The Fish Foundation
The joints in the human body are areas where two or more bones move against one another, to provide the body with it's flexibility and movement. Just as in steel machines, those hard elements moving against each other require some special arrangements so as to minimise or prevent the long term friction damage which can arise in such situations. The joints in the human body are equipped with special tissues which can deal with such friction in a normally painless way. Things can and do go wrong with these arrangements, and when it does, pain and immobility can result. Such a condition is referred to popularly and medically as "arthritis".
The sections that follow look at arthritis in more detail, and at the role that the long chain omega-3 polyunsaturates have been shown to play in it's prevention and treatment.
Arthritis - the disease
Arthritis is the most common disease in the world, and about 20 million people in Britain are affected by it. Most people will be affected at some stage in their lives to some degree by arthritis. Something like 65 million working days are lost because of arthritis every year in the UK. People in the North of Britain tend to suffer from arthritis more than those in the South, and women tend to get it more than men, but we don't as yet know why. What causes of arthritis we don't yet know, but we do know from ancient skeletons that it has been around for a very long time. Quite a lot is known about certain aspects of arthritis, but the factors which decide who will be afflicted and who will not are largely unknown.
Mankind has been searching for ways and means to ease the pain and discomfort arthritis brings for many years. Much money has gone on research to study the disease, and we now know that there are over 200 kinds of arthritis, though most sufferers have one of the two commonest types, osteoarthritis or rheumatoid arthritis.
Osteoarthritis is the commonest form, affecting about 1 in 7 of us (in Britain), usually in our later years. It is a condition caused by the failure of the "lubricating system" in joints. When this happens, friction causes wear and tear on the bones in a joint, particularly the weight-bearing joints like hips and knees. Usually, only one or two joints are affected and the condition rarely spreads to other joints in the body. Since the pain can often be helped by painkilling drugs of the aspirin/paracetamol type the degree of disability can be small.
Replacement of the joint or joints is commonly carried out, especially in older patients, and is normally quite successful. Once a patient is diagnosed with osteoarthritis, he or she will have it for the rest of his or her lifetime, and drug therapy must be viewed with this in mind, especially in those people who may be sensitive to aspirin, or those prone to digestive upsets, which can be made worse by certain types of painkillers.
Rheumatoid Arthritis is the second most common form, and tends to be more of a "come and go" condition, in which several joints can be affected. It is usually accompanied by more marked inflammation, the joint typically being hot, swollen, painful and tender. The actual cause of the condition is the inflammation of the membranes surrounding the ends of the bones, the synovial membrane. Why this happens is not known. Although it usually affects adults, it does sometimes strike young children, when it is known as Still's Disease. Rheumatoid arthritis is more amenable to treatment than osteo-arthritis, mainly by drug and or diet therapies, though neither approach is instantaneous.
is a painful, inflammatory condition which can last for many years, although not always in a severe form. The spine is the area usually affected, and in severe cases some of the bones which make up the spine can fuse together, making the spine very stiff.
Gouty Arthritis is a form of arthritis affecting mainly the toe, knee and wrist joints. The inflammation is caused by the formation within the joint of crystals of a substance called sodium urate. T
There are a large number of other types of arthritis, which fortunately affect relatively few people. Lupus (SLE), Reiter's Disease, Carpal Tunnel Syndrome, fibrositis, psoriatic arthritis, bursitis and even tennis elbow all fall within this group. Some form of inflammatory change within the joint is the common factor.
What can be done about it?
Most sufferers learn by trial and error what things they can or can't eat and what things they can or can't do. Medical treatment can help, though in the case of osteo-arthritis, it is largely confined to aspirin-type drugs to relieve pain, or joint replacement surgery. Even so, over �150 million per year is spent on drugs to treat arthritis (that's about �3 per year for every man woman and child in the UK). Experience with arthritis drugs has made many older sufferers very cautious about popping pills to reduce the pain of arthritis. Many of them are turning to more traditional methods to deal with the problem, and just now medical research is providing us with the evidence to back up one of the oldest of the old-wives tales about arthritis. The oil from fish, the commonest form of which is known as cod liver oil, is unique in that it is made up from components not normally found in the human diet, things called long chain omega-3 polyunsaturates. For a more in-depth explanation of these key nutrients, see the pages on fats and oils, and on the omega-3 polyunsaturates
The scientific studies which provide the information for this conclusion will be looked at in more detail in following sections.
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Use of cod liver oil to relieve painful joints is the earliest recorded use of a food substance specifically for it's medicinal properties. Cod liver oil can therefore be considered the first "health food" or to use more modern parlance, the first "functional food".
Records from the Hope Hospital in Manchester show that cod liver oil was being widely prescribed by the physicians there in the mid 1800's, as it most probably was in many hospitals at the time. Although it is difficult to decide whether the benefit felt by the patients was the result of vitamin D curing their rickets, or whether the omega-3 polyunsaturates was helping their arthritis, there is little doubt that they did benefit. Cod liver oil was reported by one physician as being
" much requested by the poorer sort..."
Hospitals throughout the land made extensive use of cod liver oil during the latter half of the 19th century, and up to the middle of the 20th century, when it's popularity declined as synthetic vitamin tablets became available.
The modern history of cod liver oil, and more recently fish oil, in the treatment of arthritis started in the 1950's, a time when the relationship between a raised level of cholesterol in blood was being linked for the first time to an increased risk of heart disease. At that time it was also noticed that many arthritis sufferers had high cholesterol levels, and since at the time it was considered that cod liver oil could lower serum cholesterol, trials with arthritis patients were started.
The earliest published work in this area is that of two American clinicians, Brusch and Johnson. They published in the Journal of the National Medical Association in 1959. They reported their experiences with a group of 98 arthritis sufferers and claimed that 92% of their patients reported improvements in their condition after taking a probable 20mls of cod liver oil daily for 2 - 20 weeks.
Work by Coke at the Charterhouse Rheumatism Clinic reported in 1963 showed that dietary cod liver oil could change the composition of the fatty acids in the fluid within a joint (articular fluid). This pioneering work has recently been confirmed and extended by Navarro and colleagues, in a report of their work published in the Journal of Rheumatology.
Papers published after the early 1970's recognised the different types of arthritis, and tend to fall into two groups, those dealing with rheumatoid arthritis (RA) , and those dealing with osteo-arthritis(OA). The former group is the larger of the two. To view more detail on the scientific evidence on the role of the long chain omega-3 polyunsaturates in rheumatoid arthritis, click on rheumatoid arthritis
To see a summary of the scientific evidence dealing with the long chain omega-3 polyunsaturates and osteoarthritis, click on osteoarthritis
What to do about it.
To take advantage of the omega-3's, arthritis sufferers should aim to eat at least 5-10g of fish oil daily, or 35-70g per week. There are various ways of getting this quantity of oil. A daily 4 oz portion of oil-rich fish such as smoked mackerel, smoked salmon, or kippers, will supply this much oil, as will a similar amount of canned or fresh salmon, herring, sardines, sprats, pilchards. One or two teaspoonsful of cod liver oil can offer an alternative, as can fish oil capsules. Arthritis is a condition which has been developing within sufferers for 30 or 40 years, so it is unlikely to disappear overnight. In conjunction with the oil, sufferers should modify their diet, so as to cut out red meats, reduce dairy fats like cheese and cream, and increase fruit and vegetable consumption. Fish should be eaten as often as possible. Vegetarian diets have been shown to help, but if sufferers want to eat meat, then they should eat chicken or turkey, preferably without the skin. These dietary changes have been demonstrated by medical research to be helpful, and recently the Arthritis and Rheumatism Council recommended such changes to arthritis patients.