Comparing Fish Oil with Another Dietary Approach for Arthritic Inflammation

Troll Fjord The Troll Fjord in Northern Norway Photo by Grant from Oslo

A few years ago I published a guide I called the Norwegian Diet for Fighting Inflammation. Basing the article on a treatment method that was clinically tested that I discussed with a Norwegian doctor, I described a way of treating rheumatoid arthritis with diet alone.

Not everyone who follows this diet gets better, but about 80% do, over the course of a year. I believe that adding fish oil to an anti-arthritis diet usually results in greater relief, but I've never heard of anyone who reversed rheumatoid arthritis just by taking oil. I don't think I ever will.

If you will follow the diet I describe here, however, and take fish oil and other supplements, I believe you are likely to enjoy considerable relief from pain and stiffness and you may be able to stop the progression of the disease. However, I think there is another essential fatty acid product that may work even better than fish oil and that you should try it first.

Let's begin with when diet doesn't make a difference, and when it does.

Antioxidants Aren't Effective for Rheumatoid Arthritis

Delicious Tropical Fruits Delicious Tropical Fruits Rich in Antioxidants Photo by Penny Greb

If there is anything "we all know" about antioxidants, it is that they cure everything, right? Actually, although antioxidants relieve many other kinds of inflammatory diseases, they don't do a lot of good for rheumatoid arthritis.

Rheumatoid arthritis (RA) is a condition of inflammation affecting the whole body that is most intense in the joints. No one knows precisely what causes rheumatoid arthritis, although there is general agreement that damage to the joints occurs as white blood cells thicken the linings of the joints.

The joints themselves release enzymes that destroy collagen as well as inflammatory cytokines and prostaglandins, chemicals that the body makes more readily when certain kinds of fatty acids are in short supply.

Since prooxidants trigger inflammatory processes and antioxidants stop them, researchers have tried to determine whether rheumatoid arthritis might simply be the result of a shortage of antioxidants.

Research results have been mixed. One study found that people with rheumatoid arthritis have normal levels of the antioxidant vitamin E, while another study found that people with rheumatoid arthritis have deficient levels of several antioxidants including vitamin E. Later research found elements of truth in both findings.

The immune systems of people who have RA are supersensitive, sending out floods of inflammatory chemicals and white blood cells in response to allergies or infection.

Put in everyday terms, their immune systems lack an “off switch.” In the open bloodstream, massive amounts of antioxidants usually overcome the aberrant tendency of these white blood cells to cause inflammation. Within the confines of a joint, however, antioxidants do not reach the T cells and inflammation continues unchecked. In especially severe cases of rheumatoid arthritis, the same process occurs even outside joints, resulting in fatigue, fever, and the formation of nodules.

If Antioxidants Don't Help, What Does?

There are serious limitations to all kinds of treatment for rheumatoid arthritis. No conventional medication cures the disease, and all of them have serious side effects, although the newer COX-2 inhibitors for pain relief present notably fewer problems (and they are considerably more expensive).

Natural treatments for rheumatoid arthritis have their own downside. Nothing recommended here is going to create a new set of problems for you, but no holistic intervention works for everyone who has rheumatoid arthritis, and most complementary treatments take 3-6 months to show results.

Occasionally, however, people with rheumatoid arthritis experience dramatic and complete remissions as a result of dietary changes, herbs, or nutritional supplementation. Please read carefully as you choose the therapies most likely to bring a remission of your symptoms.

Why Doctors Don't Prescribe Diets

Doctors seldom recommend dietary changes for the simple reason that most doctors don’t believe in the theory of food allergy. Nonetheless, eliminating certain foods brings some rheumatoid arthritis sufferers considerable relief.

One study found that eliminating beef, dairy products, eggs, nuts, and wheat flour brought drug-free relief to 23 out of 25 rheumatoid arthritis patients in 10-18 days.

Another study found that eliminating gluten, meat, fish, eggs, dairy products, refined sugar, citrus fruits, preservatives, coffee, tea, alcohol, salt, and strong spices completely (although dairy and wheat products were allowed after 14 weeks if they did not cause resumption of symptoms) not only relieved pain, but decreased the number of tender joints and swollen joints, and improved pain score, duration of morning stiffness, grip strength, and range of motion.

Benefits of the diet continued throughout the 2 years of the study. This study was the basis of the Norwegian Diet for Fighting Inflammation I mentioned at the beginning of this article.

Elimination diets are best suited for palindromic rheumatism, a form of arthritis primarily affecting people under age 45 that does not cause heat in the joints or damage to cartilage, and is clearly triggered by a specific food. Vegan (meat-, fish-, egg-, and dairy- free) diets can be helpful when symptoms vary greatly from day to day.

