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://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.

How Strengthening Can Hurt Your Muscles

March 13, 2014 by Dr. Steve Chaney

Preventing & Healing Repetitive Strain Injuries – Part 2

Author: Julie Donnelly, LMT

In part I of this series we explored “how” muscles cause joint pain and prevent us from moving easily and without pain. In Part II we’ll take a look at the “why.”

When a person can’t freely move a joint they are frequently told they need to strengthen the muscle that moves the joint, but this is often a serious misconception. Let’s look at this further so it will become clear.

Most people have heard the term Repetitive Strain Injury (RSI), but they don’t have a clear concept of how that affects them on a daily basis.

Repetitive Strain Injuries (RSIs)

Repetitive strain injuries happen when a muscle does the same movement over and over, causing the muscle to develop an excess of Hydrogen ions (H+), which is a part of lactic acid. Lactic acid was once thought to be the “bad guy” that created spasms/knots in your muscles. Then research showed that lactic acid has two components, one is called lactate and it is an important piece of energy production, and the other is H+, which is the acid byproduct of energy production and is the cause of the spasms.

Your body has the ability to flush out H+, but if you are exercising, or repetitively doing the same movement, you are creating more H+ than your body can eliminate. The scales tip and the excess lactic acid will cause the muscle fibers to contract into a spasm. The spasm is usually formed slowly so you don’t notice it until it is so evolved that the fibers are twisted into a knot and are putting a strain on the insertion point at the joint.

Strengthening vs Lengthening

When you can’t bend a joint, such as your elbow, you are often told to strengthen the muscle that pulls on the joint, in this case, the biceps. However, you actually need to lengthen your triceps.

In fact, I tell my clients to first look at the area where they are feeling pain, and then find out which muscle inserts at that point. If you can’t bend a joint, I tell people to look at what muscles should be stretching to enable the joint to move. The likelihood is great that the tight muscle is the cause your problem.

You’ll be amazed at how quickly you will regain full range-of-motion when you release the “straps that are holding you bound” by lengthening the contracted muscles.

Another piece of the strengthening misconception occurs when a person feels they are losing power in their muscle. Many times the person isn’t feeling any pain in their body, just a general feeling of loss of strength. You know you are exercising, but still you aren’t as strong as you were, so you feel you need to increase your strengthening exercises.

How Strengthening Can Hurt Your Muscles

To demonstrate this topic we’ll use the biceps of the upper arm as our example. I do a lot of my work with endurance athletes, athletes who are power lifters or simply individuals who exercise to the extreme. I’ve seen how they are in severe pain, sometimes to the point where they can’t do even the simplest movements without having not only pain but also losing power.

Often they lose power because the pain is too sharp when they go to lift the weight, or do pull ups. Other times they just feel like they are having weakness in the muscle, which makes them more determined to exercise that muscle even more. What has happened is the muscle is now too short to have any pulling power.

Look at the graphic to the left. Many endurance athletes look just like this drawing, and some people think this is the picture of strength. However what is happening is the biceps muscles have been shortened to the point where he can’t completely straighten his arm, so he has actually lost power.

But you don’t need to be an endurance athlete to have this experience. If any muscle in your body is shortened by spasms, whether they are from doing a repetitive movement or from exercise, you will also lose strength in those muscle fibers.

Consider this: if you couldn’t move your body, but you wanted to pull a heavy object toward you, you would stretch your arm out all the way and then pull on the object. If you stepped closer to the object so your arm is now bent, you can see that you wouldn’t have as much strength to move the heavy object. In the same way, when a muscle is already shortened by either a spasm or a static contraction, it won’t have the full pulling power it needs to function properly. You need to lengthen the fibers to their optimal length so they can pull with full strength.

You stretch, but often people will complain that the muscles aren’t stretching, or they hurt worse after the stretch than they did before stretching. This brings us to the “stretching misconception,” which will be explained in Part III of this trilogy.

Julie Donnelly is an internationally respected muscular therapist specializing in the treatment of chronic pain and sports injuries. She has co-authored several self-treatment books, including The 15 Minute Back Pain Solution, Treat Yourself to Pain-Free Living and Carpal Tunnel Syndrome-What You Don’t Know CAN Hurt You. Julie is also the co-developer of TriggerPoint Yoga. She teaches Julstro self-treatment workshops nationwide and is a frequent presenter at Conventions and Seminars. Julie may be contacted through her websites: http://www.julstro.com and http://www.TriggerPointYoga.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.

How Muscles Cause Joint Pain

March 6, 2014 by Dr. Steve Chaney

Preventing & Healing Repetitive Strain Injuries – Part 1

Author: Julie Donnelly, LMT

Using the words “pain” and “free” in the same sentence causes people who love to exercise laugh since it seems to be a contradiction of terms, but it is not only possible, it’s easy to achieve. It is understood that exercising, or even just daily living, causes muscles to ache and will also put stress on joints.

When the pain begins you are told to use “RICE” (Rest, Ice, Compression, Elevation) – but you don’t have the time, or you simply don’t want to rest! So, you keep going and just as you’ve been told, it gets worse, even to the point where you may need to stop your world!

You’ve also come to realize that resting (when you do decide to rest) only lasts for a short time, and then the pain returns. The good news is you can be a pain-free; you just need to know how to find the source of your pain and then how to effectively treat it.

How Muscles Cause Joint Pain

RICE certainly works immediately after having a traumatic injury, but repetitive stress on your muscles requires treatment of the knots that are putting tension onto the tendons and joints. Getting back to basic anatomy will help to unravel the misconceptions that plague both athletes and non-athletes alike. Once you understand the logic of why you are feeling pain, you will know exactly what needs to be done to immediately release a muscle-related pain anywhere in your body.

