Burgeoning rheumatoid arthritis research demonstrates that fish oil supplements fight inflammation and help relieve joint tenderness and morning stiffness. A daily dose could also enable rheumatoid arthritis (RA) patients to reduce non-steroidal anti-inflammatories (NSAIDs) and other pain relievers to avoid their side effects. Supportive but inconclusive studies show boswellia, ginger, GLA and Vitamin-D also helpful for RA.1
EPA and DHA, the omega-3 fatty acids found in fish oil and fish oil supplements, are clear winner for RA patients as natural complements to drug therapy. Omega-3s curb inflammation and, as a bonus, help protect against heart disease. Studies show people with RA are more likely to get heart disease than the general population. 2
Conventional treatment prescribed by doctors and rheumatologists follows a varied pharmaceutical approach to help control inflammation, alleviate pain, and hopefully stop disease progression. However, a growing body of rheumatoid arthritis research suggests that diet and exercise also can play a role to help maintain overall health and possibly reduce inflammation. Specific anti-inflammatory foods to help ease inflamed joints and manage pain are frequently doctor-recommended.3
Research shows foods that contain omega-3 fatty acids, antioxidants, and fiber lower inflammation levels. Omega-3 fatty acids are found in certain dark green vegetables, walnuts, almonds and flaxseed, but fish have the highest concentration of EPA and DHA. Fish oil supplements are recommended by many physicians when the patient is unable or not willing to eat fish. Small, cold-water fatty fish like salmon, tuna, herring, and mackerel are considered the best choices by Rheumatoid Arthritis.org 3.
Omega-3s block inflammatory cytokines and prostaglandins and are converted by the body into powerful anti-inflammatory chemicals called resolvins. EPA and DHA have been extensively studied in rheumatoid arthritis research and dozens of other inflammatory conditions. A 2010 meta-analysis found that fish oil significantly decreased joint tenderness and stiffness in RA patients and reduced or eliminated NSAID use, according to the Arthritis Foundation.4
Rheumatoid arthritis is an autoimmune inflammatory disease for which there is no known cure. In RA, for unknown reasons, the body’s immune system begins to attack and destroy its own tissues. Most damage is to the cartilage in identical joints on both sides of the body. Rheumatoid arthritis symptoms are characterized by red, swollen, hot and painful joints with restricted range of motion. The disease typically manifests between the ages of 35 and 60 and is more common in women. 5
In most of the studies using fish oils, benefits are not usually observed until at least twelve weeks of continuous use and appear to increase with extended treatment time, according to the John Hopkins Arthritis Center.6
Optimal results may be reached in about one month with larger doses. Blood levels of omega-3 fatty acids increase in proportion to the dose, according to the article How Long Before Fish Oil Takes Effect? in Livestrong.com by Sandi Busch on Oct. 3, 2017. In addition, overall health, the type and quality of fish oil consumed influence the time needed for results to materialize.
Recent rheumatoid arthritis research involving a noteworthy 12-month trial of 140 patients showed exciting results that highlight the power of food and nutrition as an important adjuvant therapy for RA. Patients treated with supplemental fish oil of up to 5.5 grams per day of EPA and DHA in combination with traditional DMARD pharmaceutical therapy were more likely to achieve remission than DMARDs alone, according to the John Hopkins Arthritis Center. The study was published in Annals of Rheumatic Disease (Proudman, et al) as Fish oil in recent onset RA; a randomized, double-blind controlled trial within algorithm based drug use January 2015, 74-1 Volume.7
According to Harvard Health, rheumatoid arthritis research suggests that omega-3 fatty acids found in cold-water fish such as salmon, tuna, herring, sardines and mackerel have the best anti-inflammatory properties, whether by eating more fish or by taking fish oil supplements. Studies in which people with RA took supplements found that fish oil may help with tender joints and stiffness and may reduce the need to take non-steroidal anti-inflammatory (NSAID) medications.8 Living with RA requires more than just finding the right medications. Many people find they can protect their joints and reduce discomfort through alternative and complementary therapies, including dietary supplements.8
Living with RA requires more than just finding the right medications. Many people find they can protect their joints and reduce discomfort through alternative and complementary therapies, including dietary supplements, according to Harvard Health.8
Outside of rheumatoid arthritis, the health benefits of omega-3 dietary supplements are unclear, according to the National Institutes of Health’s (NIH) National Center for Complementary and Integrative Health (NCCIH). There is evidence that eating seafood moderately increases general health.9
The NIH bases information about research findings primarily on the most rigorous review articles, known as systematic reviews and meta analyses. Scientific journals publish study results and review articles that evaluate evidence as it accumulates. The NIH publishes fact sheets that provide information on whether an approach is helpful and safe for the public.