The problem with elimination diets is that patients beg the question, “If I eliminate all of these foods, what’s left?” In the case of the 2-year elimination diet study, the answer was herbal teas, garlic, vegetable broth, a thin soup of potato and parsley, and juices from carrots, beets, and celery, at least during the first month of treatment. (The study notes that patients following the 2-year elimination diet lost weight.)

Most rheumatoid arthritis sufferers who don’t live alone would find following a severely restricted diet extremely difficult. Moreover, elimination diets are based on the principle that “one size fits all.” In other words, the assumption is that everyone with rheumatoid arthritis has food allergies, and everyone who has food allergies is allergic to the same foods.

This simply isn’t true, and there is an easier way to get relief from rheumatoid arthritis through dietary restriction.

A study published in the British medical journal The Lancet reported the experience of 53 people with RA who either ate their regular diet or ate meals excluding common allergenic foods. (The following table lists allergenic foods and the percentages of people allergic to them.)

After 1 week, foods with the potential to cause allergies were reintroduced one at a time. If the test participant experienced no change in symptoms, the food was restored to the diet plan. If the food made symptoms worse, it was permanently excluded. One-third of patients on dietary exclusion therapy remained well on diet alone, without any medication, for up to 7.5 years after starting treatment.

Many participants in the study lost weight, but weight loss was not necessary for improvement in rheumatoid arthritis. The higher a food is on this list, the more likely you are to benefit from eliminating it.

Common Food Allergies

FoodPercentage of Rheumatoid Arthritis Patients
Corn56%
Wheat54%
Bacon or Pork39%
Oranges37%
Milk37%
Rye34%
Eggs32%
Beef32%
Coffee32%
Malt27%
Cheese24%
Grapefruit24%
Tomato22%
Peanuts20%
Cane sugar20%
Butter17%
Melons17%
Lemon17%
Soy17%

Russian scientists report that rotation diets work best when there is a healthy balance of bacteria in the intestine.

You can encourage friendly bacteria by eating yogurt or similar dairy products on a regular basis. If you cannot eat dairy foods, take 1 or 2 capsules of Acidophilus or Lactobacillus every day. A product available in North America called Oikos yogurt has additional strains of helpful bacteria that are hard to find in probiotic supplements

You Have to Eat Something, However

Fasting isn’t a good way to control the symptoms of rheumatoid arthritis. Some rheumatoid arthritis sufferers don’t benefit from fasting at all, and no clinical study has found fasting to reduce symptoms for more than 10 days.

There is usually an improvement in pain and swelling on day 4 or 5 of a fast, and benefits continue as long as the fast is observed. However, other serious, even life-threatening health problems can arise during fasting, especially for people with rheumatoid arthritis who also have heart disease or diabetes, and symptoms always return when the fast is broken.

If You Can't Stay on a Rheumatoid Arthritis Diet.

While dietary modification is your first and best treatment for rheumatoid arthritis, realistically, most of us have problems staying on a diet for a few weeks, much less for a lifetime.

Nutritional supplements and herbs can also be extremely helpful, but the first thing to understand is that not all supplements that are helpful in osteoarthritis (OA) are necessarily helpful in rheumatoid arthritis. That's why it's best not to use something because it worked for a friend who had a different kind of arthritis.

What I Recommend Instead of Fish Oil, At Least at First

Borage Seed Flower Borage Seed Flower Photo by John Radford

Various sources of essential fatty acids, not just fish oil, are clinically proven to reduce swelling and inflammation in rheumatoid arthritis. Of these, the most effective fatty acid with the fewest side effects is borage seed oil. In one double-blind trial, 37 volunteer patients with active rheumatoid arthritis were randomly assigned by the investigators to receive borage seed oil (providing 1.4 grams of the fatty acid GLA per day) or a placebo (cottonseed oil) for 6 months.

Long-term treatment with borage seed oil supplements lowered tender-joint scores by 45 percent and swollen-joint scores by 41 percent. The study volunteers who took cottonseed oil experienced either no change or an actual worsening of disease activity.

There were no serious side effects from taking borage seed oil, although some participants taking it reported minor stomach upset. Recent research suggests that essential fatty acids like those in borage seed oil, fish oil, and evening primrose oil (EPO) cancause the defective immune system cells that cause rheumatoid arthritis in joints to “fade away,” passing through their normal life cycle without being replaced by more defective cells.

Black currant seed oil, evening primrose oil (EPO), and fish oil are also helpful, although the results of using these oils are not likely to be as dramatic as those from using borage seed oil. What you need to know about fish oil for rheumatoid arthritis is that it takes a lot to do you good.

Most of the studies of fish oil for arthritis that found benefit used about 6 grams of fish oil a day. That's about 8 capsules of New Vitality or 15 capsules of Xtend Life or Nordic Naturals fish oil-or a lot more if you buy a Walmart or Costco brand of fish oil (which I don't recommend in high doses because the less expensive brands can cause stomach upset).

