Spine Surgery and Advancement of Minimally Invasive Techniques
Alternative Treatments for Joint Pain
Posted on 16. Feb, 2011 by Dr. Joseph Maroon in Supplements
In the early 1970s, researchers began investigating the Inuit Eskimo and their diet, which consisted of mostly fish and animals who ate fish. They soon discovered this population had a very low incidence of heart disease, stroke and joint pain, despite their very strenuous lifestyle. They eventually found the Eskimos blood was slightly thin or had a tendency to clot less, compared to those who consume a Westerner diet high in beef fat.
This was eventually called the “Inuit Effect” and attributed this to the Eskimos’ high omega-3 fats diet from the fish oil they consumed. Now more than 900 clinical studies have been done showing the positive effects of fish oil’s omega-3 EFAs. The mechanisms for much of these effects are due to reductions in cellular and vascular inflammation and reduced blood clotting, and specifically two ingredients in fish oil, EPA and DHA, act to provide these benefits. Based on these observations, fish oil supplements are often recommended for prevention against heart disease and other inflammatory conditions such as arthritic joint pain.
How does fish oil act as an anti-inflammatory?
Plant and animal-derived nutraceutical preparations have been used for thousands of years to obtain effective pain relief. Natural herbal medications are becoming increasingly popular because of their relatively few side effects. Nevertheless, there are problems associated with these dietary supplements, and their use requires knowledge of their biological action, clinical studies (both affirmative and negative) and potential interactions with other alternative products and prescription medications.
Alternative treatment outcomes evaluated with appropriately designed controlled studies have exploded in recent years, and their findings must be viewed with a greater degree of confidence due to the study designs and quality of the investigators.It is important for both the general public and their healthcare practitioners to understand this new science.
Mechanism of EPA/DHA to Help Joints
The active ingredients in fish oil are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These are stored in the membranes of the cells that make up our bodies, and act as building blocks for the micro-hormones that are used primarily to counter inflammatory response. In addition to acting as a natural anti-inflammatory agent, there is a dose-dependent decrease in the activity of the proteins designed to breakdown cartilage when EPA and DHA are incorporated into joint cartridge cells. Omega-3s found in fish oil can directly reduce the degenerative enzymes often associated with joint disease and arthritis.
Fish vs. Fish Oil Supplements
Optimally, we would obtain omega-3s through the regular consumption of fish. However, there are pollutants and contaminants in their water environment and when fish consume these toxins they become concentrated in their tissues. Mercury and polychlorinated biphenyls (PCBs) are the most common toxins in seafood. Mercury is concentrated up the food chain when plankton are consumed by small fish that are then eaten by larger fish. The toxic effects of mercury can be profound and long lasting, and in some cases permanent. Mercury may cause vague symptoms like fatigue, memory loss and headaches and can also raise the risk of heart disease. Cooking fish does not remove these toxins. PCBs are stored in the fatty layers of fish, so exposure can be minimized by removing the fish skin and any surface fat before consumption. However, this will also remove the fish oil, where the omega-3 EFAs are located.
Common Dosage
Because of pollution, many recommend fish oil supplements as the best method to consume fish oil. The recommended dosage can range from about 1.0 to 3 grams of EPA and DHA per day, taken with meals. Rare side effects include fatty or loose stools and occasional belching if the supplements are not taken with meals. Typically, persons on a regimen of anticoagulant medications or with a history of abnormal bleeding tendency should not take omega-3 EFAs because of the possibility of increasing the bleeding potential.
AHA Recommendations
Fish oil supplementation should be done under physician guidance for people with cardiac disease. The American Heart Association’s (AHA’s) dietary guidelines now recognize the benefits of omega-3 EFAs. The AHA recommends consuming fish, which is high in omega-3 fatty acids, at least twice weekly to reduce the risk of CHD. In addition, the AHA recommends the inclusion of oils and other food sources high in omega-3 fatty acids. The AHA concluded that omega-3 EFAs decrease the risk of arrhythmias (which can lead to sudden cardiac death), decrease triglyceride levels, decrease the growth rate of atherosclerotic plaque and lower blood pressure.
Source: AHA website
Fish Oil Quality
Approximately 35 percent of adults take dietary supplements on a daily basis. The fish oil supplements industry in particular has seen phenomenal growth in recent times, at a rate of about 50 percent per year. But not all fish oil supplements are the same. Due to the types of fish the oil is extracted from, the processing techniques and the storage conditions, many consumers can experience very different concentrations and qualities of fish oil supplements. As is the case with most consumer items, you generally get what you pay for. The major manufacturing standards that one should familiarize with are purity, potency and oxidation.
