For those suffering from the painful and often debilitating effects of rheumatoid arthritis, the only possibility of relief - until recently - involved either painful surgery or expensive medications that also bring with them their own complications.
Now, however, an increasing amount of research into alternative therapies has shown promising results from fish oil and fish oil supplements. The omega-3 fatty acids found in large amounts in fish oil seems to act as an anti-inflammatory agent with no serious side effects and only the possibility of some minor adverse reactions. Omega-3 is found naturally in fish oil or can be ingested through supplements, which is even safer than eating fish known to have high concentrations of omega-3 because those fish also run the risk of containing toxic chemicals such as mercury and PCB's.
Fish oil has been shown to benefit those with cardiac problems, improve cholesterol levels and increase brain function. For those with rheumatoid arthritis, studies have shown increased amounts of omega-3, which has the highest concentrations in fish oil, improves their condition, decreases the amount of time they have stiffness in the morning and can also decrease the amount of non-steroid anti-inflammation drugs they have to take to combat the illness.
These non-steroid anti-inflammation drugs come with plenty of potential side effects, most commonly nausea, decreased appetite, vomiting, rash, dizziness and constipation. More serious side effects include fluid retention, which can lead to edema. The most serious side effects range from kidney and liver failure, to ulcers and prolonged bleeding after surgery.
Steroid medications can be prescribed for the most seriously affected patients, but those also have serious side effects, such as bone loss, suppress the body's immune system and increase blood sugar levels.
On the other hand, fish oil supplements have shown to have no side effects and only minor adverse reactions. They are also much cheaper than the non-inflammatory medications and more readily available.
While eating fish could be an important part of a good diet, fish oil supplements may be better and safer due to the fact that in order to reap the benefits of omega-3, a large amount of fish would need to be eaten on a regular basis and the fish with the highest concentrations also may contain toxic chemicals. Meanwhile, taking fish oil supplements ensures the dosage is regulated properly and worries about mercury or other toxic chemicals are non-existent since they are removed in pharmaceutical grade supplements.
To understand the potential benefits of fish oil and fish oil supplements, it is important to first understand rheumatoid arthritis, what causes it and thus how fish oil can counteract it.
What is rheumatoid arthritis?
Rheumatoid arthritis is a painful, chronic type of arthritis that impacts about 1.3 million people in the U.S., and occurs about three times more often in women than in men.
While the exact cause of the disease remains unknown, contributing factors to developing it are believed to include genetics, environment and hormones.
Infectious agents, such as viruses, bacteria and fungi have been suspected as causes, but this has not been proven. It is possible an outside source, such as the environment, may trigger the immune system of the body to mistakenly initiate the reaction. Usually, it is believed a combination of problems result in contracting rheumatoid arthritis. There are juvenile cases of rheumatoid arthritis, but the onset usually occurs in middle age.
It is mainly characterized by inflammation of the lining of the joints. It affects people differently, with some developing rather mild cases that may only last a few months or a couple of years, and others advancing to stages where joint damage occurs along with chronic pain, disability and deformities. It can also affect organs in the body. Often, the disease will progress through three stages.
In the first stage, the joint lining swells, causing warmth, pain, stiffness, redness and swelling around the joint. Next is a rapid division of cells and growth of cells which cause the lining to thicken. In the third stage, the inflamed cells release enzymes that can break down the bone and cartilage in the affected area.
Most theories on the development of the disease have centered on it being an autoimmune response by the body, meaning the body basically attacks itself, though some studies in recent years indicate an outside agent, such as a viral protein, may cause the reaction. Either way, the long-time prognosis for rheumatoid arthritis is not a particularly good one.
The medical and economic costs of all types of arthritis, including rheumatoid, add up to billions of dollars every year when including medications, surgeries and wages lost. Daily joint pain associated with the disease can also lead many to experience feelings of depression, anxiety and helplessness.
Currently, there is no cure for rheumatoid arthritis, but early diagnosis can help someone continue to live a productive life. Studies show early, aggressive treatment can limit joint damage, which reduces loss of movement, increases the ability to continue to work, lowers medical costs and may be able to delay the need for surgery.
In 80 percent of patients with rheumatoid arthritis, an anti-body called "rheumatoid factor" can be found. However, this anti-body can also be found in other conditions, so its presence, as well as abnormal readings on tests, does not point exclusively to rheumatoid arthritis.
