Fish oil reduces heart disease risk in arthritis patients
ADELAIDE, AUSTRALIA. The potential benefit of fish oils on rheumatoid arthritis (RA) has been the subject of many previous studies. Overall, the results suggest that fish oil supplements containing the omega 3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) can reduce stiffness and pain. But could these supplements also help reduce the increased risk of cardiovascular disease in RA patients?
A team from the Royal Adelaide Hospital investigated the effects of fish oil supplementation on several cardiovascular risk factors. They recruited 31 early RA patients all taking drug treatment for the condition, of whom 18 also chose to take fish oil. The dose was considered by the researchers to be sufficiently high to have an anti-inflammatory action. After three years of supplementation, data from the patients who did not take fish oil was compared with data from those did and reached a level of EPA greater than 5 per cent of total plasma fatty acids. Arachidonic acid, an omega 6 fatty acid which competes with omega 3 FAs, was lower in participants who reached the required level of EPA. It was 30 per cent lower in platelets and 40 per cent lower in peripheral blood cells. Serum thromboxane B2, a cardiovascular risk factor, was 35 per cent lower. Prostaglandin E2, a compound which RA drug treatment seeks to reduce, was 41 per cent lower.
Fish oil was also linked to positive changes in blood lipids, and a greater rate of remission after the 3 years - 72 per cent compared to 31 per cent in the non-fish oil group. The authors conclude that fish oil reduces cardiovascular risk in RA patients, and that this takes places via several biological pathways. They suggest that fish oil could potentially replace drug treatment for many RA patients. In this study, non-steroidal anti-inflammatory drug use was reduced by 75 per cent in the fish oil group between the start and finish of the study, compared with 37 per cent in the non-fish oil group. Added to which, RA drugs may themselves contribute to cardiovascular risk. Fish oil is a cheaper, safer treatment option and could also serve as a preventative measure against RA, the authors conclude.
Cleland, LG, et al. Reduction of cardiovascular risk factors with longterm fish oil treatment in early rheumatoid arthritis. Journal of Rheumatology, published online August 1, 2006
Fish oils benefit patients with lupus
BELFAST, NORTHERN IRELAND. Systemic lupus erythematosus (SLE) is a chronic inflammatory
disease. It
can manifest itself via a photosensitive facial rash, fatigue, anorexia, weight loss, and night sweats and
can
progress to life-threatening involvement of the heart, lungs, kidneys or central nervous system. Flare-ups
of SLE
are typically followed by periods of clinical remission. Fish oils and copper have both been found useful
in the
treatment of other inflammatory diseases, so researchers at the University of Ulster decided to see if
supplementation with one or both of these would help alleviate SLE symptoms.
Their clinical trial involved 52 SLE patients who were randomly assigned to receive 3 grams/day of fish oil
providing 540 mg/day of EPA (eicosapentaenoic acid) and 360 mg/day of DHA (docosahexaenoic acid), 3
mg/day of copper in the form of a copper di-glycinate amino acid complex, both fish oil and copper, or a
placebo.
The study lasted 24 weeks and participants were assessed at baseline, 6, 12 and 24 weeks.
The researchers found that disease activity at 24 weeks, as measured by the SLAM-R score, was
significantly
less in the groups that had supplemented with fish oil than in the placebo and copper only groups. They
conclude that supplementation with fish oil may be effective in favourably modifying the symptomatic
disease
activity in SLE.
Duffy, EM, et al. The clinical effect of dietary supplementation with omega-3 fish oils and/or copper in
systemic lupus
erythematosus. Journal of Rheumatology, Vol. 31, August 2004, pp. 1551-56
Fish oils help reduce arthritis symptoms
EPSOM, UNITED KINGDOM. Dr. Gail Darlington of the Epsom General Hospital and Dr. Trevor Stone of
the University of Glasgow have just released a major paper reviewing the current state of the art in
regards to diet and inflammatory diseases such as rheumatoid arthritis (RA). About 2% of the world’s
population suffers from RA and the disease is three times more prevalent among women than among
men. RA can strike at any age and involves an inflammation of joint tissues associated with the release
of toxic substances in the synovium that leads to cartilage destruction. The main symptoms are swelling
of the affected joints, morning stiffness, fatigue and general malaise. There is considerable evidence now
that RA is caused by oxidative stress and involves an excessive production of pro-inflammatory
compounds like tumor necrosis factor-alpha and interleukin-1beta.
