Welcome to the new year! It's resolution season, and large part of many peoples' gym resolutions is getting the "right" supplements. Every evening on cable television, you can find several supplements promising everything from "improved vigor" to "mental clarity." One of the most common markets for our population is for patients and athletes with arthritis, but is there really any evidence for these? In the next few posts, I'll be breaking down for you the evidence for the most commonly used supplements and evaluating their efficacy!
Fish Oil - Omega 3 Fatty Acids
One of the most commonly touted supplements in the fitness and arthritis worlds is fish oil. The ingredient in fish oil that is the topic of discussion is omega three fatty acids. Let's take a second and demystify this compound. Fatty acids are molecules made mostly of carbon and hydrogen that our bodies can use for fuel. They come in a variety of types: saturated, unsaturated, trans-fatty acids. Very broadly speaking, unsaturated fatty acids tend to be healthier fats than their saturated or trans-fatty acid counterparts. The thing that makes a fatty acid "unsaturated" is the presence of one or more kinds of chemical bonds within that molecule. Instead of getting deep into the chemistry of double and single covalent bonds, let it suffice that the denotation "omega-three" means that three carbon atoms from the omega end of the fatty acid (in Greek, lower case omega looks a lot like a "w") is the chemical bond of interest. If I were to talk about omega-six fatty acids (the kind of unsaturated fatty acid commonly found in tree nuts), then that would mean that the sixth carbon atom from the omega end of the molecule is the one with the chemical bond of interest. Just to name names, that chemical bond is called a double bond, simply meaning it has two bonds to its neighbor atom.
Now that we've deconstructed some of the aura around these molecules, let's talk about whether or not they work for arthritis and pain! Medicine and science have purported the anti-inflammatory effects of these kinds of fatty acids, and with good reason. Chemically, they can be incorporated into the walls of our bodies' cells and also can interfere with production of inflammatory products: prostaglandins, interleukins, and arachadonic acid. These are just a few of the mechanisms behind omega-3 acid's utility.
In the above study, researchers from Serbia examined the number of painful joints and a subjective pain score in 60 women with rheumatoid arthritis on standard medical treatment. The treatment arm, received 1 gram of fish oil with a minimum of 300 mg of DHA (docosahexaenoic acid), 200 mg of EPA (eicosahexaenoic acid), and 100 mg of other omega-3 fatty acids. They found that the participants in the treatment arm had lower disease activity as manifested by less pain reported in the participants and lower disease activity. This evidence was corroborated by a recent study in the Journal of Nutrition found here. More evidence in journals of biochemistry and biophysics, Archives of Medical Research, and the European Journal of Pharmacology show benefit of omega-3 fatty acids and lower use of over the counter anti-inflammatories, though at different dosages.
So how much fish oil should I supplement to get the improvements in pain? While studies differ on amounts, the minimum dose of omega-3 fatty acid that still confers benefits seems to be about 1 gram every day with food without significant difference between high doses (5 grams) and low doses (1 gram).