Arthritis Archives - Health Tips From The Professor

Do Omega-3s Reduce Osteoarthritis Pain?

April 16, 2024 by Dr. Steve Chaney

How Do Rheumatoid And Osteoarthritis Differ?

Author: Dr. Stephen Chaney

This week I am concluding my series on recent omega-3 advances by reviewing a meta-analysis that asks whether omega-3s are beneficial for people with osteoarthritis.

This is an important question because osteoarthritis affects around 32.5 million adults in the United States, and that number is increasing each year as our population ages. Osteoarthritis causes pain and disabilities that can significantly affect quality of life.

And the costs are high. Health care costs due to osteoporosis are around $140 billion/year. And when you include lost workdays, the annual cost is around $468 billion.

There are several medications for reducing symptoms of osteoarthritis. But they each have side effects and some patients cannot tolerate them. Joint replacement surgery is the final resort. But the recovery period is long, and the surgery isn’t always effective. For both reasons many patients with osteoarthritis are looking for natural solutions.

Most of the research on omega-3s and arthritis has been done with patients who have rheumatoid arthritis. Omega-3 supplements have been shown to reduce the pain, swelling of the joints, and inflammation associated with rheumatoid arthritis for many people with the disease.

Based on several dose-response studies, the NIH says the optimal dose is around 2.7 gm/day of EPA + DHA but cautions not to go above 3 gm/day without your doctor’s OK.

The evidence is less clear for omega-3s and osteoarthritis. Some studies suggest that EPA + DHA reduce the pain and inflammation associated with osteoarthritis. But other studies have come up empty. There is no consensus as to whether omega-3s are beneficial for people with osteoarthritis.

When there is disagreement between individual studies, a meta-analysis of the studies is often helpful. By pooling the data from multiple studies, a meta-analysis can smooth out some of the differences between the studies and accumulate enough data points to discover effects that would not have been statistically significant with the smaller data sets from individual studies.

With that in mind, the authors of this manuscript (W Den et al, Journal of Orthopaedic Surgery and Research, 18: 381, 3023) performed a meta-analysis on the data obtained from 9 double-blind, placebo-controlled studies looking at the effect of omega-3s versus a placebo on both pain and joint mobility in osteoarthritis patients.

How Do Rheumatoid And Osteoarthritis Differ?

While the causes of rheumatoid arthritis and osteoarthritis are very different, there are some underlying similarities between the two diseases that suggest both might benefit from omega-3 supplementation.

Rheumatoid Arthritis: Rheumatoid arthritis is thought to be an autoimmune disease, which means that our immune system attacks our cells rather than foreign invaders. It results in chronic inflammation that attacks our joints and can affect other tissues in our body.

It initially affects the lining of our joints which can result in painful, swollen joints. As the disease progresses it can also lead to bone erosion and joint deformity.

Osteoarthritis:Osteoarthritis is generally thought of as a “wear and tear” disease. It is associated with sports injuries and accidents. It is also associated with stress to particular joints due to repeated motions associated with either sports or a job. Obesity also increases wear and tear of the joints because it increases the load on the joints.

The wear and tear causes the cartilage that cushions the junction between bones to deteriorate. Eventually, the cartilage deteriorates to the extent that bone is grinding against bone, which can lead to bone loss and deformities.

Eventually, this results in an inflammation of the joint lining which causes pain and accelerates bone loss. It also causes deterioration of the connective tissue which holds bones together and connects them to muscle.

What Do These Diseases Have In Common? Inflammation is the common factor associated with both rheumatoid and osteoarthritis, and many studies suggest that omega-3s reduce inflammation. In the simplistic description of the two diseases I shared above, it sounds like inflammation occurs much earlier in the disease process for rheumatoid arthritis than for osteoarthritis. This might suggest that omega-3s could be more effective at reducing the symptoms and progression of rheumatoid arthritis than of osteoarthritis.

However, we know that the risk of developing osteoarthritis is increased by chronic inflammation caused by obesity, diseases like diabetes, and/or an inflammatory diet.

How Was This Study Done?

This study was a meta-analysis of 9 double-blind, placebo-controlled clinical studies looking at the effect of omega-3 fatty acids on the pain and loss of joint mobility associated with osteoarthritis. These studies were performed in countries from around the world and included a total of 2,070 participants.