Research has shown that supplementation with fish oils (eicosapentaenoic acid and docosahexaenoic
acid) can markedly reduce interleukin-1beta production and results in a significant reduction in
morning stiffness and the number of painful joints in RA patients. Omega-6 polyunsaturated fatty acids
(found in cooking oils and margarine), on the other hand, have been found to exacerbate RA symptoms.
Fish oils have also been found useful in the management of systemic lupus erythematosus.
Drs. Darlington and Stone point out that long-term supplementation with fish oils may affect immune
function and caution against daily intakes of more than 750 mg of EPA. (Editor’s Note: Other
studies have found intakes of 5 grams/day or more to be entirely safe for periods as long as seven years.)
They also point out that fish oil supplements should contain at least 3 mg of vitamin E per gram of fish oil
in order to avoid excessive peroxidation. [225 references]
Darlington, L. Gail and Stone, Trevor W. Antioxidants and fatty acids in the amelioration of rheumatoid
arthritis and related disorders. British Journal of Nutrition, Vol. 85, March 2001, pp. 251-69
Fish oils recommended for rheumatoid arthritis
NEWCASTLE, AUSTRALIA. At least 13 published randomized, controlled clinical trials have reported
significant benefits of fish oil supplementation in rheumatoid arthritis patients. Now researchers at the
University of Newcastle weight in with the additional evidence to support these earlier findings. Their 15-
week study involved 50 patients who had been diagnosed with rheumatoid arthritis. The patients were all
consuming a diet which contained less than 10 grams/day of omega-6 fatty acids. These fats are known
to promote inflammation through their eicosanoid metabolites. Half the patients were given fish oil
capsules to provide a daily intake of 40 mg/kg body weight (about 2.8 grams for a 70 kg person); the
other half received placebo capsules containing 50/50 corn/olive oil. All subjects continued with their
regular diet and medications. About half the patients dropped out during the experiment, mainly due to
changes in their medications. Complete clinical evaluations were carried out at baseline, 4, 8 and 15
weeks.
There were no significant changes after 4 or 8 weeks, but at the 15-week evaluation major improvements
were noted in the group receiving fish oil. Particularly impressive were the improvements in the duration
of morning stiffness and the overall assessment of disease activity (by both patients and physicians).
Significant improvements were noted in 6 of the 9 evaluation parameters in the fish oil group; no
improvements were noted in the control group. Only the total number of joints affected, the erythrocyte
sedimentation rate (ESR), and the C-reactive protein level were unaffected by supplementation.
In an accompanying editorial Drs. Cleland and James of the Royal Adelaide Hospital emphasize the
importance of maintaining a low intake of omega-6 fatty acids in order to keep the ratio of omega-6 to
omega-3 as low as possible. They conclude that “dietary fish oil supplements should now be regarded as
part of standard therapy for rheumatoid arthritis”.
Volker, Dianne, et al. Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis. Journal of
Rheumatology, Vol. 27, October 2000, pp. 2343-46
Cleland, Leslie G. and James, Michael J. Fish oil and rheumatoid arthritis: antiinflammatory and collateral
health benefits. Journal of Rheumatology, Vol. 27, October 2000, pp. 2305-06 (editorial)
Borage and fish oils go together
JACKSONVILLE, FLORIDA. Supplementation with gamma-linolenic acid (GLA) found in borage and
evening primrose oils reduces the symptoms of chronic inflammatory diseases such as rheumatoid
arthritis and atopic dermatitis. It is believed that the transformation of GLA to DGLA (dihomo-gamma-
linolenic acid) in the inflammatory cells (white blood cells) helps dampen the inflammatory effects of AA
(arachidonic acid). Unfortunately, there is a fly in the ointment. While GLA supplementation results in a
decrease in AA in the inflammatory cells it also causes, somewhat paradoxically, a very significant
increase in AA in the blood serum itself. A high blood level of AA is associated with an increased risk of
blood clotting and is a potent risk factor for heart disease.
