More than one million Americans suffer from Rheumatoid arthritis. It is the commonest type of autoimmune disease. Common symptoms include loss of appetite, loss of energy, low fevers, dry mouth and eyes, and most importantly prolonged stiffness and pain in the joints.
The main cause of the disease is unknown but most of the time, it is caused due to genetic factors. In this the body’s own immune cells start attacking the Synovium and tender tissue around the joints. They trigger an immune reaction which is followed by pain and inflammation which ultimately may cause severe joint damage.
There are drugs available in the market which help alleviate the symptoms but complete cure is still to be found. Nature, on the other hand, offers some help in the form of ingredients that might help reduce the disease symptoms without any side effects. So patients must check out these home remedies to improve their quality of living.
Omega-3-Fatty acids for Rheumatoid arthritis- Why and How they are important?
Rheumatoid arthritis is an auto-immune disorder. Thus it is only possible to manage the symptoms of the disease. Complete cure is not yet known! However regular medications may cause various side effects and are also not a pleasant experience for most of the patients. But again certain natural remedies could prove to be effective in combating against the disease symptoms. One of these remedies include omega-3-fatty acids found in fishes and sea food.
Omega-3-fatty acids are also known as Poly-unsaturated Fatty Acids (PUFA). These are extremely important for the body and serve various functions. Some of the chief activities in which they play a significant role are: muscle activity, digestion, fertility, blood clotting, growth and cell division . They are extremely important for the health of our brain as they are found in high concentration in the brain cells. They have essential behavioural and cognitive roles in the brain.
However despite being of great significance for human health, they cannot be produced by the body and hence we have to rely on external sources to fulfil our daily requirements of omega-3-fatty acids. They can be obtained from cold water fish, plant oils and seafood.
The most important function of these fats is in monitoring the inflammatory reactions in humans. Omega-3-fatty acids have been found to inhibit a number of inflammatory reactions in the body like leukocyte chemotaxis, expression of adhesion molecules leading to adhesive reaction between leukocytes and endothelial cells, production of eicosanoids such as leukotrienes and prostaglandins, T-cell reactivity and production of inflammatory cytokines. Due to all this interventions, omega-3-fatty acids are considered to be one of the best known remedy for alleviating the symptoms of rheumatoid arthritis (RA).
Omega-3-fatty acids can be obtained in three forms from the food. The form used by the body cells are: docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) and the one obtained from plant sources is Alpha-linolenic acid (ALA).DHA is needed for brain development and brain function. EPA gives rise to eicosanoids, signalling molecules. While EPA and DHA are responsible for the production of anti-inflammatory factors like resolvins and protectins in the body. These work at molecular level to reduce inflammation due to arthritis. This mechanism includes the following steps:
- Alteration of phospholipid composition of the cell membrane of leukocytes;
- Disruption of lipid rafts responsible for the entry and exit of molecules into and out of the cell;
- Inhibition of the activation process of transcription factors responsible for production of inflammatory molecules;
- Activation of anti-inflammatory transcription factors;
- Binding to G-protein coupled receptors .
Thus the entire mechanism of the functioning of omega-3-fatty acids in reducing inflammation is known. Initially there effect in controlling heart diseases were identified in humans. But soon these were found to be of importance in controlling various other disease symptoms as well. In fact low intake of omega-3-fatty acid may result in various deficiency symptoms. These include; fatigue, dry skin, poor memory, heart troubles, depression, mood swings and poor circulation . Hence omega-3-fatty acid are crucial for the overall functioning of the body. Additionally they play a role in ameliorating symptoms in rheumatoid arthritis, heart troubles, diabetes, etc.
A 2012 meta- analysis on omega-3-polyunsaturated fatty acids (PUFA) (dosage being >= 2.7 g / day) in patients with rheumatoid arthritis looked into 10 randomly controlled trials involving 183 RA patients and 187 placebo-treated controls. This study reported its clinical outcomes after a duration of 3 months.
It was found that intake of omega-3-polyunsaturated fatty acids significantly reduced the consumption of non-steroidal anti-inflammatory drugs (NSAIDs), a major treatment for Rheumatoid arthritis. Also considerable improvement in symptoms like tender joints, swollen joints, morning stiffness and physical function was reported. This study established that use of omega-3-fatty acids over a period of at least 3 months will result in reduced NSAID consumption in patients with rheumatoid arthritis .
Similar results were obtained when scientists used fish oils in place of artificial supplements to fulfil the requirements of omega-3-fatty acids among patients. However consumption of fish oil simply helped in lowering the rate of progression of the disease, i.e., they were effective in relieving the symptoms of the disease only.
Another study has identified green-lipped mussel (Perna canaliculus), a native of New Zealand as a rich source of omega-3-fatty acids. Regular intake of these mussels led to reduced joint stiffness, increased grip strength, reduced pain and improved walking pace among people with osteoarthritis. Some of the people however reported worsening of their symptoms before experiencing the improvements. Nevertheless, these are encouraging results which show that supplementation of omega-3-fatty acids through dietary intake in the form of fish oils, sea food and plant oils can be equally effective as artificial supplementation.
One study looked at the effectiveness of omega-3-fatty acid supplementation along with conventional therapy among patients with rheumatoid arthritis. This study analysed 17 randomly controlled clinical trials and suggested that intake of poly-unsaturated fatty acids in addition to the conventional NSAID treatment for rheumatoid arthritis could be effective in treating pain and inflammation in the patients .