The criteria for inclusion in the meta-analysis were:

1) The articles were written in English.

2) The studies had to be double-blind, placebo-controlled studies (The gold standard for clinical studies).

3) Patients with osteoarthritis were randomly assigned to an intervention group receiving omega-3 supplementation or a placebo group receiving olive oil or another plant oil.

4) The studies measured efficacy and safety outcomes including joint pain (efficacy), joint mobility (efficacy), and treatment-related adverse events (safety).

5) Patients in both the omega-3 and placebo groups were using medications to reduce osteoarthritis symptoms when they were enrolled in the study and were advised to continue with their prescribed medicines for the duration of the study.

The characteristics of the clinical studies included in this meta-analysis were:

Sample size (47-1221), Average = 230.

Mean age (55.9-68), Average = 63.

% men (13.8-45.1%), Average = 31%.

Omega-3 (EPA + DHA) dose (350 mg/day – 2,400 mg/day), Average = 1,085 mg/day.

Do Omega-3s Reduce Osteoarthritis Pain?

When the data from all 9 studies were combined in a single meta-analysis, omega-3 (EPA + DHA) supplementation:

Reduced joint pain by 29% compared to the placebo.

Increased joint mobility by 21% compared to the placebo.

Was not associated with any adverse effects.

The authors concluded, “The results of the meta-analysis indicate that supplementation with omega-3 fatty acids is effective to relieve pain and improve joint function in patients with osteoarthritis, without increasing the risk of treatment-related adverse events. These findings support the use on omega-3 fatty acid supplementation as an alternative treatment for osteoarthritis.”

What Are The Strengths and Limitations Of This Study?

Strengths:

All the studies included in this meta-analysis were randomized, double-blind, placebo-controlled studies (the gold standard for clinical trials).

All the individual studies that qualified for this meta-analysis found that omega-3 supplementation reduced joint pain and improved joint mobility. This improves confidence that the conclusions of the meta-analysis are correct. The meta-analysis simply improved the statistical significance of this conclusion by combining the data from the individual studies.

Limitations:

The biggest limitation was that the individual studies included in this meta-analysis were not performed under the guidelines of the “Fatty Acids and Outcomes Research Consortium” that I discussed in last week’s issue of “Health Tips From the Professor”.

- The “Fatty Acids and Outcomes Research Consortium” guidelines harmonize the designs of individual studies, which strengthens the meta-analysis.

- - In contrast, the design of the individual studies within this meta-analysis was very different, which prevented the meta-analysis from being able to determine the optimal dose of omega-3 supplements and the minimum time required for omega-3 supplementation to significantly reduce the symptoms of osteoarthritis.

- The “Fatty Acids and Outcomes Research Consortium” guidelines would have also required these studies to measure tissue levels of omega-3s (something called Omega-3 Index) at the beginning and end of each study. This was not done in any of these studies.

- - This is important because if a patient’s tissue levels of omega-3s at the beginning of the study were already in the optimal range, you would expect little additional benefit from supplementation for that patient.

All the individual studies were very small. This limits the ability of these studies to provide definitive conclusions. Unfortunately, this is probably unavoidable.

- Double blind, placebo-controlled clinical studies are expensive. Only major pharmaceutical companies have the multi-million-dollar budgets required to conduct large double blind, placebo-controlled clinical studies that would provide more definitive evidence that omega-3 supplementation reduces the symptoms of osteoarthritis – and the follow-up studies that would determine the optimal dose of omega-3 supplements and the minimum time required to show an effect of omega-3 supplementation.

The patients in these studies were already taking medications to reduce their osteoarthritis symptoms prior to entering the study and were instructed to continue taking those medications during the study. This means that the studies were not asking whether omega-3s alone were effective at reducing osteoarthritis symptoms. They were asking whether omega-3 supplementation provided any additional benefits for people who were already taking medications to reduce symptoms.

- Unfortunately, this is also probably unavoidable. Current guidelines consider it unethical to withhold the medical “standard of care” from any patient in a clinical trial.

What Does This Study Mean For You?

This study, while not definitive, strengthens the evidence that omega-3 supplements containing EPA + DHA may reduce joint pain and improve joint mobility for people with osteoarthritis. It also shows that the doses required to achieve these benefits are not associated with any significant side effects.

