Dr Sarah Brewer September 20, 2018

Over the last decade or so, inflammation in the body has become a huge focus of investigation — trying to understand what causes it, and how to reduce it. This is particularly the case for arthritis: a condition that gives rise to sore and severely inflamed joints. In fact, chronic low-grade inflammation is now linked to many diseases, including arthritis and joint pain. Luckily, there is a potential way to reduce the discomfort felt from inflammatory arthritis, in the form of fish oil.

What is inflammation?

Put simply, inflammation is a sign something is wrong, and your body is trying to find a way to resolve it. Imagine you hit your thumb with a hammer. Soon after, it’ll become swollen, hot and painful. This is an inflammatory response that warns your body something is amiss, and that it can then kick-start the healing process. But this only happens when the inflammation is short-lived. If we experience intermittent or recurrent inflammation, it can then become chronic. Chronic inflammation, essentially the type that persists, serves no purpose and just damages the body. It’s even now recognised as the underlying basis of a significant number of diseases, including cardiovascular disease, dementia, diabetes, and arthritis. 1

What is arthritis

Arthritis is a condition in which one or more of your joints are inflamed. There are over 100 different types, the two main ones being osteoarthritis (OA) and Rheumatoid Arthritis (RA). Dubbed the ‘wear tear and repair’ arthritis - as it results from an excessive healing response to damage - OA is referred to as non-inflammatory arthritis, although it still causes the joints (and tissues around them) to become inflamed. 2 RA is known as an inflammatory arthritic condition caused when the body’s autoimmune system starts attacking healthy tissue — but both manifest themselves as stiff, sore and swollen joints. 3 These inflamed joints and the pain that accompanies them can be hugely debilitating and can get in the way of doing even the most basic things like walking up stairs, kneeling, peeling vegetables or even holding a pen or a knife and fork. The pain can also stop you from sleeping well.

Can fish oils help?

While there is no one magical food or food group that can wholly reduce inflammation, components of some foods may be able to regulate or dampen down the inflammatory response. Fish oils, in particular, might be able to help do this. Cod liver oil and fish oil contain two long-chain omega-3 fatty acids called EPA and DHA, and researchers have found both can help to reduce inflammation. One study of 176 people from RA showed those who ate fish just twice a week experienced less joint pain and tenderness when compared to those who rarely or never ate it. What’s more, the same study found the more fish eaten, the less active the painful symptoms like swollen or tender joints were. 4

A different study also showed that fish oil supplements can be beneficial in managing RA by suppressing the production of anti-inflammatory chemicals in the body. 5 It’s also been shown that fish oil can provide a significant decrease in pain, morning joint stiffness and tender joints for those suffering with RA. 6

Though there is good evidence to show that eating more fish can help to reduce pain and stiffness, improve mobility, and generally enhance the quality of life, a poll suggests that 64% of Brits don’t hit the recommended weekly target of two portions of fish a week, one of which should be oily.7 As a result, many of us are deficient in omega-3 fatty acids. 8 If you find it difficult to get more fish in your diet, then taking a fish oil supplement daily can help to ensure you get the optimal levels of omega-3 in your diet.

Cracking the combination

Emerging evidence suggests that taking a combination of fish oils with fish liver oils could potentially alleviate RA symptoms 9 and reduce the need for non-steroidal anti-inflammatory drugs (NSAID). Another small study has shown how taking glucosamine with fish oils is slightly better at reducing OA pain than taking glucosamine on its own. 10 There is currently no UK recommended daily intake for fish oil supplements, but the European Food Safety Authority has said up to 5,000mg a day from supplements is a safe upper limit. 11, 12 It might well be a matter of experimenting to see how much it takes — and possibly in what combination with other supplements — to ease your particular aches and pains.

Lifestyle changes

It’s helpful to think of eating fish and taking fish oil supplements as just one lifestyle change that will hopefully lead to a reduction in inflammation and pain. Many of the factors of a modern Western lifestyle — like taking little or no exercise, and consuming a diet often high in sugar, processed food and ‘unhealthy’ fats — appear to make it easier for chronic inflammation to develop. It’s also more likely to make you overweight, and this can have a negative effect on inflammation because too much fat can increase inflammation in the body, making your joints more painful. 13

Regular exercise and stretches, like pilates , are important factors in keeping your arthritic symptoms at bay, as is eating a healthy diet with plenty of anti-inflammatory foods including oily fish, nuts, seeds, fruits, and vegetables. Research suggests that to encourage beneficial gut bacteria by eating prebiotic foods like onions, garlic, leeks and Jerusalem artichokes, as new research suggests that prebiotics could help improve the symptoms of OA. 14

If you’re interested in learning more about how to keep your joints healthy, head over to our advice centre for more information.


References
1 Lopez-Candales, A., Burgos, P. M. H., Hernandez-Suarez, D. F., and Harris, D. (2017). Linking Chronic Inflammation with Cardiovascular Disease: From Normal Aging to the Metabolic Syndrome. Journal of Natural Sciences, 03(04).
2 Imm, N. (2017). Osteoarthritis. Patient.
3 Arthritis Research UK. (nd). The inflammatory arthritis pathway Arthritis Research UK
4 Tedeschi, S. K., Bathon, J. M., Giles, J. T., et al. (2017). Relationship Between Fish Consumption and Disease Activity in Rheumatoid Arthritis. Arthritis Care & Research.
5 Cleland, L. G., James, M. J., and Proudman, S. M. (2003). The Role of Fish Oils in the Treatment of Rheumatoid Arthritis. . Drugs, 63(09).
6 Khanna, S., Jaiswal, K. S., and Gupta, B. (2017). Managing Rheumatoid Arthritis with Dietary Interventions. Frontiers in Nutrition, 04(52).
7 Ninna K. Senftleber,1,2,† Sabrina M. Nielsen,1,2,† Jens R. Andersen,2 Henning Bliddal,1 Simon Tarp,1 Lotte Lauritzen,2 Daniel E. Furst,3 Maria E. Suarez-Almazor,4 Anne Lyddiatt,5 and Robin Christensen, (2017). Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials, Nutrients
8 WCRF. (2017). Two in three Brits not eating enough fish. World Cancer Research Fund.
9 Arthritis Research UK. (nd). Fish oils. Arthritis Research UK.
10 Gruenwald, J., Petzold, E., Busch, R., et al. (2009). Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis. Advances in Therapy 26(09).
11 Lanigan, J. (2017). Food Fact Sheet: Omega-3. BDA: The Association of UK Dieticians.
12 Agostoni, C., Bresson, J-L., Fairweather-Tait, S., et al. (2012). Scientific Opinion on the Tolerable Upper Intake Level of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA). EFSA Journal, 10(07).
13 Arthritis Research UK. (nd). The inflammatory arthritis pathway.Arthritis Research UK.
14 14. URMC. (2018). The Bugs in Your Gut Could Make You Weak in the Knees.University of Rochester Medical Center: Newsroom.

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn't possible, supplements can help. This article isn't intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.

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