If you’ve spend some time on fix-knee-pain.com or read my email series on the ten most common casuses for knee pain, you know that I’m a proponent of supplementing with liquid fish oil. This page will recap the most important benefits of supplementing with fish oil and provide you some steps you can take today to get you started.
Introduction: Fish oil and Omega-3 fatty acids
Fish oil provides you with essential omega-3 fatty acids. These fatty acids are essential because your body can’t make them and you have to get them through your diet. Once you’ve ingested them, your body will use the fatty acids for all sorts of important things. The crucial point to remember is that they won’t be stored as fat, but actually aid in fatty acid metabolism and thereby help you lose weight.
The two omega-3 fatty acids in fish oil responsible for all the magic are EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Let’s not get hung up on those complicated names, but instead take a look at some research about fish oil and joint pain.
Fish oil for knee pain
A direct mechanism by which fish oils reduce knee pain is by lowering the inflammation in the body and by pushing pro-inflammatory fats out of the cell membranes. This effect adds up over time, as more and more pro-inflammatory fats are removed from the cell membranes. The net result is lowered pain. Additionally, fish oils will lead to faster healing of the injury, as they improve overall health, giving your body more time and resources to deal with the site of pain.
Here is a selection of findings from research studies on the effects of omega-3 fatty acids on joint pain:
“The nutritional supplement containing standardized lemon verbena extract (14% verbascoside, w/w) and fish oil omega-3 fatty acid reduced symptoms of pain and stiffness significantly, and improved physical function (…) after 9 weeks of treatment.” (Caturla et al. 2011)
Participants in this study received 2.2 g per day of EPA/DHA for the first 5 weeks and 1.1 g per day of EPA/DHA for the remaining 4 weeks.
“We conducted a meta-analysis of 17 randomized, controlled trials assessing the pain relieving effects of omega-3 PUFAs in patients with rheumatoid arthritis or joint pain secondary to inflammatory bowel disease and dysmenorrhea. (…)
The results suggest that omega-3 PUFAs are an attractive adjunctive treatment for joint pain associated with rheumatoid arthritis, inflammatory bowel disease, and dysmenorrhea.” (Goldberg, Katz 2007)
“The results suggest distinctive, differential prolonged effects on IBD-related joint pain of short-term duodenal administration of n-3-rich seal oil (significant improvement) and n-6-rich soy oil (tendency to exacerbation).” (Bjørkkjaer et al. 2004)
In other words, omega-3 fatty acids lessened the pain, but omega-6 fatty acids exhibited a tendency to make the joint pain worse.
Fish Oil and other diseases
The benefits of omega-3 fatty acids aren’t limited to joint health. Here are some other diseases in which lack of omega-3 fatty acids has been implicated as contributing factor:
- Weight gain
- Heart disease
- Violent tendencies
- Memory problems
- Inflammatory diseases
- Dry skin
- Postpartum depression
- Irritable bowel syndrome
- Premenstrual syndrome (PMS)
- Cravings for carbohydrates and sweet cravings
- Noncancerous breast disease
- Ulcerative colitis
- Bipolar disorder
- Soft or brittle nails
- lowered immunity or frequent infections
Source: (Gedgaudas 2011, pp. 97f)
The common denominator among these diseases is an increased level in inflammation in the body. Fish oil is an effective way of preventing this inflammatory state, as are certain dietary changes such as lowering the intake of omega-6-rich vegetable oils.
Are you still not convinced?
If you only have money to spend on one supplement, it should be fish oil. It’s that important. Here are some other benefits of omega-3 fatty acids, in case you’re not convinced yet:
- Helps reduce stress by lowering the amount of stress hormones secreted
- Lowers VLDL cholesterol and triglycerides
- Increases HDL cholesterol
- Improves cognitive abilities (i.e., you’ll be smarter)
- Helps you lower your body fat by turning on fat-burning genes
- Will help you build muscle
For more information see (Carter et al. 2013), (Delarue et al. 2003), (Guebre-Egziabher et al. 2013), (Hellhammer et al. 2012), (Poliquin), and (Sofi et al. 2013).
6 Steps to increase omega-3 intake
Here is a list of six steps you can take to improve your intake of omega-3 fatty acids:
2) Choose grass-finished organic meats over conventionally raised meat (higher omega-3 and lower omega-6)
3) Remove all mostly poly-unsaturated vegetable oils (e.g., corn, safflower, sunflower, soybean oil, grapeseed oil). Only use a little olive oil or sesame oil on salads. For frying use lipids such as tallow, coconut oil, palm oil, red palm oil, butter, ghee or other mostly saturated lipids (they are low in omega-6).
4) Reduce carbohydrate intake, preferably by eliminating all sources of concentrated carbs such as grains, legumes, sugar and all products with these as main ingredients.
5) Completely remove all foods containing trans-fats (e.g., “hydrogenated vegetable oil”, “partially hydrogenated vegetable oil”, or “hardened vegetable oil”), which by their nature includes 99.9% of all convenience foods and snacks. This is critically important because trans-fats interfere with your fat metabolism.
6) Supplement with liquid fish oil.
Source: Taken from my book Total Knee Health.
Fish Oil and Omega-3 Fatty Acid FAQ
Q: Can I get my omega-3 fatty acids from flaxseed oil?
A: No, you can’t. This is because flaxseed oil doesn’t contain the two important fatty acids EPA and DHA. It contains another omega-3 fatty acid known as ALA and while ALA can be converted to EPA and DHA in the body, the mechanism for conversion is extremely inefficient.
