For INFLAMMATORY ARTHRITIS, the omega-3 fatty acids in a Fish Oil Concentrate directly interfere with the body’s inflammatory cycle, to improve joint mobility, reduce swelling, and alleviate tenderness and pain. We always use a fish oil concentrate, or the omega-3 dose could be too small to be effective. Omega-3 fats stop the cascade of inflammatory compounds secreted by white blood cells, suppress the inflammation process, boost white blood cells to clear away inflammatory waste, and actively encourage tissue repair to return joints to a healthy state. These “good fats,” specifically EPA and DHA, are one of the most studied dietary interventions since the 1980s for conditions like rheumatoid arthritis (RA).

How does Fish Oil Concentrate work?

Omega-3 polyunsaturated fatty acids are essential fats which the body cannot make. They are in very few foods, mostly in oily fish such as salmon, sardines, and mackerel in the animal kingdom, and in flax seed oil as a plant source. We highly recommend a concentrated form of fish oil to ensure that enough omega-3 fats enter the bloodstream, as both fish and flax seed oil omega-3s are poorly absorbed.

Fish oil’s omega-3 fatty acids (EPA and DHA) are powerful anti-inflammatory agents that target the core mechanisms driving conditions like inflammatory arthritis. Boosting the ratio of good fats in the body can significantly improve inflammatory joint disease. Omega-3s have numerous other crucial metabolic roles: for eye and heart health; for brain health and making myelin sheaths around nerves that speed nerve impulse conduction and protect nerves; for cell membranes; and as building blocks for important hormones.

Fats and fatty acids are building blocks for compounds that are produced by many cells including prostaglandins, thromboxanes and leukotrienes; these may either exacerbate or calm the inflammatory response. For inflammatory joint disorders, there is mounting evidence that fish oil omega-3 fats can encourage the compounds that curb the immune system’s attack on the body’s own tissues.

The primary way omega-3s reduce inflammation is through prostaglandin balance. Prostaglandins are hormone-like substances released from cell membranes. Amongst many other actions, they regulate inflammation and the body’s healing response. The types of prostaglandins made from a 20-carbon fatty acid named arachidonic acid will trigger inflammation. The conversion of arachidonic acid into prostaglandin is catalyzed by enzymes like cyclooxygenase (COX), which can be blocked by omega-3 fats.

In a healthy system, prostaglandins are produced in response to injury or infection, leading to the redness, swelling, and pain associated with the healing process. With inflammatory joint disease and other disorders, excess amounts of prostaglandins cause needless inflammation that becomes destructive.

Omega-3 fatty acids are precursors to the prostaglandin E3 group (PGE3) which is anti-inflammatory, compared to the inflammation-causing E2 prostaglandins (PGE2) derived from omega-6 fatty acids. Omega-3 fatty acids compete with omega-6 fatty acids and arachidonic acid for the same enzymes, including cyclooxygenase (COX) and lipoxygenase (LOX) pathways. Omega-3s can block the conversion of omega-6s to pro-inflammatory leukotrienes and prostaglandins PGE2, thus reducing inflammation and pain.

Looking more deeply, fish oil’s omega-3 fats work in several other ways: They may also suppress the output of mediators of inflammation called cytokines and interleukin-1. Omega-3 fatty acids from fish oil can reduce expression of the enzyme prostaglandin E synthase which helps create pro-inflammatory PGE2 prostaglandins.

In our modern Western diets, the balance of omega-3 and omega-6 fatty acids is often skewed. Omega-6 fats are found in refined vegetable oils like corn and soybean oils, often used in deep-fried, processed or fast food. Omega-6 fats are not inherently bad; they are used for cell function, brain health, and energy. The issue lies in too high a ratio of omega-6 to omega-3 fats.

Omega-6 fats are the precursors to molecules (eicosanoids) that act as “pro-inflammatory” signals. They switch on inflammation, giving the body fuel for fighting infection and healing injuries. But when these fats dominate and are not balanced by enough omega-3s, the body gets stuck in a state where the signal for inflammation is constantly on. This contributes to chronic inflammatory diseases like arthritis.

When you consume fish oil, especially in a concentrated form, the beneficial omega-3 fats are absorbed into your body’s cells where they compete directly with the pro-inflammatory omega-6 fats (like arachidonic acid) for the enzymes like cyclooxygenase (COX) and lipoxygenase (LOX) that generate chemical signals. Instead of an excess of omega-6 fats producing powerful, pain-triggering signals for inflammation, the omega-3s can dominate and release different signal molecules such as PGE3 prostaglandins and leukotrienes that calm inflammation or even act as off switches. By increasing your omega-3 intake, you tilt the balance of mediators in inflammatory pathways towards dampening the inflammation response and cooling down joint pain and swelling.