While large scale double blind, placebo-controlled clinical studies to confirm these conclusions would be nice, they are unlikely to occur for the reasons discussed above.

The investigators said, “[This study shows that] supplementation of omega-3 fatty acids is effective to relieve pain and improve joint function in patients with osteoarthritis…These findings support the use of omega-3 fatty acid supplementation as an alternative treatment for osteoarthritis.”

This might lead you to believe that omega-3 fatty acids can potentially replace medications for reducing osteoarthritis pain and loss of joint mobility. That may be true, but that is not what the study showed.

Patients in both the omega-3 and placebo group continued their prescribed medicines for osteoarthritis. In reality, the study only shows that omega-3s provide additional benefit for people already taking osteoarthritis medications. The effect of omega-3 supplements by themselves has not been tested and, as I discussed above, is not likely to be tested in the foreseeable future.

However, the use of omega-3 supplements may allow you to reduce or eliminate the medications you are on for osteoarthritis and may delay the need for joint replacement surgery. Of course, if you wish to reduce/eliminate your medications and/or delay joint replacement surgery, I recommend consulting with your doctor first.

Finally, this study provides no information on the optimal dose of omega-3s. Some studies suggest the dose of omega-3s needed to reduce osteoarthritis symptoms may be less than that required to reduce rheumatoid arthritis symptoms, but that evidence is weak.

In the absence of good dose response data, I recommend you aim for an omega-3 index of 8%. You will find a more detailed discussion of the Omega-3 Index and how to use it in last week’s “Health Tips From the Professor” article .

The Bottom Line

A recent meta-analysis looked at the effect of omega-3 supplementation on the pain and lack of joint mobility associated with osteoarthritis.

The study showed that omega-3 (EPA + DHA) supplementation:

Reduced joint pain by 29% compared to the placebo.

Increased joint mobility by 21% compared to the placebo.

Was not associated with any adverse effects.

For more details about the study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

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My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

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About The Author

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years. Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Treatment For A Painful Thumb

February 15, 2022 by Dr. Steve Chaney

Is It Arthritis Of The Thumb Joint?

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

Is It Arthritis of the Thumb Joint?

I was pondering what to write about in this month’s newsletter and then I had three clients come in, all suffering from the same problem. That made up my mind. The topic this month is thumb pain.

Several years ago, when I was still in New York, I had a regular client come in and tell me she had just been told she had arthritis in her thumb joint. I asked how she knew that, and she showed me her hand. Her thumb was bent all the way in toward her palm and when she tried to bring her hand flat, the joint was painful, preventing her thumb from moving.

She had been given medications for the arthritis, but when she checked it out on the internet, the potential side-effects scared her so much she decided to just suffer with the arthritis.

But it wasn’t arthritis at all. The pain she was experiencing was caused by a tight muscle. I taught her the self-treatment I’m going to show you, and the results were fantastic!

Why a Tight Muscle Causes the Symptoms of Arthritis of the Thumb Joint

We use our thumbs uncountable times every day. It is impossible to even consider how many times we have used our thumb muscles over the course of our lives, but we never think about the muscles that enable us to do that movement. Yet, think of what life would be like if you lost your ability to use your thumb.

Your thumb muscle, called Opponens Pollicis, originates on the ligament that forms the bridge to your carpal tunnel. (More about carpal tunnel syndrome in a future newsletter) It inserts into the joint that is at the base of your thumb. It forms the bulge at the base of your thumb, right where the thumb of the right hand, shown on the graphic on the left, is pressing into the left hand.

For example, do the movement shown above, pressing your right thumb into the thick muscle at the base of your thumb. Then move your left thumb in toward the palm of your hand. You’ll feel the muscle contract.

As the muscle is repetitively strained it shortens. The problem is, as it’s shortening it is pulling on the bridge to the carpal tunnel and moving your thumb in toward your palm. When it gets tight, if you try to bring your thumb out it will pull at the joint. It’s like pulling your hair and then your scalp hurts.

The good news is it’s simple to release the tension in the muscle fibers, it just takes a long time to get it to fully release.

Treatment For A Painful Thumb

It’s simple to treat your Opponens Pollicis muscle.

