Rheumatoid Arthritis and Omega 3 Fatty Acids

There has been a study on rheumatoid arthritis and omega-3 fatty acids recently. D. di Giuseppe and colleagues published: “Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: a prospective cohort study of women.” The authors collected data on diet via a self-administered food-frequency questionnaire in 1987 and 1997. “Among 32 232 women born 1914-1948, 205 RA cases were identified during a mean follow-up of 7.5 years (1 January 2003 to 31 December 2010; 2 41 120 person-years).” They concluded: “This prospective study of women supports the hypothesis that dietary intake of long-chain n-3 PUFAs may play a role in aetiology of RA.” Link: http://www.ncbi.nlm.nih.gov/pubmed/23940215.

Some people already think that we all have to take fish oil supplementation to avoid getting rheumatoid arthritis. I think that most of the population need more omega-3 fatty acids, but I don’t think that we need supplementation. Y.H. Lee and colleagues published a meta-analysis in 2012: “Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis.” At ≥2.7 g omega-3 polyunsaturated fatty acids per day there has been reduced nonsteroidal anti-inflammatory drug (NSAID) consumption over the 10 RCTs. Tender joint, swollen joint count, morning stiffness, and physical function only showed a trend but did not reach statistical significance. Link: http://www.ncbi.nlm.nih.gov/pubmed/22835600.

So what can one do? Reduce omega-6 fatty acids and increase omega-3 fatty acids. I don’t think that fish or krill oil is necessary. If you eat fish, prefer fish to meat (meat is bad anyway). If you live the happy vegetarian life watch out to significantly reduce omega-6 fatty acids (especially if you’re going vegan) and use more oils and seeds containing omega-3 fatty acids, linseed contains the most.

Krill Omega Red Oil - English version

I've been asked to translate my German blogpost on Krill Omenga Red Oil

I had seen an advertisement in a German magazine called tina "the premium women's magazine" No. 16 of the 10.04.2012 edition, p. 65, concerning Krill Omega Red Oil.

We see Kirsten, a "busy and helpful lady" in retirement. She has dressed up for the poster in the colour of the advertised product. The ad wants to tell us, what "krill Omega unlike fish oil" can do. In the first paragraph after under the title "I look after my heart" but no difference to fish oil is presented. Then addressed as"the secret of krill Omega", the krill capsules are described as odor-free - same applies to the salmon oil capsules from ALDI, Lidl & Co.[German discounter chains]. Secondly, it is claimed that krill is a more effective source of than omega-3 fatty acids than fish oil . "1 Capsule contains: 200 mg phospholipids, of which 60% are omega-3 phospholipids." 115 mg omega-3 fatty acids with the following composition: 50% EPA, 28% DHA and 22% other fatty acids. "Antioxidant: astaxanthin 25 µg." The ALDI (South) salmon oil capsule contains 191 mg omega-3 fatty acids, of which 148 mg are DHA and EPA (in a capsule of krill Omega there are only 90 mg). Well, there's something fishy! Moreover it's advertised, that krill oil comes from the most unpolluted sea - this may be true, but also the fish oil capsules are free of pollutants. Whether krill oil or fish oil can maintain heart health, is still under discussion. There is not a single study that describes an advantage of krill oil.

Let's have a look at costs. Most sites on the Internet charge about €27 for 60 pills [German sources]. At ALDI, you pay approx. 5 ct (approximately €3.00 for 120 capsules) per gram of fish oil. For Krill Omega Red Oil you'd pay a whopping €2.50 per gram of krill oil.

Krill Oil is a by-product of the extraction of krill powder for animal fodder.

Learn more about: Krill Oil Supplementation
http://rheumatologe.blogspot.de/2012/10/krill-oil-supplementation.html

Krill Oil Supplementation

I’ve written a blogpost on krill oil in German, which I’ll translate here and add a couple of things, which I’ve seen, when researching in English. The German text is here: http://rheumatologe.blogspot.de/2012/08/antarktis-krill-komplex-und-arthrose.html  

In an advertisement on Antarctic krill complex, I’d found the usual blending of osteoarthritis, arthritis and back problems, which should be treated with this krill oil. It is a supplement of omega-3-fatty acids. "The lack of Omega-3 fatty acids is the nutrition problem number 1..." so the advertisement. I also see a nutrition problem in inadequate intake of omega-3 fatty acids, but not as the most important dietary problem! The product advertises with a greater anti-inflammatory effect, but it does not describe how it has been tested, perhaps against old grease from a fast-food fryers?

"Krill oil is much more pleasant to take than fish oils, because it causes no belching." Oil having equivalent effect means same amount, everything else is wishful thinking. "The omega-3 krill oil also is absorbed better by the body than omega-3 from fish oil!" That still would have to be proven. Whether the omega-3 fatty acids come from krill or fish is not significant for the absorption by the body.

