Osteoarthritis is a type of arthritis that involves degradation of cartilage of the joint. Cartilage is a type of tissue that makes the end of your bones. It is the same tissue that makes up your ear and nose tip.
Cartilage ensures flexibility and good movement of the joints. In osteoarthritis, the top layer of the cartilage starts degrading. This exposes the bone below the cartilage which rub against each other and experience friction and wear.
These events lead to swelling, pain and reduced joint mobility. Bone spurs may grow at the edges of the bone and even bits of bone and cartilage start floating in the joint space causing pain.
Osteoarthritis can affect joints like that of thumbs, fingers, neck, lower back, knee and hips.
Unlike other forms of arthritis, osteoarthritis affects only the joints and not internal organs. Treatment involves exercise and pain medications such as NSAIDs and opioids. Osteoarthritis is the most common form of arthritis and affects a number of people above the age of 65.
What is fish oil?
Fish oil is obtained from tissues of oily fish like salmon, mackerel, sardines etc. This oil is rich in polyunsaturated fatty acids called omega 3 fatty acids. The body cannot make omega 3 fatty acids and hence these are essential fatty acids.
There are 3 main omega 3 fatty acids: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and Alpha-linolenic acid (ALA). EPA and DHA are marine omega 3 fatty acids.
Omega 3 fatty acids form a part of cell membranes and hence are important for functioning of various proteins on cell membranes.
They also serve as precursors to various hormones and molecules that participate in processes like blood clotting and inflammation and thus find therapeutic use in various diseases.
Fish oil is found to be beneficial in cardiovascular disease, high cholesterol, depression, anxiety, bipolar disorder, cancer, lupus, Crohn’s disease etc.
3 Benefits Of Fish Oil In Osteoarthritis
Fish oil exerts anti-inflammatory and analgesic effect which serves as palliative support in osteoarthritis.
1. It can help reduce inflammation
Fish oil is rich in omega 3 fatty acids-EPA and DHA. Arachidonic acid is the main metabolite that is responsible for formation of many inflammatory chemicals. EPA competes with arachidonic acid in metabolism via COX and LOX pathways which are inflammatory enzymes.
The end products produced from EPA have reduced biological activities in comparison to those produced by arachidonic acid. They do not have potent inflammatory effect. EPA reduces formation of pro-inflammatory chemicals and reduces the level of clot formation.
Animal study shows that omega 3 fatty acids serve as anti-inflammatory agents and prevent cartilage degradation.
Studies in humans show that fish oil supplementation brings about a decrease in inflammatory parameters such as tumor necrosis factor.
What does this mean?
EPA and DHA present in omega 3 fatty acids interfere in inflammatory pathways and lead to production of anti-inflammatory proteins that can aid in reducing pain, inflammation and cartilage degradation in osteoarthritis.
2. It reduces progression of osteoarthritis
A clinical trial was conducted where individuals with osteoarthritis were given 1000-2000mg of fish oil for 8 weeks. 1,000 mg of fish oil have EPA 400 mg and DHA 200 mg.
All participants taking fish oil reported relief after taking fish oil and experienced improvement in knee function. Average score of satisfaction was 9.06 out of 10.
Researchers at South Australia University of Adelaide examined the effect of high dose (4.5g of omega 3 fatty acids) and low dose (0.45 g of omega 3 fatty acids) in osteoarthritis.
There were improvement in both groups, but the low dose group fared better. Improvement at the end of 2 years and loss of cartilage volume was similar in both groups thus showing that high dose does bring any additional benefit.
Combination of glucosamine sulphate and omega 3 fatty acids is found to be beneficial in osteoarthritis. Krill oil at a dose of 300mg per day is found to reduce inflammation and arthritic symptoms with 7-14 days.
Dietary omega 3 fatty acids are found to suppress the formation of inflammatory proteins in osteoarthritis and can also reduce structural damage such as inflammation of synovial fluid that lubricates the joints.
Animal study shows that dietary omega 3 fatty acids can protect from injury induced osteoarthritis. Knott et. al have reported that omega 3 fatty acid supplementation can reduce risk of osteoarthritis development in those prone to it.
A review study did mention that long term good quality clinical trials are required to make concrete recommendations about the use of fish oil supplements in osteoarthritis. However they also mention that EPA and DHA does reduce inflammation and improve joint lubrication.
What does this mean?
Low dose supplementation of fish oil improves joint function in osteoarthritis. Dietary fish oil can help in preventing and reducing progression of osteoarthritis.