Q: Are there vegetarian/vegan sources of omega-3 fatty acids?
A: Yes, there are some vegetarian/vegan supplements that provide fish oil. Please make sure that the supplement you buy contains both, EPA and DHA, in dosages similar to that of pharmaceutical grade liquid fish oil products (5 ml should contain around 750 ml of EPA and 450 ml of DHA). I have never tried vegan omega-3 supplements and thus can’t comment on them in detail.
Q: How much omega-3 should I take per day?
A: Follow the instructions on the label. Most brands recommend to take one teaspoon three times per day (e.g., with the meals). Personally, I increased this dose to one tablespoon three times per day and then tapered down to one tablespoon twice per day after a month. I’m not a doctor and I don’t know your personal situation, so I can’t tell you how much you should take.
Q: Are there any side effects?
A: Make sure you read the patient leaflet and inform yourself about all side effects of omega-3 supplementation (e.g., it’s blood-thinning and you should consult with your doctor before taking this supplement if you take any other blood-thinning medication. You should also stop taking fish oil a week before surgeries because of this).
Q: How should fish oil be stored?
A: Ideally, fish oil should be refrigerated at all times. To make sure your fish oil is of the highest quality you should buy it somewhere where it’s stored refrigerated. Granted, this will be expensive. Buying from a reputable source and opting for expedited shipping may be the only viable option for you. Once the package has arrived, put the fish oil in the fridge (regardless of whether you’ve opened it yet).
Q: Why does it have to be liquid fish oil?
A: Liquid fish oil is superior because it makes ingesting a higher dose much easier. If you tried to get the same amount of omega-3 fatty acids from a supplement in soft-gel form, you’d have to pop dozens of pills per day. Additionally, by going the liquid route you avoid ingesting the additional chemicals of the soft-gels.
Q: Can I buy my omega-3s at GNC or a drugstore?
A: I have yet to find a retail store that stocks a liquid omega-3 supplement, so chances are you won’t find the good stuff there anyways.
Q: Can I put the fish oil into my food to mask the taste?
A: I don’t recommend doing that, as you’d lose some of that very expensive oil on your plate. Don’t ever put it into hot food or use it for frying, because it will go rancid quickly.
Q: What about foods that are fortified with omega-3 fatty acids?
A: Avoid these foods, because you can’t be sure about the source of the fat or its quality. Manufactures can add flaxseed oil, which doesn’t contain any EPA/DHA, and still claim it’s omega-3-enriched, but it won’t do you any good at all.
Bjørkkjaer, T.; Brunborg, L. A.; Arslan, G.; Lind, R. A.; Brun, J. G.; Valen, M. et al. (2004): Reduced joint pain after short-term duodenal administration of seal oil in patients with inflammatory bowel disease: comparison with soy oil. In Scand. J. Gastroenterol. 39 (11), pp. 1088–1094.
Carter, Jason R.; Schwartz, Christopher E.; Yang, Huan; Joyner, Michael J. (2013): Fish oil and neurovascular reactivity to mental stress in humans. In Am. J. Physiol. Regul. Integr. Comp. Physiol. 304 (7), pp. R523-30.
Caturla, Nuria; Funes, Lorena; Pérez-Fons, Laura; Micol, Vicente (2011): A randomized, double-blinded, placebo-controlled study of the effect of a combination of lemon verbena extract and fish oil omega-3 fatty acid on joint management. In J Altern Complement Med 17 (11), pp. 1051–1063.
Delarue, J.; Matzinger, O.; Binnert, C.; Schneiter, P.; Chioléro, R.; Tappy, L. (2003): Fish oil prevents the adrenal activation elicited by mental stress in healthy men. In Diabetes Metab. 29 (3), pp. 289–295.
Gedgaudas, Nora T. (2011): Primal body, primal mind. Beyond the paleo diet for total health and a longer life. Rochester, Vt: Healing Arts Press.
Goldberg, Robert J.; Katz, Joel (2007): A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. In Pain 129 (1-2), pp. 210–223.
Guebre-Egziabher, Fitsum; Debard, Cyril; Drai, Jocelyne; Denis, Laure; Pesenti, Sandra; Bienvenu, Jacques et al. (2013): Differential dose effect of fish oil on inflammation and adipose tissue gene expression in chronic kidney disease patients. In Nutrition 29 (5), pp. 730–736.
Hellhammer, Juliane; Hero, Torsten; Franz, Nadin; Contreras, Carina; Schubert, Melanie (2012): Omega-3 fatty acids administered in phosphatidylserine improved certain aspects of high chronic stress in men. In Nutr Res 32 (4), pp. 241–250.
Poliquin, Charles: Why Fish Oils Are The Most Important Supplement – Charles Poliquin. Available online at http://www.charlespoliquin.com/Blog/tabid/130/EntryId/118/Why-Fish-Oils-Are-The-Most-Important-Supplement.aspx, checked on 13/05/2013.
Sofi, Francesco; Giorgi, Gianluca; Cesari, Francesca; Gori, Anna Maria; Mannini, Lucia; Parisi, Giuliana et al. (2013): The atherosclerotic risk profile is affected differently by fish flesh with a similar EPA and DHA content but different n-6/n-3 ratio. In Asia Pac J Clin Nutr 22 (1), pp. 32–40.