Place your opposite elbow directly onto the muscle. Wrap your fingers around your elbow to stabilize it so it won’t slide off the muscle.

Press deeply into the muscle and either stay still or move very slightly back and forth to lengthen the muscle fibers.

Or you can…

Place your bent middle finger directly into the muscle and wrap your hand around your hand to stabilize so your knuckle won’t keep sliding off the muscle.

Hold the pressure for about 30 seconds and then move ¼” along them muscle to a new spot.

I developed this technique when I had carpal tunnel syndrome. It took me hours of self-treatment to get the muscle to final relax and not be painful. That’s when you know you have finally released the tension and the strain is removed from the bridge to your carpal tunnel (flexor retinaculum).

Even if you don’t have the symptoms of carpal tunnel syndrome, doing this technique will make your hand feel so much better, more flexible, and light.

Treat Yourself to Pain-Free Living!

It’s the name of my book, and it says exactly what you will experience when you discover how to release tight muscles that cause joint pain.

People have told me this book is their first “go to” when they have aches and pains, and it has saved them hundreds of dollars in doctor visits and pain medications.

For only $49.00 you can treat muscles that cause everything from headaches to foot pain…a bargain at twice the price!

Order Now and start to feel more flexible and pain-free quickly.

Wishing you well,

Julie Donnelly

www.FlexibleAthlete.com

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

What Is An Anti-Inflammatory Diet?

July 21, 2021April 6, 2021 by Dr. Steve Chaney

Can Diet Douse The Flames?

Author: Dr. Stephen Chaney

If you have arthritis, colitis, bursitis, or any of the other “itis” diseases, you already know that inﬂammation is the enemy. Chronic, low level inﬂammation is also a contributing factor to heart disease, cancer, and many other diseases. Clearly, inﬂammation is a bad actor. It is something we want to avoid.

Obesity and diabetes are two of the biggest contributors to inﬂammation, but does diet also play a role? With all the anti-inﬂammation diets circulating on the internet, you would certainly think so. How good is the evidence that certain foods inﬂuence inﬂammation, and what does an anti-inﬂammatory diet look like?

The Science Behind Anti-Inflammatory Diets

Let me start by saying that the science behind anti-inﬂammatory diets is nowhere near as strong as it is for the eﬀect of primarily plant-based diets on heart disease and diabetes. The studies on anti-inflammatory diets are mostly small, short duration studies. However, the biggest problem is that there is no standard way of measuring inﬂammation.

There are multiple markers of inﬂammation, and they do not change together. That means that in every study some markers of inﬂammation are altered, while others are not. There is no consistent pattern from one study to another.

In spite of these methodological diﬃculties, the studies generally point in the same direction. Let’s start with the strongest evidence and work our way down to the weakest evidence.

Omega-3 fats are anti-inﬂammatory (I. Reinders et al, European Journal of Clinical Nutrition, 66: 736-741, 2011). The evidence is strongest for the long chain omega-3s found in ﬁsh and ﬁsh oil, but the shorter chain omega-3s found in foods like walnuts, ﬂaxseeds, chia seeds and ﬂaxseed oil, soybean oil, and canola oil also appear to be anti-inﬂammatory.

Inﬂammation is directly correlated with glycemic index (L. Qi and F.B. Lu, Current Opinion in Lipidology, 18: 3-8, 2007). This has a couple of important implications.

The most straightforward is that reﬁned carbohydrates and sugars (sodas, pastries, and desserts), which have a high glycemic index, increase inﬂammation. In contrast, complex carbohydrates (whole grains, most fruits and vegetables) decrease inﬂammation. No surprise there. The second implication is that it is the glycemic index, not the sugar, that is driving the inﬂammatory response.

That means we need to look more closely at foods than at sugars. Sodas, pastries and desserts are likely to cause inﬂammation, but sugar-containing foods with a low glycemic index are unlikely to be inﬂammatory.

Fruits and vegetables are anti-inﬂammatory. This has been shown in multiple studies. At this point most of the research is centered on identifying the nutrients and phytonutrients from fruits and vegetables that are responsible for the reduction in inﬂammation. I suspect the investigators are hoping to design an anti-inﬂammatory supplement and make lots of money. I will stick with the fresh fruits and vegetables.