In its fact sheet, Omega-3 Supplements: In Depth, the NIH provides basic information on omega-3s, which summarizes scientific research on effectiveness and safety of dietary supplements. Commonly used supplements that contain omega-3s include fish oil (which provides EPA and DHA) and flaxseed oil (which provides ALA). Algae oils are a vegetarian source of DHA.
Omega-3 fatty acids, according to the NIH webpage, are important for many bodily functions, including muscle activity, blood clotting, digestion, fertility, and cell division and growth. DHA is important for brain development and function. ALA is an “essential” fatty acid, meaning that people must obtain it from food or supplements because the human body cannot manufacture it.
A 2012 systematic review concluded that the types of omega-3s found in seafood and fish oil supplements may be modestly helpful in relieving symptoms of rheumatoid arthritis. According to the NIH web page, during the studies reviewed many of the participants reported when they took fish oil they had briefer morning stiffness, less joint swelling and pain, and less need for anti-inflammatory drugs to control their symptoms.9
The gold standard in rheumatoid arthritis research is double blind, placebo-controlled studies published in reputable scientific journals. By a wide margin, fish oil and omega-3 fatty acids are the most well-proven natural RA symptom treatment studied.
At least 13 separate double-blind, placebo-controlled studies on more than 500 participants have shown that omega-3 supplements significantly reduce RA symptoms and enables patients to lower their NSAID usage. Some research suggests that fish oil becomes even more effective when taken as part of a diet that is low in omega-6s, such a vegetarian diet, or when olive oil is also taken, according to Natural News.5
While research for RA has been encouraging for some symptoms, none has yet been proven to effectively slow the progression of the disease. Most of the severe joint damage occurs early in RA. For these reasons, it is important that people with rheumatoid arthritis continue to consult with qualified health professionals, even if already taking fish oil, antioxidants, or other alternative natural treatments. The NIH warns against using omega-3 supplements to replace conventional care or to postpone seeing a health care provider.9
A seven-year rheumatoid arthritis research trial involving 32,232 women over age 65 in Sweden found that those who eat one or more servings per week of cold-water fish rich in omega-3 acids, such as salmon and Atlantic mackerel, have a lower risk for the onset of rheumatoid arthritis.
The study shows that the relative risk of RA is decreased by 52% among those with a consistently high intake averaging 210 mg day of the long-chain omega-3 polyunsaturated fatty acids (PUFAs) from eating fish. The 2013 research was published in Annals of Rheumatic Diseases The study design measured omega-3s from fish consumption but had too few fish oil omega-3 supplement users to adequately assess their impact.10
An older double blind, placebo-controlled rheumatoid arthritis research study of 66 people with the disease concluded patients taking dietary fish oil supplements exhibit improvements of disease activity from baseline, including the number of tender joints, duration of morning stiffness and significant decreases in levels of pain.
During the study, RA patients, while taking the NSAID diclofenac (75 mg twice a day), took either 130 mg day of omega 3 supplements, or 9 capsules of placebo corn oil. Placebo diclofenac was substituted at week 18 or 22, and fish oils supplements were continued for 8 weeks (to week 26 or 30). Some patients who took 130 mg day of omega-3 supplements were able to discontinue NSAIDs without experiencing a disease flare.
The study was published in the journal Arthritis & Rheumatism in August 1995 as Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal anti-inflammatory drugs clinical and immune correlates by lead author J. M. Kremer.11
A recent arthritis research analysis of 22 clinical studies concluded that marine oils (i.e., oil from any marine origin) can reduce pain associated with rheumatoid arthritis. The 2016 peer-reviewed study was published in the Journal Nutrients January 2017.
The study objective was to evaluate whether marine oil supplements reduce pain and/or improve other clinical outcomes in patients with osteoarthritis (OA) and rheumatoid arthritis (RA). While this meta-analysis suggests a small favorable effect of marine oil in reducing pain in patients with OA, the evidence was considered of low quality. However, they found moderate quality evidence for pain relief effect in RA patients.
Study authors said further study is warranted to provide evidence for firm conclusions regarding the effect of marine oil in OA and other types of arthritis, but also regarding the optimal dose, ratio of EPA and DHA, and which type of marine oil is preferable. They suggested that RA patients should find an omega-3 supplement with an EPA ratio 50% higher than DHA. There were no adverse effects for study participants from marine oil consumption. 12
Rheumatoid arthritis research hasn’t always kept pace with the popularity of supplements, but more natural remedies are being put to the test in well-designed clinical trials. In addition to omega-3’s (a clear
first choice), the Arthritis Foundation lists three additional supplements it says are backed by science and shown to be effective in the treatment of rheumatoid arthritis: 4
Interesting rheumatoid arthritis research published in Journal of Autoimmunity, Nov. 2017, surprised its authors who discovered that maintaining sufficient vitamin D levels may help to prevent the onset of inflammatory diseases like rheumatoid arthritis. The research also found that while effective at preventing the onset of inflammation, it is less effective once inflammatory disease is established because diseases such as rheumatoid arthritis leads to vitamin D insensitivity.13
The study, conducted at the University of Birmingham, involved using paired peripheral blood and synovial fluid from the inflamed joint of patients with RA. Professor Martin Hewison, a study author, said: “Our current understanding of vitamin D and rheumatoid arthritis is based on studies of patient blood which may not truly represent the situation at the site of the inflammation—the joints. We therefore investigated responses to the active form of vitamin D in immune cells from the inflamed joints of patients with RA. He said further: “Compared to blood from the same patients, the inflamed joint immune cells were much less sensitive to active vitamin D. This appears to be because immune cells from the joints of RA patients are more committed to inflammation, and therefore less likely to change, even though they have all the machinery to respond to vitamin D.”