Beyond reducing the production of inflammatory chemicals, omega-3s actively help to end the inflammatory response. Fish oil’s omega-3 fatty acids, EPA and DHA, are precursors to a class of powerful molecules called Specialized Pro-Resolving Mediators. These substances signal immune cells to stop the release of inflammatory chemicals and stop migrating to the joint. Specialized Pro-Resolving Mediators dramatically boost the ability of immune cells including macrophages to clear away inflammatory waste consisting of dead white blood cells and damaged tissue. Even better, Specialized Pro-Resolving Mediators actively encourage tissue repair and regeneration and the return of joint tissue to a healthy state.

The science behind fish oil and joint health

Since the 1980s, dozens of studies have documented fish oil’s ability to reduce swelling, stiffness, and joint tenderness, and also to suppress inflammatory compounds secreted by white blood cells. Longer term studies, lasting more than a year, have revealed that an ample dose of fish oil capsules daily brings enduring clinical benefits. We always recommend a fish oil concentrate for better absorption of omega-3s from fewer pills.

Shifting the balance towards more omega-3 fats and away from arachidonic acid, which derives from saturated fats, can have outstanding effects for calming inflammation. Several studies found that people with lower saturated fat intake, such as vegetarians and people who ate more omega-3 fats in oily fish twice per week, had relief from inflammatory joint symptoms.

A notable meta-analysis in 2007 that included 10 randomized controlled trials involving 187 RA patients and 183 placebo-treated RA control subjects showed that omega-3 fatty acid consumption significantly reduced tender joint counts, swollen joint counts, and morning stiffness; overall physical function improved more in patients receiving omega-3 fatty acids. Notably, the studies found that fish oil led to a significant reduction in the use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), suggesting a genuine reduction in disease activity and pain.

A 2017 study illustrated that fish oil supplementation consistently led to a decrease in the circulating levels of pro-inflammatory cytokines. This supports the mechanism that omega-3 fats directly dampen the autoimmune inflammatory cascade at the molecular level, thereby reducing the fuel for joint destruction.

Inflammatory arthritis, like rheumatoid arthritis, involves the immune system mistakenly attacking the body’s own joint tissues. It is an autoimmune disease where the body’s own defense system has gone rogue. Multiple studies show that omega-3s help regulate this aggressive immune response by suppressing the production of pro-inflammatory cytokines, such as TNF-alpha. Cytokines are small proteins that immune cells use to communicate. In an autoimmune disease, the balance of these messengers heavily leans toward pro-inflammatory signals. Pro-inflammatory cytokines tell the other immune cells to attack, stimulate joint tissue destruction, and cause the systemic symptoms of pain, swelling, and stiffness. Research confirms that omega-3 fatty acids directly interfere with the chemical pathways which produce aggressive cytokines.

Clinical trials frequently measure subjective improvements reported by patients, which often correlate with better daily function. Many randomized, double-blind trials specifically evaluate patient-reported outcomes, such as duration of morning stiffness and overall pain levels. Supplementation with omega-3s was shown to significantly decrease the duration of morning stiffness, a hallmark symptom of RA, and lead to improved scores on measures of physical function and quality of life compared to placebo.

In our clinic

Our patients too have reported less joint pain and stiffness, reduced swelling that resolves more quickly, less redness around joints, improved range of motion over time, and less generalized feeling unwell or “inflamed” when taking a daily concentrate of fish oil.

We have found over time that a fish oil concentrate which is formulated for high absorption is the best approach by far. The concentrate has several advantages: it is more bio-available so more omega-3 fats enter the body; there is no fishy aftertaste; and it is more economical and convenient because far fewer capsules are needed. With most standard fish oil capsules, the omega-3 fats are poorly absorbed — thus people get insufficient omega-3s unless they take huge doses, like 8 pills daily, which nobody wants to do. By contrast, just 2 or 3 capsules daily of a concentrate ensures that the omega-3 dose is sufficient and effective.

Recommendation: Fish oil concentrate 2,000 to 3,000 mg daily total, from sustainably sourced fish, free of mercury or PCBs, providing at least 750 mg eicosapentaenoic acid (EPA) and 250 mg docosahexaenoic acid (DHA), the active omega-3 fats, taken with meals; or as directed by your healthcare provider.

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