Researchers at the Mayo Clinic now report that the potentially harmful effects of GLA supplementation
can be eliminated by simultaneous supplementation with fish oil. Their small clinical trial involved a
control group of 2 healthy men and 2 healthy women who consumed a controlled diet while
supplementing with 3 grams/day of GLA (5 capsules of borage oil morning and evening). The active
treatment group (5 women and 7 men) followed the same protocol with the addition of 3 grams/day of
EPA (eicosapentaenoic acid) taken in the form of 5 capsules of concentrated fish oil (each capsule
containing 600 mg of EPA and 280 mg of DHA (docosahexaenoic acid). After 3 weeks of
supplementation samples of white blood cells and samples of blood serum were analyzed to determine
fatty acid profiles. Both groups experienced a marked increase in beneficial DGLA in their white blood
cells. The control group (GLA supplementation only) also saw a significant increase in detrimental AA in
their blood serum, but no such increase was observed in the group taking fish oil as well.
The researchers conclude that the detrimental effects of GLA supplementation can be avoided by adding
fish oils to the supplementation regimen.
Barham, J. Brooke, et al. Addition of eicosapentaenoic acid to gamma-linolenic acid: supplemented diets
prevent serum arachidonic acid accumulation in humans. Journal of Nutrition, Vol. 130, 2000, pp.
1925-31
Fish oils and rheumatoid arthritis
BADALONA, SPAIN. Several studies have shown that supplementation with n-3 polyunsaturated fatty
acids (n-3 PUFAs) found in fish oils is beneficial for rheumatoid arthritis (RA) patients. Spanish medical
researchers now report that RA patients tend to have decreased levels of n-3 PUFAs in their blood and
synovial (joint) fluid. Their study involved 24 female and 15 male RA patients (median age of 64 years).
Blood and joint fluid samples were collected from the patients and from a control group consisting of 28
healthy volunteers (17 male and 11 female with a median age of 61 years). All samples were analyzed to
determine their fatty acid profile. RA patients were found to have significantly lower levels of
eicosapentaenoic acid (the main component of fish tissue oil) in both their blood plasma and synovial
fluid. The level of alpha-linolenic acid was lower in the synovial fluid of RA patients, but not in their blood
plasma. The level of docosahexaenoic acid (a major component of fish tissue oil) also tended to be lower
in synovial fluids of RA patients, but not in their blood plasma.
The researchers conclude that RA patients have an abnormal fatty acid profile and a significant deficiency
in certain essential fatty acids. They believe this finding may explain why supplements such as fish oils
and gamma-linolenic acid (from evening primrose and borage) have been found to be beneficial in the
treatment of rheumatoid arthritis.
Navarro, Elisabet, et al. Abnormal fatty acid pattern in rheumatoid arthritis - A rationale for treatment with marine and
botanical lipids. Journal of Rheumatology, Vol. 27, February 2000, pp. 298-303
Fish oils relieve rheumatoid arthritis
ALBANY, NEW YORK. Rheumatoid arthritis is a systemic inflammatory disease involving an excessive
release of leukotriene B4 and interleukin 1 in the body. Both animal experiments and human studies
have shown that supplementation with fish oils reduces the release of these inflammatory compounds
and in the process relieves the common arthritis symptoms of morning stiffness and tender joints. Dr.
Joel Kremer of the Albany Medical College has summarized the current knowledge concerning fish oils
and rheumatoid arthritis and concludes that taking 3-6 grams daily of fish oils (n-3 dietary fatty acids) for
12 weeks or more will significantly diminish joint pain and morning stiffness in RA patients. Several
studies have shown that the improvement in some patients is significant enough to allow them to
materially reduce or completely discontinue their use of non-steroidal anti-inflammatory drugs (NSAIDs)
such as diclofenac and naproxen. Dr. Kremer also points out that fish oil supplementation has been
found to benefit patients with inflammatory bowel disease.