Saturated fats are inﬂammatory. At face value, the data on saturated fats appear to be contradictory. Some studies say that saturated fats increase inﬂammation, while others say they do not. However, similar to my earlier discussion on saturated fats and heart disease), the outcome of the study depends on what the saturated fats are replaced with.

When saturated fats are replaced with reﬁned carbohydrates, sugar and highly processed foods (the standard American low-fat diet), inﬂammation doesn’t change. This doesn’t mean that a diet high in saturated fat is healthy. It just means that both diets are bad for you. Both are inflammatory.

However, when saturated fat is replaced with omega-3 polyunsaturated fats (J.A. Paniagua et al, Atherosclerosis, 218: 443-450, 2011) or monounsaturated fats (B. Vessby et al, Diabetologia, 44: 312-319, 2001), markers of inﬂammation decrease. Clearly, saturated fats are not the best fat choice if you wish to keep inﬂammation in check.

I would be remiss if I did not address the claims by the low-carb diet proponents that saturated fats do not increase inﬂammation in the context of a low-carb diet. I want to remind you of two things we have discussed previously:

The comparisons in those studies are generally with people consuming a diet high in simple carbohydrates and sugars.

These studies have mostly been done in the short-term when the participants are losing weight on the low-carb diets. Weight loss decreases inﬂammation, so the reduction in inﬂammation on the low-carb diet could be coming from the weight loss.

The one study (M. Miller et al, Journal of the American Dietetic Association, 109: 713-717, 2009) I have found that compares a low-carb diet (the Atkins diet) with a good diet (the Ornish diet, which is a low-fat, lacto-ovo vegetarian diet) during weight maintenance found that the meat based, low-carb Atkins diet caused greater inﬂammation than the healthy low-fat Ornish diet.

Red meat is probably pro-inﬂammatory. Most, but not all, studies suggest that red meat consumption is associated with increased inﬂammation. If it is pro-inﬂammatory, the inﬂammation is most likely associated with its saturated fat, its heme iron content, or the advanced glycation end products formed during cooking.

What Is An Anti-Inflammatory Diet?

Anti-inﬂammatory diets have become so mainstream that they now appear on many reputable health organization websites such as Harvard Health, WebMD, the Mayo Clinic, and the Cleveland Clinic. Each have slightly diﬀerent features, but there is a tremendous amount of agreement.

Foods an anti-inﬂammatory diet includes: In a nutshell, an anti-inﬂammatory diet includes fruits and vegetables, whole grains, plant-based proteins (like beans and nuts), fatty ﬁsh, and fresh herbs and spices. Speciﬁcally, your diet should emphasize:

Colorful fruits and vegetables. Not only do they help ﬁght inﬂammation, but they are a great source of antioxidants and other nutrients important for your health.

Whole grains. They have a low glycemic index. They are also a good source of ﬁber, and ﬁber helps ﬂush inﬂammatory toxins out of the body.

Beans and other legumes. They should be your primary source of protein. They are high in ﬁber and contain antioxidants and other anti-inﬂammatory nutrients.

Nuts, olive oil, and avocados. They are good sources of healthy monounsaturated fats, which ﬁght inﬂammation.
Fatty ﬁsh. Salmon, tuna, and sardines are all great sources of long chain omega-3 fatty acids, which are incorporated into our cell membranes. Those long chain omega-3s in cell membranes are, in turn, used to create compounds that are powerful inﬂammation ﬁghters.

Walnuts, ﬂaxseeds, and chia seeds are good sources of short chain omega-3s. The eﬃciency of their conversion to long chain omega-3s that can be incorporated into cell membranes is only around 2-5%. If they ﬁght inﬂammation, it is probably because they replace some of the saturated fats and omega-6 fats you might otherwise be eating.

Herbs and spices. They add antioxidants and other phytonutrients that ﬁght inﬂammation.

Foods an anti-inﬂammatory diet excludes: In a nutshell, an anti-inﬂammatory diet should exclude highly processed, overly greasy, or super sweet foods, especially sodas and other sweet drinks. Specifically, your diet should exclude:

Reﬁned carbohydrates, sodas and sugary foods. They have a high glycemic index, which is associated with inﬂammation. They can also lead to weight gain and high blood sugar, both of which cause inﬂammation.

Foods high in saturated fats. This includes fatty and processed meats, butter, and high fat dairy products.

