Glucosamine, Fish Oil & Curcumin

This family of treatments are designed to provide symptom relief for pain associated with arthritis. All have similar effects, and can be regarded as non-pharmacological anti-inflammatory products. Each has different properties, and individual response varies widely. Generally, if you wish to try the products, we recommend using one product at a time, for a period of six weeks. Some patients describe a noticeable improvement within a couple of weeks, for others the effects are subtle and it can be difficult to know if there is any improvement. If you don’t feel there is any improvement at six weeks, , the product should be ceased and if no change is noted then it is safe to assume that there has been no effect. You can then commence a trial for six weeks of a different product if you wish.

It is important to note that these products do not rebuild cartilage, prevent progression of arthritis or lead to stronger bones.

Fish Oil and Krill Oil

What are fish oils?

Fish oils are oils found in the tissues of fish. They contain a certain type of fat called omega-3.

What are omega-3 fats?

Omega-3 fats are a type of fat that may be important for good general health. Our bodies cannot produce omega-3 fats so they must be obtained from food. Omega-3 fats are mostly found in oily fish and certain nut and seed oils.

How do omega-3 fats work for arthritis?

Certain types of omega-3 fats can reduce inflammation from arthritis. This may help to relieve joint pain and stiffness in a similar way to non-steroidal antiinflammatory drugs (NSAIDs).

What types of arthritis benefit from omega-3 fats?

Omega-3 fats have not been studied in all forms of arthritis. Current research suggests omega-3 fats are helpful for people with inflammatory arthritis, such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. There is also evidence that fish oils may help control symptoms of osteoarthritis and lupus (systemic lupus erythematosus).

Other benefits

Long-term intake of fish oil has been shown to reduce the reliance on NSAIDs in some cases of arthritis. This can help decrease the risk of side effects from these medicines. Fish oils can also help reduce the risk of heart disease and heart attack. There is some evidence that they may also play a role in preventing and treating depression.

Where do I find omega-3 fats?

  • Oily fish, such as tuna, salmon, herring, sardines and mackerel
  • Flaxseed (linseed) and canola oil (however these oils are not as active against inflammation as fish oils)
  • Walnuts
  • Foods fortified with omega-3, such as margarines and eggs.

Eating foods rich in omega-3 fats may help you to achieve benefits for your heart and general health. However it is unlikely that you can obtain enough omega-3 fats from your diet to reduce inflammation without fish oil supplements.

Where do I find fish oil supplements?

There are many different brands of fish oils supplements available at health food shops and pharmacies.

What type of supplement should I choose?

Fish oil supplements are available as capsules or as a liquid. Different brands of capsules vary in the amount of omega-3 fats they contain so it is worthwhile to compare brands. Check the label to see the amount of omega-3 contained in each capsule (it may be listed as a total omega-3 or as EPA and DHA, which are two forms of omega-3). Bottled fish oil is generally the most convenient and least expensive way to take the dose needed to reduce inflammation. Capsules are preferred by some people and are more portable when travelling.

Should I take fish oil or krill oil?

Nearly all of the information about omega-3 fats and arthritis has come from studies of fish oils. To date, there is very little evidence to show whether krill oil is useful for arthritis.

What dose should I take for arthritis?

Research suggests the dose needed to reduce inflammation is 2.7 grams of omega-3 (EPA plus DHA) daily. This dose usually requires approximately either:

  • nine to 14 standard 1000mg fish oil capsules or five to seven capsules of a fish oil concentrate per day, or
  • 15mL of bottled fish oil or five to seven mL of concentrated bottled fish oil per day.

Recent studies suggest that daily fish oil supplements which provide omega-3 (containing a minimum of 180mg EPA plus 120mg DHA) may be useful for osteoarthritis.

(Note, fish oil can benefit your heart and general health at lower doses. However, these doses, generally, will not control symptoms of arthritis).

How long will it take to notice an effect?

You may need to take fish oil supplements regularly at the recommended arthritis dose for six to 8 weeks before you notice improvements in your arthritis symptoms. If there is no change by then, the supplements are probably not effective for your arthritis.

Are there any side effects?