In early stages of the disease, X-rays may not show any joint damage, or show only minor swelling. In the second stage, evidence of bone thinning with or without slight bone damage may be seen on an X-ray. Slight cartilage damage may be seen, joint mobility may be decreased but no joint deformities are present, surrounding muscle may be atrophied and soft tissue around the joint may show signs of abnormality.
Typically in the third stage, an X-ray will show signs of bone thinning and damage to bone and cartilage around the joint. Also likely present will be some joint deformity without permanent stiffness of the joint, extensive muscle atrophy and abnormalities in the tissue surrounding the joint.
Stage four rheumatoid arthritis characteristics include joint deformity with permanent fixation of the joint, extensive muscle atrophy and abnormalities in the soft tissue around the joint. X-rays will show evidence of cartilage and bone damage, as well as osteoporosis.
Those with class I rheumatoid arthritis are able to complete normal activities of their day, while those in class II will be able to care for themselves and perform most work activities, though their activities in such areas as sports and household chores will be limited. Those in class III will still be able to care for themselves, but their activities in and out of work will be limited. Class IV patients will be limited in their abilities to care for themselves, work and engage in other activities.
Research into benefits of fish oil
In the last decade or so, several studies have been conducted to determine the possible benefits on rheumatoid arthritis patients of increasing omega-3 fatty acids into one's diet, usually through increased consumption of oily fishes like salmon, mackerel and herring. While we've all been conditioned in the last several years to cut out fat in our diet, omega-3 fatty acids have beneficial effects on the body.
In fact, it was reported in August of this year in the "Evening Courier" of Halifax that Greenland Inuits have low incidences of heart disease despite having a diet high in fat. However, much of their high-fat diet comes from marine mammals, which are high in omega-3s. Scientists who study diet and diseases have found that heart disease, cancer and diabetes are nearly non-existent among Eskimo populations.
While Eskimo and Inuit diets consist largely of fat from marine animals, many Western diets contain fat from vegetable oil coming from fast food and store bought baked goods.
Fish oil has also been found to be the best source of two particular fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have been found to reduce inflammation, reduce the clotting tendency of blood, improve brain function, improve heart health and inhibit abnormal cell growth, which could help reduce cancer risks.
Fish oil's effect as an anti-inflammatory agent is of particular interest to rheumatoid arthritis patients, since the disease results from the inflammation of the lining of the joints.
A 1993 study gave rheumatoid arthritis patients 2.8 grams of fish oil daily compared to a placebo given to others. After three months, those receiving the fish oil supplementation showed decreased use of non-steroidal anti-inflammatory drugs (NSAIDs) compared to those given the placebo, and after 12 months that reduction peaked.
Another study in 1995 showed 130 milligrams of fish oil supplements per kilogram of the person's weight per day could decrease the number of tender joints, the duration of morning stiffness and overall pain experienced by rheumatoid arthritis patients.
It has also been shown that the amount of omega-3 fatty acids added can be lowered if combined with a decreased amount of omega-6 fats, which is found in many vegetable oils and actually promotes inflammation. Some research suggests increased levels of omega-6 can heighten the possibility of some diseases and depression. Many Western diets have ratios of omega-6 compared to omega-3 of 10 to 1, though some can be as high as 30 to 1. The ration should be 1 to 1.
A 2000 study showed that lower doses of omega-3 supplements could lessen inflammation from arthritis if paired with a reduction in the amount of omega-6s ingested. The amount of omega-3 found to still be effective was lowered to 2.3 grams if small amounts of omega-6 were included in the patient's diet.
Use of both steroid and non-steroid medication to reduce symptoms in patients with severe arthritis was found in 2003 to be lowered if omega-3s were added to the diet and omega-6s reduced. Again, using less of the medications means less risk of their side effects.
In Leuven, Belgium, patients were divided into three groups: one group received six tablets of olive oil a day as the placebo group; the second received three tablets of olive oil and three tablets of fish oil per day; and the last group received six tablets of fish oil each day.
After three months, the placebo group showed very little improvement (about 10 percent showed some signs of being better), while 33 percent in the group receiving split treatment showed improvement. However, 53 percent of patients receiving fish oil alone showed significant signs of improvement and 47 percent of this group was able to reduce its use of non-steroid anti-inflammatory drugs. In the placebo group, only 15 percent lowered their use of the non-steroid anti-inflammatories and 29 percent were able to do so in the split group.