Foods high in trans fats. This includes margarine, coﬀee creamers, and any processed food containing partly hydrogenated vegetable oils. Trans fats are very pro-inﬂammatory.

French fries, fried chicken, and other fried foods. They used to be fried in saturated fat and/or trans fat. Nowadays, they are generally fried in omega-6 vegetable oils. A little omega-6 in the diet is OK, but Americans get too much omega-6 fatty acids in their diet. Most studies show that a high ratio of omega-6 to omega-3 fatty acids is pro-inﬂammatory.

Foods you are allergic or sensitive to. Eating any food that you are sensitive to can cause inﬂammation. This comes up most often with respect to gluten and dairy because so many people are sensitive to one or both. However, if you are not sensitive to them, there is no reason to exclude whole grain gluten-containing foods or low-fat dairy foods from your diet.

Can Diet Douse The Flames?

In case you didn’t notice, the recommendations for an anti-inﬂammatory diet closely match the other healthy diets I have discussed previously. It should come as no surprise then that both the Mediterranean (L. Gallard, Nutrition in Clinical Practice, 25: 634-640, 2010; L. Schwingshackl and G. Hoﬀmann, Nutrition Metabolism and Cardiovascular Diseases, 24: 929-939, 2014) and DASH (D.E. King et al, Archives of Internal Medicine, 167: 502-506, 2007) diets are anti-inﬂammatory.

Vegan and vegetarian diets also appear to be anti-inﬂammatory as well. The anti-inﬂammatory nature of these diets undoubtedly contributes to their association with a lower risk of heart disease, diabetes, and cancer.

As for the low-carb diets, the jury is out. There are no long-term studies to support the claims of low-carb proponents that their diets reduce inﬂammation. The few long-term studies that are available suggest that low-carb diets are only likely to be anti-inﬂammatory if vegetable proteins and oils replace the animal proteins and fats that are currently recommended.

What does this mean for you if you have severe arthritis or other inﬂammatory diseases? An anti-inﬂammatory diet is unlikely to “cure” your symptoms by itself. However, it should deﬁnitely be a companion to everything else you are doing to reduce inﬂammation.

The Bottom Line

Obesity and diabetes are two of the biggest contributors to inﬂammation, but does diet also play a role? With all the anti-inﬂammation diets circulating on the internet, you would certainly think so. In this article I review the evidence that certain foods inﬂuence inﬂammation and describe what an anti-inﬂammatory diet looks like.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Do Omega-3s Oil Your Joints?

March 30, 2021 by Dr. Steve Chaney

Fish Oil And Osteoarthritis

Author: Dr. Stephen Chaney

Osteoarthritis is not just painful. It is one of the leading causes of disability in this country. And because the joint pain associated with osteoarthritis limits activity levels, it is linked to:

Obesity

The diseases associated with obesity (diabetes and heart disease).

- Osteoarthritis increases the risk of heart disease by 50%.

Premature death associated with the increased prevalence of obesity, diabetes, and heart disease.

- Osteoarthritis increases the risk of all-cause mortality by 55%.

If osteoarthritis were rare, these statistics would just be an interesting side note. But osteoarthritis is the most common form of arthritis. It affects more than 32 million Americans. And it is costly. It costs the American economy:

$65 billion in health care costs.

$17 billion in lost wages.

$136 billion in total costs.

Conventional therapy for osteoarthritis is treatment with anti-inflammatory drugs, but they have side effects. They may even increase the risk of premature death in some individuals.

What about natural anti-inflammatory nutrients and phytonutrients? Two that have received a lot of press in recent years are omega-3s (fish oil) and curcumin.

A recent meta-analysis (NK Senftleber et al, Nutrients, 9: 42, 2017) of 42 clinical studies on the effects of omega-3s on various types of arthritis found that:

There is moderate quality evidence that omega-3s reduce the pain associated with rheumatoid arthritis. Basically, this means that there is strong, but not definitive, evidence that omega-3s reduce the pain of rheumatoid arthritis. Other general conclusions with respect to rheumatoid arthritis were:

- The best results were obtained from fish oil preparations with an EPA/DHA ratio of >1.5, suggesting that EPA is more beneficial than DHA.