Purity we have discussed, but quantity of fish oils is often is varied and inconsistent. Most high-end, more expensive fish oil supplements have a considerably higher potency of EPA and DHA per capsule. The majority of scientific studies employed dosages in the range of two to four grams of EPA/DHA. A lower end 1-gram fish oil capsule typically provides only 180 milligrams (mg) of EPA and 120 mg of DHA; the rest of the capsule content is “marine product” This is a mix of many different fatty acids and cholesterol with very few omega-3 EFAs. In order to achieve a potent dosage of approximately three grams with a lesser quality product, we would need to take ten capsules per day. This amount of oil can often cause burping, loose stools and a fishy taste.
Fish oil has had a bad reputation among many people who were forced to take cod liver oil as children. Cod liver, high in omega-3 EFAs and vitamins A and D, has been used for more than 200 years to promote good health, but at a price. Its foul odorl and taste made an indelible mark on many, and left people resistant to taking the fish oil supplements produced today by modern techniques. The smell and taste problem with cod liver oil is due to rancidity, which is caused by oxidation. Rancidity is a problem for all polyunsaturated fatty acids, including fish, safflower, sunflower seed, flaxseed and hemp seed oils. Polyunsaturated oils can become rancid when exposed to heat, light or oxygen. Typically, the cod liver oil of yesteryear was exposed to one of these factors during manufacturing, storage and/or sale. The best practice manufacturers address these issues by reducing the amount of oxidation, and thereby reducing any foul taste.
Other Natural Therapies
Glucosamine/chondroitin supplementation has also been used to help prevent or reverse joint cartilage degeneration. Recently the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), was designed to assess glucosamine and chondroitin sulfate for reducing pain and improving function for patients with knee osteoarthritis. The GAIT results on over 1,500 patients show significant improvement of pain in those patients with moderate to severe arthritic knee pain. More subtle changes were seen in mildly-afflicted patients. These changes, however, were not considered as significant.
Along with fish oil (omega-3 EFAs) and glucosamine/chondroitin, we also recommend considering other supplements and herbal treatments, such as: Turmeric (Curcuma longa) – fragrant yellow spice found in curry and used for centuries in ayurvedic medicine similar anti-inflammatory effects as aspirin but without its anti-coagulation properties; Boswella – inhibits the 5-LOX pathway of the inflammatory cascade; Bromelain -enzyme contained in pineapple, interferes with inflammatory prostaglandin synthesis; White willow bark -natural precursor to aspirin but without the unpleasant gastrointestinal side effects; Green tea – anti-inflammatory and anti-oxidant; Nettle Leaf – reduces increased inflammatory markers; S-Adenosylmethionine (SAMe) protects joint synovial cells by reversing glutathione depletion.
Conclusion
For centuries, natural anti-inflammatory agents have been used to mediate the inflammatory process. More recently, many of these have been found to reduce inflammation in a similar manner to pharmacological agents but often with fewer side effects. Fish oil supplements and other natural agents are often overlooked as a first line treatment in the current practice of Western medicine, but many practitioners outside the west often consider these as standard treatments. Ongoing experiments and clinical trials have and will provide the scientific basis for the effectiveness of these agents that have been used empirically for centuries to reduce inflammation. But as with pharmaceutical agents, it is imperative that both individuals and their healthcare practitioners understand the indications and limitations of natural products.
About the author
Joseph Maroon, MD, is a world-renowned, board-certified neurosurgeon, who has been honored as one of America’s Best Neurosurgeons for 8 consecutive years. He has published over 250 scientific papers, 8 books, and 40 book chapters. His other research has focused on the prevention and treatment of injuries and disease. In his most recently published book, The Longevity Factor: How Resveratrol and Red Wine can Activate Genes for a Longer and Healthier Life, Dr. Maroon relates the new science of genetic activation and the ability of food choices, supplements like resveratrol and lifestyle choices to activate human genes, to better health and disease prevention. He has also authored Fish Oil: The Natural Anti-inflammatory, which discusses the wide range of conditions for which omega-3 fish oil has been found helpful.
As a world famous neurosurgeon, he has been honored by various national and international neurological societies for his contributions to neurosurgery. Despite his busy professional schedule, he is a devoted athlete, completing 50 Olympic distance triathlons since 1980, and was inducted in Lou Holtz Upper Ohio Valley Hall of Fame in 1999 for his athletics and sports medicine.
