foods.

SR: At the government-funded rural health clinic [in Hilo], we see a proportion of native Hawaiians and Pacific Islanders, and this particular population experiences the highest rates of death from any type of cancer compared with other racial and ethnic groups of the same age, and the highest incidence of heart disease and stroke and diabetes. … We’re seeing a lot of cancer in young folks here. Part of the problem is that the “local” diet has taken over—a lot of fried foods, very meat-heavy. By contrast, the ancestral Hawaiian diet is largely plant-based. It involves a variety of vegetables, like ulu (breadfruit), which can be prepared in so many different ways, taro (a starchy vegetable), and seaweed. A return to this type of diet is what I push for my patient population. I try to put it in that cultural context: This is the diet that your forefathers followed, and this is a diet that can help you thrive.

SR: To an extent, you can indeed dull the inflammatory spikes you get from junk foods by pairing them with something healthy. For example, there are studies that show if you add berries or nuts to processed breads and cereals or some spices to your chicken dinner, you see less of an inflammatory spike as opposed to if you’ve eaten those foods on their own.

I think the biggest problem with that outlook is the opportunity cost, because the goal is not just to prevent inflammation but also to reverse it so that your body has greater potential to heal. Someone who is 90 years old and eating a highly plant-based diet, exercising regularly, breathing clean air, drinking clean water is going to have more potential to resolve the inflammation from, say, an infection, and a more robust immune response as well.

We asked Ravella to break down some of the most common myths she encounters about inflammation.

“Certain plant foods or components of plant foods, like nightshade vegetables, gluten, or lectins, are often demonized for being inflammatory,” Ravella says. “However, evidence to date shows that these foods are actually anti-inflammatory and beneficial for human health.”

“We need some inflammation in our bodies to fight off infections and keep us healthy in other ways. And in fact, increased bodily inflammation is a natural part of aging. It’s when inflammation becomes excessive or deployed without reason that problems arise.”

“A true, evidence-based anti-inflammatory diet does not rely on expensive foods or supplements,” Ravella says. “Anti-inflammatory, plant-forward diets—such as traditional Mediterranean, Okinawan, African, Latin American, Native American, Asian, and Hawaiian diets—are rooted in ancient traditions and arise from humble origins.”