- Early studies suggested that the optimal dose of omega-3s was ≥2.6 g/day for ≥12 weeks.

There was low quality evidence for an effect of omega-3s on osteoarthritis. Only 5 clinical trials have been published on the topic and the results of those studies are conflicting.

The data for an effect of curcumin on osteoarthritis pain are even more limited. There is some evidence it might be beneficial, but the studies are small and are conflicting.

In this week’s issue of “Health Tips From the Professor” I discuss an exploratory study (JC Kuszewski et al, Rheumatology Advances In Practice 4: 1-9, 2020) on the effect of omega-3s and curcumin on osteoarthritis pain.

How Was The Study Done?

You are probably wondering, “What is an “exploratory study?” Let me start by providing you with a little perspective from my years of heading a cancer research laboratory at the University of North Carolina:

Clinical studies are expensive. And if you are trying to study an approach that has not already proven to be successful, the money needed to fund the study can be hard to come by. It is a “Catch 22” situation. You need to conduct an “exploratory study” to show your project is likely to succeed before the funding agency will give you money to fund your project.

But where do you get the money to fund your exploratory project? One way that investigators overcome that barrier is to use data from a previous study that was originally designed for a different purpose. The study I will describe today is an example of that approach.

The study utilized data collected from a clinical trial designed to measure the effect of omega-3s and curcumin on brain function in older adults. The study recruited 152 older adults (average age = 65) who were overweight to obese (average BMI = 31) and sedentary (˂55 min/week of physical activity) from New South Wales, New Australia.

The participants were randomly divided into 4 groups:

Placebo group. [Note: The fish oil placebo contained 20 mg of fish oil so it would match the odor of the fish oil supplement, and the curcumin placebo contained yellow food dye so it would match the color of the curcumin supplement.]

Fish oil group (2,000 mg DHA & 400 mg EPA per day).

Curcumin group (160 mg/day curcumin).

Fish oil + curcumin group.

Participants were followed for 16 weeks. At the beginning and end of the study participants filled out questionnaires assessing (among other things):

The severity of their chronic osteoarthritis pain.

Disabilities caused by osteoarthritis in the participant’s daily life (physical distress, sleep disturbances, psychological distress, loss of productivity, physical limitations, physical deconditioning due to reduction in physical activity, and financial hardship).

Their physical and mental wellbeing during the past 4 weeks.

Their mood during the past 7 days.

Do Omega-3s Oil Your Joints?

The results were as follows:

Omega-3 supplementation reduced chronic osteoarthritis pain by 42%.

Omega-3 supplementation reduced disability associated with osteoarthritis by 40%.

- The reduction in pain and disability in participants supplemented with fish oil was greatest in those who reported the highest pain/disability at the beginning of the study.

- The reduction in pain was associated with an improved perception of physical and mental wellbeing.

- The reduction in pain was also associated with a decrease in depression and other mood disturbances.

Curcumin did not affect pain or osteoarthritis burden either alone or paired with omega-3s.

What Are The Pros And Cons Of This Study?

Pros:

The results for the effects of omega-3s on osteoarthritis were highly significant. In addition, the questionnaires used were well designed to capture the intensity and location of pain, mood, and feelings of wellbeing.

Cons:

This was an exploratory study using data collected from a study designed to measure the effect of omega-3s and curcumin on brain health in older adults. It was not ideally designed to measure the effect of omega-3s and curcumin on osteoarthritis.

If the original study had been intended for investigating the effect of these supplements on osteoarthritis, it would have been designed differently:

Participants would have been recruited into the study based on the presence and intensity of osteoarthritis pain.

The diagnosis of osteoarthritis would have been confirmed by X-rays.

Participants would have been admitted into the study only if they had moderate to severe osteoarthritis pain. Most of the participants in this study had only mild osteoarthritis pain. That may have limited the ability of this study to find an effect of curcumin on osteoarthritis pain.

The design of the omega-3 supplement would have been different.

- Because the original study was designed to determine the effect of omega-3s on brain health, the omega-3 supplement chosen had more DHA than EPA.

- Had the study been designed to determine the effect on omega-3s on an inflammatory disease like osteoarthritis, the omega-3 supplement would have had more EPA than DHA.