Senior author Karim Raza, professor at the University of Birmingham, said: “Our findings were unexpected as we initially thought that cells from the inflamed rheumatoid joint would respond just as well to vitamin D as cells from the blood. The fact that they don’t has important implications for how we think about using vitamin D to treat inflammation.”
The authors of this rheumatoid arthritis research said this is the first study of its kind to characterize the effects of vitamin D in both peripheral blood and inflamed joints of patients with inflammatory disease.
Omega-3 fish oil is proven through hundreds of studies as quite safe when compared to the side effects of conventional RA drug treatments. However, there are some precautions of note:
It is uncertain whether people with fish or shellfish allergies can safely consume fish oil supplements, according to the NIH.
All dietary supplements are regulated by the current Good Manufacturing Practices (cGMP) rules, over which the Food and Drug Administration (FDA) has enforcement responsibility for purity, quality and safety. The FDA's fragmented facilities inspections, limited by resource limitations, have repeatedly discovered the cGMP guidelines are poorly adhered to by manufacturers.
Fish oil supplement consumers are warned of two serious potentials:
A 2011 study commission by the government of Norway concluded there would be some health concern related to the regular consumption of oxidized marine/fish oils, particularly in the gastrointestinal tract, but not enough evidence to determine the risk. The study was published as Oxidation Report by The Norwegian Scientific Committee for Food Safety, which conducts open, independent, scientific risk assessments. 14
The source of raw materials and the thoroughness in methods of processing are of concern whether a dietary supplement contains marine oil or plant-based ingredients. Because omega-3 fatty acids are obtained from natural sources, levels of fatty acids and/or possible contaminants in the raw supply vary. The amount of spoilage and contamination in a supplement depends on the raw material and processes of extraction, refining, concentration, encapsulation, storage and transportation, according the Norway study.
Sophisticated testing and technologically-advanced equipment is a necessity to formulate very safe, high quality supplements, but IS NOT required by law.17
A still unsettled 2010 lawsuit filed by environmentalists in California Superior Court in San Francisco claims popular brands of fish oil dietary supplements contain unsafe and illegal levels of the carcinogenic chemicals known as polychlorinated biphenyls, or PCBs (banned by Congress in 1979). 15
The plaintiff, Mateel Environmental Justice Foundation, targeted world-leading Omega Protein, a Houston-based corporation, and the companies they produce and label fish oil for, including CVS, GNC, Rite Aid, Solgar, Twinlab, Now Health and Pharmavite. The suit charged the defendants for marketing fish oil dietary supplements containing PCB levels that exceed California’s Proposition 65’s limit for human consumption of the contaminants, and illegally failing to disclose this to consumers on product labels.16
The Mateel group alleged it only tested 10 omega-3 supplements manufactured by Omega Protein and found PCBs in 100% of them, ranging from 12 nanograms a day to more than 852 nanograms a day, based on the daily recommended label dosage.
California is the only state that requires labeling to warn consumers a product may contain trace amounts of PCBs, which have been tied to cancer and birth defects.16
My rheumatoid arthritis research develops more than 100 omega-3 supplements on the market from which to choose—few are top rated. A wide variance in quality describes the rest. Many low-quality products are found across America on shelves of well-known retailers.
So, which omega-3 supplement can you trust? I asked that same question years ago when trying to find the best nutritional dietary supplements.
In searching, I developed a list of 30 questions concerning safety, quality and efficacy of supplement manufacturers. The answers led me to an industry pioneer, a recognized leader since 1956. They are 'beyond organic' in ingredient testing. They also guarantee the efficacy of their supplements.
The FDA does not require that a supplement’s effectiveness be proven before it’s marketed. Dietary supplements are considered as food, not as drugs.17
Very few supplement companies go the extra mile to ensure the efficacy of their products. Why should they bear the extra cost to do so when it’s not required?