Kremer, Joel M. n-3 fatty acid supplements in rheumatoid arthritis. American Journal of Clinical Nutrition, Vol. 71
(suppl), January 2000, pp. 349S-51S
Fish oils benefit rheumatoid arthritis patients
BOSTON, MASSACHUSETTS. Many small studies have concluded that fish oil supplementation leads to
a marked improvement in rheumatoid arthritis symptoms. However, precisely because these studies
have been small their publication has not had a major impact on the medical treatment of arthritis. A
team of researchers from the Harvard Medical School has now combined and analyzed the results of
these smaller studies. Their meta-analysis covered 10 double-blind, randomized, placebo-controlled
studies aimed at determining the effect of fish oil supplementation on 8 measures of arthritis severity
including the number of tender joints, number of swollen joints, extent of morning stiffness, grip strength,
erythrocyte sedimentation rates, and overall global assessment of disease severity. The studies involved
a total of 368 participants who took fish oil supplements for at least three months. The meta-analysis
revealed a highly significant decrease in the number of tender joints and a significant shortening in the
duration of morning stiffness among patients supplementing with fish oils. No statistically significant
changes were observed for the other measured indicators of disease severity.
Fortin, Paul R., et al. Validation of a meta-analysis: the effects of fish oil in rheumatoid arthritis. Journal
of Clinical Epidemiology, Vol. 48, 1995, pp. 1379-90
Fish oil may replace NSAIDs in some RA patients
ALBANY, NEW YORK. There is considerable evidence that fish oil supplementation can alleviate the
symptoms of rheumatoid arthritis (RA). What is less clear is how much is required and whether fish oils
are effective enough to eliminate the need for non-steroidal anti-inflammatory drugs (NSAIDs).
Researchers at the Albany Medical College have released the results of a study which throws light on
both of these questions.
The double-blind, placebo-controlled study involved 66 patients with active RA as indicated by the
presence of at least 3 of the following symptoms:
- 6 or more tender joints;
- 3 or more swollen joints;
- 30 minutes or more of morning stiffness;
- a sedimentation rate of 28 mm/hour or higher.
The patients were weaned off their current anti-inflammatory medications and were then started on the
NSAID diclofenac (75 mg twice a day). After 2 weeks they were randomized into 2 groups receiving 130
mg/kg per day of either fish oil (EPA+DHA ethyl esters) or corn oil (an omega-6 fatty acid). The daily
dose of fish oil corresponds to about 9 grams/day for a person weighing 70 kg. After 18 or 22 weeks the
diclofenac was replaced by a placebo and the fish and corn oil supplementation continued for another 8
weeks after which all patients were switched to the corn oil plus diclofenac placebo until the end of the
study at week 48.
The researchers found that the fish oil group achieved a significant lessening of their symptoms from the
start of supplementation and until the replacement of diclofenac with the placebo. No statistically
significant benefits were observed in the corn oil group. Several patients in the fish oil group maintained
their improved status even after diclofenac withdrawal. The researchers conclude that some RA patients
using fish oil supplementation may be able to discontinue NSAIDs without experiencing a flare-up of their
disease. They also noted that the benefits achieved from supplementing with 9 grams/day of fish oil were
no greater than those observed in other studies using only 3 to 6 grams/day.
Kremer, Joel M., et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal
antiinflammatory drugs. Arthritis & Rheumatism, Vol. 38, August 1995, pp. 1107-14
Long-term fish oil supplementation benefits RA patients
LEUVEN, BELGIUM. Belgian researchers have released the results of a major study aimed at
determining the long-term effects of fish oil supplementation in rheumatoid arthritis patients. Sixty
patients completed the year-long, double-blind, randomized study. The participants were divided into 3
groups with 1 group receiving a daily supplement of 6 capsules containing 1 gram of olive oil each
(placebo); another group receiving 3 olive oil capsules plus 3 fish oil capsules (containing 1 gram of fish
oil each); and the third group receiving 6 fish oil capsules daily (corresponding to 2.6 grams/day of
omega-3 fatty acid). All patients continued on their regular arthritis medications.