Any essential fatty acid supplement can cause bloating, burping, diarrhea, or flatulence, although these side effects are likely to be mild. People with a history of partial seizures (blanking out or unexplained loss of emotional control should use black currant oil rather than borage seed oil, since the latter can lower the amount of stress precipitating an attack.

cHempseed oil will also relieve arthritis pain. It will not give you a marijuana high, but it can cause a false positive reading for marijuana use in some home testing kits.

Selected References:

  • Casos K, Saiz M, Ruiz-Sanz J, Mitjavila M. Axtherosclerosis prevention by a fish oil-rich diet in apoE(-/-) mice is associated with a reduction of endothelial adhesion molecules. Atherosclerosis. 2008. pp. 306-317.
  • Cleland L, Hill C, James M. Diet and arthritis. Baillieres Clin Rheumatol. 1995;9(4):771-785. doi: 10. 1016/S0950-3579(05)80313-9. .
  • Cleland LG, French JK, Betts WH, Murphy GA, Elliott MJ. Clinical and biochemical effects of dietary fish oil supplements in rheumatoid arthritis. J Rheumatol. 1988;15(10):1471-1475.
  • Darlington LG, Stone TW. Antioxidants and fatty acids in the amelioration of rheumatoid arthritis and related disorders. Br J Nutr. 2001;85(3):251-269. doi: 10. 1079/BJN2000239.
  • Fortin PR, Lew RA, Liang MH, Wright EA, Beckett LA, Chalmers TC, Sperling RI. Validation of a meta-analysis: the effects of fish oil in rheumatoid arthritis. J Clin Epidemiol. 1995;48(11):1379-1390. doi: 10. 1016/0895-4356(95)00028-3.
  • Kremer JM, Bigauoette J, Michalek AV, Timchalk MA, Lininger L, Rynes RI, Huyck C, Zieminski J, Bartholomew LE. Effects of manipulation of dietary fatty acids on clinical manifestations of rheumatoid arthritis. Lancet. 1985;1(8422):184-187. doi: 10. 1016/S0140-6736(85)92024-0.
  • Kremer JM, Jubiz W, Michalek A, Rynes RI, Bartholomew LE, Bigaouette J, Timchalk M, Beeler D, Lininger L. Fish-oil fatty acid supplementation in active rheumatoid arthritis. A double-blinded, controlled, crossover study. Ann Intern Med. 1987;106(4):497-503.
  • Kremer JM, Lawrence DA, Jubiz W, DiGiacomo R, Rynes R, Bartholomew LE, Sherman M. Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Clinical and immunologic effects. Arthritis Rheum. 1990;33(6):810-820. doi: 10. 1002/art. 1780330607.
  • Kremer JM. n-3 fatty acid supplements in rheumatoid arthritis. Am J Clin Nutr. 2000;71(1 Suppl):349S-351S.
  • Leslie C, Conte J, Hayes K, Cathcart E. A fish oil diet reduces the severity of collagen induced arthritis after onset of the disease. Clin Exp Immunol. 1988;73:328-332.
  • MacLean CH, Mojica WA, Morton SC, Pencharz J, Hasenfeld Garland R, Tu W, Newberry SJ, Jungvig LK, Grossman J, Khanna P. Effects of omega-3 fatty acids on lipids and glycemic control in type II diabetes and the metabolic syndrome and on inflammatory bowel disease, rheumatoid arthritis, renal disease, systemic lupus erythematosus, and osteoporosis. Evid Rep Technol Assess (Summ)2004. pp. 1-4.
  • Sierra S, Lara-Villoslada F, Comalada M, Olivares M, Xaus J. Dietary fish oil n-3 fatty acids increase regulatory cytokine production and exert anti-inflammatory effects in two murine models of inflammation. Lipids. 2006;41:1115-1125. doi: 10. 1007/s11745-006-5061-2.
  • Tou JC, Jaczynski J, Chen YC. Krill for human consumption: nutritional value and potential health benefits. Nutr Rev. 2007;65(2):63-77. doi: 10. 1111/j. 1753-4887. 2007. tb00283. x.
  • Tulleken JE, Limburg PC, Muskiet FA, van Rijswijk MH. Vitamin E status during dietary fish oil supplementation in rheumatoid arthritis. Arthritis Rheum. 1990;33(9):1416-1419. doi: 10. 1002/art. 1780330914.
  • van der Tempel H, Tulleken JE, Limburg PC, Muskiet FA, van Rijswijk MH. Effects of fish oil supplementation in rheumatoid arthritis. Ann Rheum Dis. 1990;49(2):76-80. doi: 10. 1136/ard. 49. 2. 76.

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