Of all other nutritional supplement makers, be assured that:
The only company that obsesses quality to that extent, also produces the world's finest fish oil supplement for its many health benefits, including anti-inflammatory properties for rheumatoid arthritis. It’s the best money can buy. You can trust its safety, purity and potency:
Rheumatoid Arthritis Research Disclaimer: Health statements on this rheumatoid arthritis research page have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.
1 Rheumatoid Arthritis, Guide: Natural Remedies for Rheumatoid Arthritis Pain Relief, published WebMD. Accessed July 15, 2018 https://www.webmd.com/rheumatoid-arthritis/guide/rheumatoid-arthritis-natural-treatments#1
2 Rheumatoid Arthritis, Slideshows: Alternative Rheumatoid Arthritis Therapies—Herbs and Supplements, published WebMD. Accessed July 15, 2018 https://www.webmd.com/rheumatoid-arthritis/ss/slideshow-ra-alternative-therapies
3 Living with RA-Diet: Anti-Inflammatory Foods, published Rheumatoid Arthritis.Org, last edited August 3, 2016, accessed July 15, 2018 https://www.rheumatoidarthritis.org/living-with-ra/diet/anti-inflammatory-foods/
4 Living with Arthritis: Natural Treatments—Supplements and Herbs, published Arthritis Foundation, Accessed July 15, 2018 https://www.arthritis.org/living-with-arthritis/treatments/natural/
5 Gutierrez, D., Article, <i>Treat your rheumatoid arthritis with antioxidants and fish oil</i>, <i>NaturalNews.com</i>, March 28, 2013 https://www.naturalnews.com/039678_rheumatoid_arthritis_antioxidants_fish_oil.html
6 Koch, Cheryl, CNSD, Manno, Rebecca MD, MHS, Article: Nutrition and Rheumatoid Arthritis—Are There Benefitis of Fish Oils on Arthritic Pain? Published John Hopkins Arthritis Center, May 11, 2015. Accessed online July 15, 2018 https://www.hopkinsarthritis.org/patient-corner/disease-management/rheumatoid-arthrtis-nutrition/#fish_oil
7 Proudman, et al, Rheumatoid arthritis research (study): Fish oil in recent onset RA, a randomized, double-blind controlled trial within algorithm based drug use, published in journal Annals of Rheumatic Disease, 2015 January Volume 74-1
8 Article: Supplements for rheumatoid arthritis, published Harvard Health Publishing, Harvard Medical School, May 2015, Accessed July 16, 2018 https://www.health.harvard.edu/alternative-and-complementary-medicine/supplements-for-rheumatoid-arthritis
9 Webpage; Omega-3 Supplements: In Depth, published National Institutes of Health (NIH), National Center for Complementary and Integrative Health (NCCIH), Accessed July 17, 2018 https://nccih.nih.gov/health/omega3/introduction.htm
10 Di Giuseppe D, Wallin A, Bottai M, et al., Rheumatoid arthritis research (study): Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: a prospective cohort study of women. Ann Rheum Dis (2013) 0:1–5. doi:10.1136/annrheumdis-2013-203338 [E-pub head of print 12 Aug 2013]
11 Kremer, J. M., Lawrence, D. A., Petrillo, G. F., Litts, L. L., Mullaly, P. M., Rynes, R. I., Stocker, R. P., Parhami, N., Greenstein, N. S., Fuchs, B. R., Mathur, A., Robinson, D. R., Sperling, R. I. and Bigaouette, J. (1995), Rheumatoid arthritis research (study): Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs clinical and immune correlates. Published Arthritis & Rheumatism, 38: 1107–1114. doi:10.1002/art.1780380813
12 Nielsen, S. (2015). Study: Conference abstract: Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials, 10.13140/RG.2.1.4150.4724. Senftleber, N.K.et al, Marine Oil Supplements for Arthritis Pain, Journal Nutrients, 2017 Jan. 6.
13 University of Birmingham. "Maintaining sufficient vitamin D levels may help to prevent rheumatoid arthritis." Published: ScienceDaily, 21 November 2017. www.sciencedaily.com/releases/2017/11/171121123308.htm .
14 Study: Oxidation Report—Decomposition substances and oxidation products in fish oils, by Norwegian Scientific Committee for Food Safety, published in SmartFish Sports Nutrition, October 20, 2011 https://smartfishsport.no/nyheter/norwegian-scientific-committee-on-food-safety-oxidation-report/
15 Millstone, Ken, Report, Lawsuit: disclose PCB levels in fish oil, published online by CBS News, March 2, 2010 https://www.cbsnews.com/news/lawsuit-disclose-pcb-levels-in-fish-oil/
16 Post: Is Fish Oil Safe? Published by Fish Oil Safety.com, Accessed July 17, 2018 https://fishoilsafety.com/
17 Webpage, Food & Drug Administration (FDA), Dietary Supplements Products & Ingredients. Accessed July 17, 2018 https://www.fda.gov/Food/DietarySupplements/ProductsIngredients/default.htm