Three months into the study it became clear that the patients on fish oil alone had improved considerably
when compared to the other 2 groups and this improvement became even more pronounced after 12
months of supplementation. Fifty-three per cent of the patients in the fish oil group showed significant
overall (global) improvement as compared to 10% in the placebo group and 33% in the fish oil plus olive
oil group. Forty-seven per cent of the patients in the fish oil group were also able to reduce their intake of
NSAIDs and disease-modifying anti-rheumatic drugs as compared to 15% in the placebo group and 29%
in the olive oil plus fish oil group. The researchers conclude that long-term supplementation with fish oils
benefits rheumatoid arthritis patients significantly and may lessen their need for NSAIDs and other RA
medications.
Geusens, Piet, et al. Long-term effect of omega-3 fatty acid supplementation in active rheumatoid
arthritis. Arthritis & Rheumatism, Vol. 37, June 1994, pp. 824-29
Fish oil and margarine don't go together
ADELAIDE, AUSTRALIA. Fish oil supplements containing EPA (eicosapentaenoic acid) have an anti-
inflammatory effect and may benefit people suffering from rheumatoid arthritis and psoriasis.
This beneficial effect is significantly reduced when the diet is high in linoleic acid. A seven week
controlled experiment involving 30 male volunteers was recently completed in Australia. The participants
were given 1.6 gram EPA and 0.32 gram DHA (docosahexaenoic acid) daily. Half the volunteers were
kept on a diet high in linoleic acid by using margarine as a spread and polyunsaturated oils for cooking.
The other half used butter and olive oil which are low in linoleic acid. The experiment clearly showed that
the incorporation of fish oil is enhanced by a diet containing butter and fish oil. Margarine and
polyunsaturated oils had an inhibiting effect and should therefore be excluded from the diet in order to
obtain maximum benefit from fish oil.
Cleland, Leslie G., et al. Linoleate inhibits EPA incorporation from dietary fish-oil supplements in human
subjects. American Journal of Clinical Nutrition, Vol. 55, February 1992, pp. 395-99
Fish oils alleviate rheumatoid arthritis symptoms
ALBANY, NEW YORK. Rheumatoid arthritis is believed to involve an overactivity of certain inflammatory
agents derived from arachidonic acid. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA),
the main components of fish oils, are known to inhibit the formation of these inflammatory agents.
Research has shown that fish oil supplementation is beneficial in alleviating the symptoms of several
inflammatory diseases.
Researchers at the Albany Medical College and the State University of New York now report that fish oils
are quite effective in relieving the symptoms of rheumatoid arthritis. Their study involved 33 arthritis
patients (25 women and 8 men) aged between 23 and 74 years who had suffered from arthritis for more
than 3 years. Half the patients were assigned to supplement daily with 15 fish oil capsules (containing a
total of 2.7 grams EPA and 1.8 grams DHA) while the other half received 15 placebo capsules every day
(containing olive oil). After 14 weeks of supplementation and a 4-week wash-out period during which
everyone took placebo capsules the group on fish oil switched to placebos and vice versa for a further 14
weeks. After 14 weeks on fish oil there was a very noticeable decrease in the average number of tender
joints among the patients (from 9 to 5.5) and a 2.5-hour increase in the time to the first onset of fatigue
after getting up in the morning. Although not statistically significant a trend to a shorter duration of
morning stiffness and fewer swollen joints were also observed.
The researchers conclude that fish oil supplementation relieves arthritis symptoms, but point out that at
least 12 weeks of fish oil ingestion is required before the benefits are felt.
Kremer, Joel M., et al. Fish-oil fatty acid supplementation in active rheumatoid arthritis: A double-blinded,
controlled, crossover study. Annals of Internal Medicine, Vol. 106, April 1987, pp. 497-503
