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Fish Oil and Omega-3 Fatty Acids for Arthritis

In the multi-billion-dollar industry of supplements, fish oil and omega-3 fatty acids are one of the top sold supplements. Have you heard about using fish oil and Omega-3 fatty acids for arthritis?

Sixty-two million people suffer from arthritis in the United States. Most people are too busy working, and taking a dietary supplement seems viable and convenient. Many of my patients are interested in their personal health and wellbeing. 

Be advised that supplements are categorized as “food”, not drugs, and are not required to undergo the rigorous testing that prescription drugs/ medication undergo. The dietary supplement manufacturers are responsible for ensuring these are safe before they are marketed, but they do not require approval from the Food and Drug Administration (FDA).

 

In this article, we will discuss

What is fish oil?

Is fish oil good for rheumatoid arthritis?

Is fish oil good for osteoarthritis?

Is fish oil good for back pain?

Can you get omega-3 fatty acids from food?

What dose should you use?

What is the risk of using fish oil supplements?

 

What is fish oil?

Fish oil is oil extracted from fatty fish and is the source of Omega-3 polyunsaturated fatty acids. It is one of the most used dietary supplements due to its potential benefits to reduce cardiovascular risk. However, you may wonder “How about the use of fish oil for arthritis?”.

Before we talk about that, we will discuss more what Omega-3 fatty acids are.

 

What are omega- 3 fatty acids and their role in our body?

Omega 3 and omega 6 are POLYUNSATURATED FATTY ACIDS. These are essential fatty acids. Why do we call them essential? Because they can’t be produced by our body, we need to get them from the food.

The omega-6 fatty acids are the most predominant fatty acids in the human diet.

They contain the

  • linolenic acid (LA)
  • gamma -linolenic acid (GLA) and
  • arachidonic acid (AA)

Omega 6 fatty acids are very abundant in the western diet, and they can be found in many of the seed oils (corn, sunflower) and beef cattle fed on a diet of grain and conventionally produced eggs. The OMEGA 6 family of POLYUNSATURATED Fatty acids have mostly pro-inflammatory effects on our body.

Omega-6 Food Sources
Where to find Omega-6 Fatty Acids?

Now, the Omega-3 family of polyunsaturated fatty acids contain the

  • alpha-linolenic acid (ALA)
  • eicosapentaenoic acid (EPA) and
  • docosahexaenoic acid (DHA). 

They are less frequently found in the Western diet. Omega- 3 fatty acids’ anti-inflammatory effects are related to decreased production of arachidonic acid-derived mediators (prostaglandins) and reduced production of cytokines that can induce inflammation. This is significant as omega-3 has more anti-inflammatory properties than Omega-6 polyunsaturated fatty acids.

Fish Oil Effect On Health

Is fish oil good for rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease that can affect multiple joints, especially the hands and feet. Untreated, patients with rheumatoid arthritis will develop deformities of their joints, which will affect their joint function and lead to disability and low quality of life. I always recommend lifestyle interventions in patients with inflammatory arthritis, like rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis.

Let’s talk about the evidence of using fish oil in patients with rheumatoid arthritis (RA).

Over the years, many studies have looked at fish oil in patients with RA. 

The addition of fish oil to the standard therapy (methotrexate, hydroxychloroquine, and sulfasalazine) showed that these patients reported

Let me present to you a recent study, published in 2015, which was a randomized controlled trial involving 139 patients with recent-onset rheumatoid arthritis. This study added a high dose of fish oil (5.5g per day) to the standard triple therapy for rheumatoid arthritis (methotrexate, sulfasalazine, and hydroxychloroquine). The study showed that patients who received a high fish oil dose were more likely to achieve disease remission faster. Adding fish oil also lowered the patient’s disease activity.

Overall, the quality of these studies is moderate. Still, many researchers suggested that, for patients with rheumatoid arthritis, fish oil can be regarded as a part of the standard therapy (Senftleber NK wt al, 2017)

Other studies suggest that Omega-3 fatty acid supplementation provides symptomatic relief in patients with lupus and ankylosing spondylitis or other forms of inflammatory arthritis

 

Is fish oil good for back pain?

Yes, fish oil supplementation might benefit patients with nonsurgical back pain. In one study, four months of fish oil supplementation in patients with nonsurgical neck and back pain (doses used were 1.2 or 2.4g per day) led to impressive results.  Approximately 60% of patients discontinued taking their prescription NSAID medications for pain, and their joint pain and overall pain improved. 

It is also essential to note that no significant side effects were reported (Maroon JC et al, 2006).

 

Is fish oil good for osteoarthritis?

In patients with OA, the results remain conflicting, and currently, it is not recommended to use it for this reason only. You may have other health benefits from taking fish oil, like decreasing triglycerides or decreasing your CV risk.

 

Can you get Omega-3 fatty acids from food?

The omega-3 fatty acids are found in FISH OIL, but also in 

Food Rich in Omega-3 Fatty acids
Where to find Omega-3 Fatty Acids?
  • flaxseed
  • flaxseed oil 
  • walnuts, walnut oil, 
  • soybeans
  • pumpkin seeds, 
  • algae, 
  • olive oil -cold pressed and unfiltered
  • wild fish or cold-water fish like sardines or wild-caught Alaskan salmon/ sockeye, herring, sardines, black cod, sablefish
  • wild game and livestock that feed on grass. 
  • eggs laid by hens fed an omega-3-rich diet.

 

What dose should you use?

The minimal effective dose is 2.5–4 g/ day (EPA plus DHA). 

The FDA has approved a 4g/ day dose, which is safe for most patients. 

 

What is the risk of using fish oil supplements?

Although there was a warning that fish oil could increase the risk of bleeding in the past, a recent study did not find this risk. 

I would like to warn you that some fish oil products might be contaminated with mercury. Choose a fish oil supplement with sustainability certification, such as the Marine Stewardship Council.

You should take fish oil with a meal, as other dietary fats improve the absorption of omega-3 fatty acids. 

Before starting any supplement, including fish oil, discuss it with your physician. Fish oil can affect your Blood pressure or contraceptive medication, and it may reduce vitamin E levels.

Summary

Supplements can be dangerous in some situations and influence how other medications are absorbed. Before you start any supplement, I do advise you to discuss your clinical condition with a physician that will be able to review your risks and benefits.

If you are interested in learning more about supplements and their scientific evidence, follow my blog posts and YouTube channel. If you are looking for a consultation for arthritis or autoimmune disease, schedule on our website, Rheumatologist OnCall. We are happy to evaluate and treat you with the most comprehensive approach to integrating cutting-edge science with integrative medicine, including nutrition, supplements, stress management, mindfulness, exercise, and sleep management.

 

Diana Girnita, MD, PhD is an US board certified internal medicine and rheumatology. She completed a PhD in immunology, postdoctoral fellowship at Harvard University, immunology fellowship at University of Pittsburgh and rheumatology fellowship at University of Cincinnati. She is the founder&CEO of Rheumatologist OnCall, a telemedicine company that serves multiple states in the US. Dr. Girnita is a graduate of the Nutrition Science course from Stanford University. Dr. Girnita was recognized many times with “Top Doctor”  award (2017-2020) and is frequently invited speaker of the US National Arthritis Foundation. Read more

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