In fact omega-3-fatty acids have been found to function in prophylactic treatment of arthritis even. A recent study conducted in 2013 helped prove this point. This study compared the effects of DHA and DHA+EPA in terms of anti-inflammatory activity in a mouse model. The model was induced with arthritis artificially. The advance and severity of the disease was then measured using various physical, serological and histological tests.
At the end of this study DHA treatment was found to be more efficacious. Also it was found that inclusion of omega-3-polyunsaturated fats in the diet could be an effective intervention in relieving from the symptoms of inflammatory arthritis and could have some preventive effects towards further damage .
While talking about omega-3-fatty acids, it is important to make a mention of omega-6-fatty acids. Omega-6-fatty acids are another class of fatty acids that are needed by the body. These can be obtained from plant sources, like evening primrose and black currant. They are crucial for the health of skin, hair, reproductive system and bones.
But where on one hand omega-3-fatty acids reduce inflammation and inflammatory reactions; there on the other hand some of the omega-6-fatty acids may function to increase inflammatory reactions. Thus it is important to maintain a good balance of both these essential fatty acids in the diet for the proper health and functioning of our body.
Mediterranean diet has been known to strike that right balance between omega-3- and omega-6-fatty acids. This diet includes whole grains, fresh vegetables and fruits, olive oil, garlic, fish and moderate amounts of wine. Owing to the right ratio of the two essential fatty acids, many studies have concluded that people following a Mediterranean diet are at a lower risk of incurring heart problems. In fact a study has shown that Mediterranean diet can help alleviate the symptoms of rheumatoid arthritis . As it is, the western diet is not rich in omega-3-fatty acid. Instead it is rich in omega-6-fatty acids. Thus inclusion of some of the omega-3-fatty acid rich food in the diet is highly recommended for these individuals.
Omega-3-fatty acids – How should we take them?
Omega-3-fatty acids are highly essential for the body. They are found in a number of natural sources. One of the richest sources of omega-3-fatty acids is cold water fish like salmon, mackerel, halibut, sardines, tuna, and herring. Alpha-linolenic acid is found in plant sources and plant oils like flaxseed, flaxseed oil, canola (rapeseed) oil, soybean, soybean oil, pumpkin seeds, pumpkin seed oil, purslane, perilla seed oil, walnut and walnut oil.
ALA is also found in green vegetables like Brussels sprouts, spinach, kale, and salad greens. Sea foods like algae and krill are also good sources of omega-3-fatty acids . For a healthy living two servings of oily fish or a handful of nuts or else a spoon of canola oil in salad are recommended.
Although apart from natural sources, there are artificial supplements too available in the market. Fish oil supplements and other omega-3-fat supplements can also be included along with conventional therapy in order to relieve the symptoms of rheumatoid arthritis. It must be noted here that omega-3-fatty acids just help in combating the symptoms of rheumatoid arthritis. Hence it must never be considered as a substitute for conventional medication. Thus discontinuation of medication must never be practiced by the patients.
Omega-3-fatty acids Dosage
Research has found that in adults the intake of EPA and DHA must be greater than 2 grams / day in order to elicit anti-inflammatory activity . The fish oil capsules commonly contain 0.18 grams of EPA and 0.12 grams of DHA. Doctors usually advise patients to consume 500 mg per day of fish oil for being effective in patients with rheumatoid arthritis .
Omega-3-fatty acids are available in natural sources but excessive use of these molecules can be dangerous for the patients. Patients must be careful before taking fish oil supplements in as they might interact with other medications and can cause further complications. Hence the main precautions that one must take before using these supplements are as follows:
- Omega-3-fatty acids interact with blood thinning medicines like clopidogrel, warfarin or aspirin. Thus people with bleeding disorders must avoid using omega-3-fatty acid supplements. In fact in high doses these might increase the risk of bleeding in patients without any history of such disorders.
- One of the side effects of omega-3-fatty acids is gas, bloating, belching and diarrhoea. Thus when such effects appear patients must avoid using the supplements for some time.
- In patients with schizophrenia and diabetes, it is advisable to consume omega-3-fatty acids in the form of EPA and DHA instead of ALA. It is because these patients lack the enzymes needed to convert alpha-linolenic acid to EPA and DHA.
- Again people with type 2 diabetes experience an increase in the fasting blood sugar level when supplemented with omega-3-fatty acids. Thus in such patients fish oil supplementation must be done under the supervision of doctor.
- Children, pregnant women and nursing women must avoid eating fishes with high amount of mercury like mackerel, swordfish, shark or tilefish. Mercury might lead to various birth defects and symptoms of mercury poisoning among young children.
- In fact, each individual must be careful while buying fish oil from the market. It is important to purchase these from reliable sources so that it is not contaminated with mercury or pesticide residues.
Rheumatoid arthritis is a condition which leaves patients in a lot of pain and discomfort. But with proper care and management normal life can be restored. Omega-3-fatty acids are one of the best known natural remedies for the disease. Lot of research work has been done one poly unsaturated fats and fish oils and all these point towards their significance in curing the disease symptoms. Thus inclusion of oily fish and other sources of omega-3-fatty acids in the food of humans could be highly beneficial for the patients with rheumatoid arthritis.