3. It can attenuate pain and side effects of painkillers
Researchers feel that anti-inflammatory action of omega 3 fatty acids can reduce the dependence of non steroidal anti-inflammatory drugs in osteoarthritis.
Tokuyama et. al have documented the role of unsaturated fatty acids in pain management. Omega 3 fatty acids and their metabolites help in attenuating pain by other mechanisms other than reduction inflammation; they also benefit in neuropathic pain.
Torres-Guzman et. al conducted an animal study where they demonstrated that oral supplementation or injections in the joints of omega 3 fatty acids reduced pain and swelling.
A clinical trial demonstrated that fish oil and paracetamol combination reduced the production of 2 series of prostaglandins, inflammatory chemical in the body, by an amount that is equivalent to therapeutic doses of NSAIDs.
Skoldstam et. al demonstrated via their study that fish oil’s anti-inflammatory effect has NSAID saving potential.
EPA present in fish oil has anti-ulcerogenic effect.
Study shows that fish oil consumption can protect from gastric lesions or erosions in the gastric mucosal lining caused by NSAIDs such as aspirin and indomethacin.
Park et. al comment that omega 3 fatty acid based NSAID can prove to be next generation GI safe NSAID. Omega 3 fatty acid can help in protecting from gastric side effects and cardiovascular effect associated with NSAID.
What does this mean?
Fish oil supplements have an analgesic effect and can attenuate side effects associated with NSAIDs and opioid painkillers.
Some scientists question the safety and efficacy of Fish Oil in Osteoarthritis
Chen et. al report that 2 year supplementation with fish oil does not have any effect on bone loss in osteoarthritis. Mild side effects such as headache and gastric symptoms were reported.
Animal study shows that supplementation with omega 3 fatty acids does not prevent onset of osteoarthritis.
In a study reviewing efficacy of dietary supplements for osteoarthritis, researchers have mentioned that there is no concrete evidence to recommend omega 3 fatty acids to replace NSAIDs in osteoarthritis.
What does this mean?
Few studies show that fish oil supplementation does not have pronounced effect in osteoarthritis in terms of reducing progression of the disease.
What is the dose of Fish Oil For Osteoarthritis?
Fish oil is available as liquid or capsules. Concentration of EPA and DHA is 8-80% in fish oil.
Standard fish oil is extracted from fish bodies and typically contains EPA 18% and DHA 12% w/w. Cod liver oil contains approximately 10% EPA and 10% DHA.
The American Heart Association recommends 250–500 mg/day of EPA and DHA while FDA suggests no more than 3g of the combination.
A dose of 1g of fish oil can serve as a preventative measure. It is advisable to consult a doctor before taking fish oil supplements.
How to take Fish Oil for Osteoarthritis?
Cleland et. al in their paper: ‘Fish oil: what the prescriber needs to know’ highlight some important points about fish oil, how to take it, possible side effects and benefits.
Fish oil has an unpleasant odor and taste which is why people opt for supplements. What you could do to mask the flavour is to include it in a juice.
Take two shot glasses and pour fruit juice in them. To one add a layer of fish oil. Take this combination first without making any contact with lips and then drink the other glass to get rid of the taste.
If reflux is a problem then avoid taking any fluids or aerated drinks with fish oil and consume it prior to meals. This ensures that it mixes with food and exits into the intestine.
If the problem still persists, you can lie down in the left lateral position which will ensure that the oil floats into the intestine.
It is advisable to take fish oil before solid meals without any fluids. Excess fluid causes the oil to float in stomach which gives the repeating taste.
Fatty fish are susceptible to contamination by toxic pollutants. Hence one should always check for pollutants and contamination issues of marketed products based on brand reputation.
Side effects associated with fish oil consumption include repeating taste, GERD like symptoms, diarrhoea, aversion to taste and smell, headache.
Fish oil supplements have been associated with increase in bleeding tendency. Possible drug interactions of fish oil include NSAIDs, cyclosporine, methotrexate and TNF inhibitors.
Fish oil has limited benefits in osteoarthritis. It can serve as an adjuvant therapy and aid in lowering inflammation, reducing pain and improving joint health.
If opting for supplements do ensure that you don’t follow it over long term and consult a doctor regarding the same.
A simple way of including fish oil in your health regime is to include oily fish like salmon in your diet; in this manner you could get essential fatty acids as well as meet protein requirement.