The Belgium scientists concluded long-time use of fish oils can improve the effects of rheumatoid arthritis significantly and can also decrease the use of non-steroid anti-inflammatory drugs.
A similar study at the University of Newcastle in Australia seems to back this conclusion. In that study, 50 patients who had been diagnosed with rheumatoid arthritis were studied for 15 weeks. All the patients had a diet in which they consumed less than 10 grams per day of omega-6 fatty acids. Half the patients were given a placebo consisting of a 50-50 mixture of corn and olive oil, while the other group was given fish oil capsules providing a daily intake of about 2.8 grams for an average sized person.
All the subjects continued their regular diets and medications. Tests were taken initially and then at 4, 8 and 15 weeks. After the four-week and eight-week periods, no significant changes occurred in either group. However, at the 15-week period, significant changes were found in the group receiving fish oil, while no improvement was seen in the group not receiving fish oil. In addition, the group receiving fish oil also reported vast improvements in the duration of morning stiffness and physicians reported an overall improvement in the condition of the disease.
The October 2006 edition of the Journal of Rheumatology reported on a study which found 75 percent of patients using fish oil were able to reduce the amount of non-steroid anti-inflammatory drugs they took after a three-year period. Remission of the disease also occurred in 72 percent of patients taking the fish oil.
Fish oil supplements
It appears there is a benefit to rheumatoid arthritis patients of increasing their intake of omega-3 fatty acids through fish oils, especially if omega-6 fatty acids absorbed through vegetable oils can be reduced.
Of course, a healthy diet is important for anyone, not just those afflicted with rheumatoid arthritis, and eating fish could be a part of that healthy diet. However, to achieve the benefits of omega-3 fatty acids at the levels seen in some of the studies above, you'd have to eat a good amount of fish on a regular basis.
Remember, those Eskimos and Inuits who rarely experience heart disease or cancer in their populations eat mainly marine mammals as part of their diet. Some people just don't care for the taste of fish as much as Eskimos do.
The highest concentrations of omega-3s can be found in mackerel, salmon, tuna, bluefish, sturgeon, anchovy, herring, trout, sardines and mullet. However, since these types of fish are higher on the food chain, often eating other smaller fish (that's why they have the increased amounts of omega-3s, because they have their own as well absorbing it from the fish they eat), they may also contain higher doses of some toxic contaminants, such as mercury, dioxin and PCBs.
Pharmaceutical Grade fish oil supplements, however, allow companies to provide the benefits of the omega-3 fatty acids from fish oil while eliminating the possibility of also ingesting toxic contaminants. Also, the dose is regulated so the patient knows how much they are taking. Tablets can come in gel form and taking one to two tablets per day should provide the benefits sought, though it can also be found in liquid form.
There have been no serious side effects reported from increased or prolonged ingestion of fish oil or fish oil supplements.
There are some mild adverse reactions that have been reported from time to time. Nausea, diarrhea and flatulence are common reactions, as well as experiencing a "fishy" burp. However, the Mayo Clinic has several recommendations to avoid this reaction, including swallowing the pill while frozen, which slows down its digestion in the stomach. Other tips include taking the pill at the beginning of a meal so the other food "traps" the fish oil in the stomach and acts as a buffer, switching brands or using an odorless tablet.
Other potential adverse reactions documented include halitosis, fishy smelling breath, skin and urine and occasional nosebleeds due to the anti-clotting agent of omega-3s. Pregnant women are advised to consult first with their physican before starting fish oil supplements as there may be complications with the Vitamin A found in fish oil. An increased level of Vitamin E intake is also recommended because the metabolism of fish oil uses large amounts of the vitamin, which is a powerful antioxidant. Some pharmaceutical grade supplements already add in Vitamin E with the fish oil to balance out this issue.
While not a side effect, it should be noted it takes time for an increase in omega-3s to achieve the goal of reducing inflammation in the joint. Most of the studies mentioned above saw no major results before at least three months.
Why you should choose fish oil supplements
Surgery options for rheumatoid arthritis patients include joint replacement, tendon reconstruction and a procedure to remove the inflamed lining. There are also medications that can relieve pain or reduce inflammation. However, these can be very expensive and may come with extensive side effects, such as chronic infections like tuberculosis as well as the others discussed previously.
It comes as no surprise then that patients are always looking for a better alternative. Pharmaceutical grade fish oil supplements may be that alternative. They are cheaper, have almost no side effects and provide most of the same benefits over a period of time. They can be purchased online or at just about any store that sells supplements.