This is NOT going to be a complicated lesson in Anatomy & Physiology, but I’ve found that a little knowledge of the body goes a long way. I’m going to put the proper names for the muscles and tendons into a parenthesis so if you want to actually see the muscles that are causing you pain you’ll be able to look them up.

I always tell the clients I work with “the most challenging part is finding where the source of the pain is located, and then treating it is easy”. This article will help you to find the source of your problem. Let’s begin at the beginning…

The Basics – How a Joint Moves

Movement is a simple process:

1. A muscle originates on a bone.

2. It then merges into a tendon.

3. The tendon crosses over the joint to insert into a movable bone.

4. When the muscle contracts it pulls on the tendon. The tendon then pulls on the moveable bone and your joint moves.

Example: The Muscles of Your Upper Leg

All joints have two (or more) muscles that determine the degree and angle that the joint will move. While one muscle is contracting, the other muscle must relax and stretch. A good example of this principle are the muscles of your upper leg. (quadriceps and hamstrings).

The quadriceps originate on the front of your hip (pelvis), merge into a thick tendon (patella tendon) and cross over the knee cap to insert onto the front of your shinbone (tibia). When they contract normally you fully extend your leg so it becomes straight. Meanwhile, your hamstrings originate on the lower edge at the back of your pelvis; go down the back of your thigh, with the tendons crossing over the back of your knee and inserting onto the back side/top of the lower leg bone.

Consider this analogy, if you attached your pants to the front of your shinbone, and then pulled up at the waist, you would feel the pressure at your knee and you also wouldn’t be able to bend your knee. Likewise, since your quadriceps originate up at the front of your pelvis and insert into your shinbone, when your quadriceps are tight they can’t stretch and you can’t bend your knee.

For example, to demonstrate an analogy of what tight hamstrings would do, consider what would happen if you bent your leg and then attached your pants to the bottom of your posterior pelvis (the bone you sit on, at the top of your thigh) and the back of your knee, you wouldn’t be able to open your leg up straight. But, clearly, you don’t have a knee problem, you have tightness in the upper thigh (hamstring) preventing your knee from moving.

When this has happened you begin to feel stiffness and a lack of your full strength. Some therapists will tell you that you need to strengthen your thigh (quadriceps) muscles. You may also think you need to stretch your hamstrings, but stretching a spasm is counter-productive and can actually make the spasm become more complicated while over-stretching the rest of the muscle fiber.

In Part II we’ll look at the first misconception – strengthening the muscle will heal the pain.

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.

How Can You Relieve Chronic Hip Pain?

October 17, 2013September 26, 2013 by Dr. Steve Chaney

Making Hip Pain Go Away

Author: Julie Donnelly

Do you have joint pain or stiffness? Does it hurt when you’ve been sitting and you try to get up and walk? Have you tried to stretch and either it feels good for a few minutes and then you’re back to square one, or maybe even worse, it hurts more than it did before? Do you sometimes feel like your joints are just tied down and you’re no longer flexible? Do you maybe even blame it on “old age?” The odds are extremely high that all that’s happening is your muscles are in spasm.

If any of these statements fit you, you’ll really love today’s message. As a bonus, at the end of this blog you’ll learn a self-treatment that you’ll love if you ever have hip pain.

I’ve mentioned many times that a tight muscle pulling on a tendon will cause joint pain, just like pulling on your hair will cause your scalp to hurt. And, just like the only way to stop the pain in your head is to let go of your hair, the only way to stop the pain in your joint is to release the tight muscle.

Another analogy that I use frequently has to do with stretching and why you may feel worse AFTER you stretch than you did before you stretched. If you took a 12” line and tied enough knots in it so it is now 11”, and then you try to stretch it back to 12” without first untying the knots, you can see what would happen. The knots would become tighter and the fibers on either side of the knot would be overstretched and could possibly even tear. If the line was attached to a fixed point on either side you can imagine the strain that is happening to the attachment points. This is exactly what is happening to you when you when you stretch a muscle that is tied up in knots (spasms). You can see how important it is to first release the spasms before stretching.

Today I’d like to share with you how to do one of the Julstro self-treatments that we teach on the Julstro self-treatment DVD. So many people have hip pain that I’d like to explain how to treat the tensor fascia lata muscle which is located on the outside of your hip, between your hip bone and the top of your thigh bone:

Using a tennis ball (hollow in the center so it is a bit less intense) or a Perfect Ball (solid in the center so it gets in deeper) place the ball right where the side-seam of your pants is located – between the two bones. If you are in a lot of pain, start by leaning into a wall. If you want to go deeper into the muscle, lie on the floor on top of the ball. You may need to move an inch or so to find the “epicenter” of the spasm, but you’ll know immediately when you locate it. Always make sure you keep your pressure to a “hurts so good” level, you’re in control so don’t over-do.

Once you find the spasm, which is also called a “trigger point,” just stay still on it for 30-60 seconds. Lift your weight off the ball for a few breaths and then press into the ball again. This second time you’ll find that it won’t be as painful as the first time because you have already pressed out some of the H+ ions that are causing the spasm (and the pain).

Keep repeating this for a few minutes and then slightly move your body so you can find other trigger points that are around your hips. You’ll probably find points that are a little bit toward the front of your hip, so make sure you rotate your body so you’re facing more toward the wall or the floor, and then rotate your body so you’re back is more toward the wall or the floor.

This one simple technique has saved several of my clients from thinking they needed hip surgery! It will help you move easier and with less discomfort – and often it will totally eliminate the pain from your hip completely.

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.