Fish oil is usually well tolerated. A possible side effect from fish oil supplements is a mildly upset stomach (for example, heartburn, nausea, diarrhoea). There is currently no evidence that fish oils increase the risk of bleeding or interact with medicines that affect bleeding, such as aspirin or warfarin. Despite this, it is recommended that you consult with your doctor before having major surgery or if you are commencing fish oil while taking warfarin. INR monitoring tests may be done more often at first, as with the addition of any new treatment, to ensure there are no side effects. If there is any bleeding, stop taking fish oils and consult with your doctor.

Caution with fish liver oils

It is important not to confuse fish oils with fish liver oils (such as cod liver oil and halibut liver oil). Fish liver oils also contain vitamin A. Large amounts of vitamin A can cause serious side effects, particularly during pregnancy. If you take fish liver oils in the doses recommended for arthritis you may exceed the recommended daily intake of vitamin A. Only take the dose of fish liver oil recommended on the label. To increase your intake of omega-3 fats, you should do so by taking pure fish oils, not fish liver oils.

Let your doctor know

Always let your doctor and pharmacist know if you are taking any treatments, including fish oils and other natural medicines. Do not stop any current treatments without first discussing it with your doctor.

Glucosamine

Glucosamine is the most common nutritional/diet supplements used in the treatment of arthritis pain and inflammation. Patients who suffer from osteoarthritis may benefit from taking these supplements. Osteoarthritis, also called degenerative joint disease is the most common form of arthritis. It occurs most often in older people. This disease affects the tissue covering the ends of bones in a joint (cartilage). In a person with osteoarthritis, the cartilage becomes damaged and worn out causing pain, swelling, stiffness and restricted movement in the affected joint.

Naturally, this supplement is found in the human bones, while their artificial origin is abstracted from animal products. These nutritional supplements may help alleviate joint pain and perhaps even slow the breakdown of cartilage or restore the joint cartilage. These are one option among the non-surgical treatment options employed to reduce pain in joint diseases. Patients taking glucosamine dietary supplement along with other osteoarthritis treatments may attain optimal levels of relief from osteoarthritis-related joint pain.

The regular dosage level for the supplements varies according to the age and weight of the individual.

Adverse Effects

The common side effects of Glucosamine may include:

  • Stomach upsets
  • Nausea/Vomiting
  • Diarrhea
  • Burning sensation in the chest

These supplements should be taken with food to reduce some of these side effects. Always talk to your doctor before you start taking these supplements.

Contraindications

Glucosamine supplements are not appropriate for everyone. Therefore,theyshould be taken onlyunder medical supervision in the following groups of patients:

  • Diabetic patients 
  • Pregnant/Breast-feeding women 
  • Young children
  • Patients allergic to shellfish 
  • Patients on Anticoagulant (Coumadin) therapy

Curcumin/ Tumeric

urcuma longa, Cur­cuma domestica

Origin: A yellow-colored powder ground from the root of the turmeric plant. The turmeric plant grows in India and Indonesia and is related to the ginger family (it is a common ingredient in curries). Curcumin is a key chemical in turmeric.

Claims: Reduces pain, inflammation and stiffness related to osteoarthritis (OA).

What we know: Traditionally used in Chinese and Indian Ayurvedic medicine to treat arthritis turmeric/curcumin blocks inflammatory cytokines and enzymes, including cyclooxygenase-2 (COX-2), the target of celecoxib (Celebrex).

Studies:

A 2010 clinical trial found that a turmeric supplement called Meriva (standardized to 75 percent curcumin combined with phosphatidylcholine) provided long-term improvement in pain and function in 100 patients with knee OA.

In a small 2012 pilot study, a curcumin product called BCM-95 reduced joint pain and swelling in patients with active RA better than diclofenac, an nonsteroidal anti-inflammatory drug (NSAID).

Dosage:

Capsules, extract (more likely to be free of contaminants) or spice. For OA: Capsule, typically 400 mg to 600 mg, three times per day; or 0.5 g to 1 g of powdered root up to 3 g per day.

"Curcumin makes up only about 2 to 6 percent of turmeric, so be sure to check the standardized amount of curcumin," advises Randy Horowitz, MD, medical director of the University of Arizona Center for Integrative Medicine in Tucson.

High doses of turmeric can act as a blood thinner and cause stomach upset. Avoid turmeric/curcumin if you take blood thinners such as warfarin (Coumadin), are about to have surgery, are pregnant or have gallbladder disease.