Fish Oil and Arthritis

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

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 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)