The curcumin supplement was also not ideally designed for this study. The curcumin supplement used in this study contained only 160 mg of curcumin and contained no other ingredients. Well-designed curcumin supplements usually contain around 500 mg curcumin standardized to 95% curcuminoids plus piperine to enhance the absorption of the curcumin.

In the words of the authors, “Further studies are warranted to evaluate the benefits of fish oil, alone or as an adjunct to pharmacotherapy, in patients diagnosed with osteoarthritis who suffer moderate-to-severe pain…” In other words, they now intend to use the data from this exploratory study to apply for funds to conduct a larger study specifically designed to measure the effects of omega-3s on osteoarthritis pain.

The study limitations described above, severely restricted the ability of the study to detect any beneficial effect of curcumin on osteoarthritis pain. The effect of curcumin on osteoarthritis pain is probably less than the effect of omega-3s, but it would be premature to conclude that it has no benefit. However, they obtained no data from their “exploratory study” to justify a follow-up study on the effect of curcumin on osteoarthritis pain.

Fish Oil And Osteoarthritis

This study suggests that 2.4 grams/day of omega-3s may be equally effective at reducing osteoarthritis pain and the effects that osteoarthritis pain has on both physical health and psychological health. However, because this study has several limitations, the evidence cannot be considered definite.

If you have either rheumatoid or osteoarthritis, I recommend trying omega-3 supplementation. Based on the studies described above, you might want to aim for 2-3 g/day of omega-3s with an EPA/DHA ration of 1.5 or greater.

As with any natural approach, this will work better for some people that for others. However, don’t forget that omega-3s are also important for heart health, healthy blood pressure, brain health, and a healthy pregnancy (https://www.chaneyhealth.com/healthtips/omega-3s-during-pregnancy-are-healthy/). If they also happen to reduce your arthritis pain, that is an extra benefit.

As usual, I recommend a holistic approach. You should also:

Follow an anti-inflammatory diet.

Keep active.

Aim for a healthy weight.

Add antioxidant and polyphenol supplements.

These lifestyle changes should allow you to reduce or eliminate any pain medication you may be taking.

Finally, if you are on blood thinners, consult with your physician before adding omega-3 supplements to your diet. My preference is to incorporate omega-3s and reduce other medications, but that is a discussion you need to have with your doctor.

The Bottom Line

A recent meta-analysis has concluded there is moderate quality evidence that omega-3s reduce the pain associated with rheumatoid arthritis. Basically, this means that there is strong, but not definitive, evidence that omega-3s reduce the pain of rheumatoid arthritis. Other general conclusions with respect to rheumatoid arthritis were:

The best results were obtained from fish oil preparations with an EPA/DHA ratio of >1.5, suggesting that EPA is more beneficial than DHA.

Earlier studies suggested that the optimal dose of omega-3s was ≥2.6 g/day for ≥12 weeks.

However, there have been few studies on the effect of omega-3s on osteoarthritis. A new exploratory study looked at the effect of 2.4 g/day of omega-3s for 16 weeks on the pain and disability associated with osteoarthritis. It found:

Omega-3 supplementation reduced chronic osteoarthritis pain by 42%.

Omega-3 supplementation reduced disability associated with osteoarthritis by 40%.

- The reduction in pain and disability in participants supplemented with fish oil was greatest in those who reported the highest pain/disability at the beginning of the study.

- The reduction in pain was associated with an improved perception of physical and mental wellbeing.

- The reduction in pain was also associated with a decrease in depression and other mood disturbances.

The authors concluded, “Our findings indicate potential for fish oil supplementation to reduce mild osteoarthritis pain and burden in sedentary overweight/obese older adults. Further studies are warranted to evaluate the benefits of fish oil, alone or as an adjunct to pharmacotherapy, in patients diagnosed with osteoarthritis who suffer moderate-to-severe pain…”

As with any natural approach, this will work better for some people that for others. However, don’t forget that omega-3s are also important for heart health, healthy blood pressure, brain health, and a healthy pregnancy. If they also happen to reduce your arthritis pain, that is an extra benefit.

As usual, I recommend a holistic approach. You should also:

Follow an anti-inflammatory diet.

Keep active.

Aim for a healthy weight.

Add antioxidant and polyphenol supplements.

These lifestyle changes should allow you to reduce or eliminate any pain medication you may be taking.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.