Fish Oil and Joint Health

Fish Oil

Joints: The Basics

The body contains over 350 joints, the areas at which two bones meet. Most joints are moveable, which means that they allow for a variety of intricate, precise movements by manipulating the position of the unbendable bones around them. Because the mechanical nature of joints requires bones to be in relatively constant movement and in close proximity to one another, joints must also be built to protect bones from damage. This protection consists of two major components:

  • The Cartilage (articular cartilage) immediately covering the ends of the bone acts as a shock-absorber, mitigating damage from occasional bumps and bangs.
  • The Synovial Membrane (synovium) that lines the joint also secretes synovial fluid, a clear, sticky liquid that keeps moveable joints lubricated, easing bone movement and preventing their erosion.

What Causes Joint Pain?

Joint health depends on a variety of factors, namely diet, medication, age and weight. While the majority of joint disorders are beyond the scope of this review, they all share one defining feature: the component(s) meant to protect joint health become damaged or functionally impaired. Osteoarthritis and rheumatoid arthritis, for example, develop as a result of damaged cartilage and improper synovial fluid balance, respectively.

Osteoarthritis is the most common of the arthritic diseases. Often called “wear-and-tear” arthritis, it develops as the protective cartilage lining the bone wears away over time. While this is most common in the elderly, heavy resistance/weight training or obesity can accelerate its progress.

Rheumatoid arthritis (RA) is a chronic inflammatory disorder caused by a dysfunctional immune reaction known as autoimmunity. Whereas the immune system normally attacks and neutralizes foreign substances (such as bacteria and viruses), it begins to attack and destroy its own tissues in autoimmune disease. In RA, the immune system targets the synovium, the thin membrane responsible for secreting the synovial fluid that lubricates joints. Over time, this fluid builds up in the joints, causing severe inflammation, which in turn, results in a decreased range of motion, swelling, and pain.

Omega-3’s and Joint Support: a Clinical Perspective

The two arthritic diseases, particularly the inflammatory RA, have been popular indication for omega-3 based therapy in clinical study. The most prevalent treatments used by RA patients are drugs such as Ibuprofen, Aleve and Aspirin, members of the Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) family. NSAIDS are known to have analgesic (pain-relieving) and anti-pyretic (fever-reducing) effects at lower doses and anti-inflammatory effects at higher doses. However, despite their widespread use, these medications have been tied to increased risk of cardiovascular disease (CVD), a risk already heightened by the presence of any inflammatory diseases underlying joint dysfunction.

Fish oil (particularly its omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) has been clinically shown to confer anti-inflammatory benefit while mitigating the risk of CVD, making it an attractive alternative to the NSAIDs. Meta- and mega-analysis of randomized controlled clinical trials have shown strong evidence of a reduction in joint pain and tenderness in people with long-standing RA who regularly supplement with fish oil.

The mechanism(s) of action have not yet been fully elucidated; however, current clinical literature attributes EPA + DHA’s anti-inflammatory activity to the inhibition of inflammation-promoting compounds (eicosanoids and cytokines) and the synthesis of lipid-based inflammatory suppressors called resolvins.

Laboratory studies have shown that those with osteoarthritis may also benefit from a diet rich in omega-3 fatty acids (and low in inflammatory omega-6 fatty acids), although significant effects in clinical trials were not noticed. Larger clinical trials may be needed before any definitive conclusions can be drawn.

Final Words & Precautions

While NSAID consumption may help further alleviate RA symptoms in those who also take fish oil supplementation, omega-3’s major benefit is its ability to effectively control RA without concomitant intake of high amounts of NSAIDs, lowering the risk of developing CVD. This is particularly useful for those with CVD. It should be noted that while symptoms of RA may be lessened, fish oil has not been shown to remedy the cause of the disease. That is, joint damage will still continue to occur.

Dosing should be taken to carefully, as well. Although there is strong clinical evidence supporting fish oil supplementation for improving symptoms associated with RA, high doses may lead to serious side effects, such as increased risk of bleeding, high LDL (“bad”) cholesterol, hard-to-control blood sugar fluctuations and a “fishy” odor. It is always recommended to contact your physician to determine an appropriate course of action.