"Krill is in the early stages of the food chain and is therefore free of heavy metals or other pollutants." If you look at the results of fish oil capsules, then these are almost all unpolluted: http://www.test.de/Fischoelkapseln-Meer-Schutz-fuers-Herz-1276864-1277493/  [German page]. So, advertising with contamination is insignificant.

The content of omega-3 fatty acids and DHA and EPA may not also be there. A capsule of Antarctic krill complex contains 150 mgs omega-3 fatty acids, which is 120 mgs DHA and EPA. The ALDI (South) [a common discount chain] salmon oil capsule contains 191 mgs omega-3 fatty acids, of which 148 mgs are DHA and EPA. Krill Oil max. contains 188 mgs omega-3 fatty acids, of which 153 mgs are DHA and EPA.

Cost? Ask for costs? That’s a good question, because at ALDI you pay approx. 5 ct (or 3.00 € for 120 capsules) per gram of fish oil and in Antarctic krill complex, it is unfortunately somewhat more expensive, because you pay € 1.31 per gram of krill oil (59.00 € for 90 capsules). With Krill Oil max. you pay 0.60 $ (36 $ for 60 capsules / 1 € = 1.28)

K.R. Baker and colleagues have shown in a study that there are links between fat composition and osteoarthritis; here studied in knee osteoarthritis: Association of plasma n-6 and n-3 polyunsaturated fatty acids with synovitis in the knee: the MOST study. They worked out that various knee joint findings, reflected in demonstrable levels of omega-3 and omega-6 fatty acids in plasma (blood), may describe a risk for the development of a knee joint osteoarthritis. "In conclusion, systemic levels of n-3 and n-6 PUFAs which are influenced by diet may be related to select structural findings in knees with or at risk of OA." Link: http://www.ncbi.nlm.nih.gov/pubmed/22353693. D.T. Felson, a scientist well known in rheumatic circles on the subject of osteoarthritis, had been involved in this study. The query in PubMed does not yield much more useable studies: ("Fatty Acids, Omega-3" [MESH]) AND "Osteoarthritis" [Mesh]. This is not surprising. Treatment with Omega-3 fatty acids has no immediate effects on pain or inflammation as the body slowly exchanges arachidonic acid (an omega-6 fatty acid, which is raw material for inflammation- and pain-producing prostaglandins) by eicosapentaenoic acid (EPA, an omega-3 fatty acid, which is raw material for inflammation- and pain-inhibiting prostaglandins). On this topic, see more at: http://rheumatologe.blogspot.de/2012/06/rheuma-und-ernahrung.html

What could be the consequence of this? You can provide a sufficient intake of omega-3 fatty acids against osteoarthritis and also because of other health benefits. If you are not vegetarian, then cold water fish such as mackerel, herring, salmon along with the regular supply of linseed oil, which is rich in alpha-linolenic acid (another omega-3 fatty acid). It only becomes problematic when you stay purely vegetable diets, because DHA and EPA (docosahexaenoic acid and eicosapentaenoic acid) are inadequately converted from alpha-linolenic acid. So, for the specific issue of vegetarians and vegans, another solution must be found, because fish oil capsule or even krill oil capsules are neither vegetarian nor vegan!

And if there still remains a reason for nutritional supplementation, then you have a cost saving of 96%, if you buy omega-3 capsules instead of Antarctic krill complex.

PS. Learn more about Omega-3 fatty acids on Wikipedia: http://en.wikipedia.org/wiki/Omega-3_fatty_acid  

Web MD has also interesting information on krill oil. “Insufficient Evidence for:
• High cholesterol.
• Premenstrual syndrome (PMS).
• High blood pressure.
• Stroke.
• Cancer.
• Depression.
• Other conditions.”
Here’s the link:  http://www.webmd.com/vitamins-supplements/ingredientmono-1172-KRILL%20OIL.aspx?activeIngredientId=1172&activeIngredientName=KRILL%20OIL  


Addendum 02.11.2012:
I've just read:
"Antarctic Pure Krill Oil is rich in essential DHA and EPA Omega 3 fatty acids and antioxidants, making it more superior to fish oil." Oh, more superior, why not most superior or even more most superior? If you see too many superlatives with anything concerning your health, usually something is fishy.

Addendum 28.02.2013
Did you think that the merry fishermen with Anthony Quinn as their captain sail for the Antarctic and come back with a few barrels of krill? You might want to look at http://www.alibaba.com/showroom/krill-meal.html, and you'll find where the krill oil might have its origin. Krill meal is used as animal fodder. Krill oil is a by-product. As krill oil contains lots of unsaturated fatty acids, it would turn the meal quickly rancid if left in the meal. Extracted it's sold to people, who have money to burn. They sell krill meal by the ton (for about 4000 US$ per metric ton) and some firm might supply 1000 tons per year. So there's more krill oil available than could be sold. It should be very cheap, but you know better, it's expensive.