Adding good oils to your diet – and eliminating bad ones – can make a
difference in how you feel. Here’s what you should know about the best and the worst
oils.
Just about anyone suffering from stiff and aching joints has wished for magical oil to
make those bones move more smoothly. Some have even tried rubbing sore joints with motor
oil or spraying them with WD-40.
Smearing yourself with these messy metal lubricants won’t do a thing for your
arthritis. But you may be surprised to learn that putting the right kind of oils inside
your body could help with the aches and pains.
Out of all the choices, four oils rise to the top. There’s strong evidence that
fish oil supplements with omega-3 fatty acids can ease rheumatoid arthritis (RA) symptoms,
help prevent Raynaud’s syndrome spasms and possibly relieve some lupus symptoms. Both
borage seed and evening primrose seed oils have been shown to ease RA inflammation, and
flaxseed oil may be also helpful. Readily available, these oils appear not to have serious
side effects when taken as directed.
Though these oils aren’t mainstream medical treatment, some people have been using
them for a decade or more, often along with conventional medications – and with their
doctors’ blessings. Lawrence Leventhal, MD, chief of rheumatology at Graduate
Hospital in Philadelphia, says many of his rheumatoid arthritis patients are taking borage
seed oil supplements.
"I prefer that my rheumatoid arthritis patients be on proven prescription
medication if they have severe disease," says Dr. Leventhal. "But there are
people who resist taking drugs because of concerns about side effects. So I start them on
borage oil. It’s a reasonable thing to try."
Although many say oil supplements give only "modest" improvement, Leventhal
says the results vary. "I’ve had some patients it doesn’t work for,"
he says. "And I’ve had others who could taper down on methotrexate or steroids
and do fine. A few patients use borage oil as their only medication."
Oil supplements are not a cure and, at best, appear to give relief similar to
nonsteroidal anti-inflammatory drugs (NSAIDs) – though without risky side effects.
Many people with RA and similar diseases need to take disease modifying drugs for maximum
protection from joint destruction, using NSAIDs or perhaps these oils as a supplemental
treatment.
Moreover, rheumatic diseases have flares and remissions, so any reduction in symptoms
has to be carefully examined for cause and effect. Also, Joel Kremer, MD, chief of
rheumatology at Albany Medical College in New York and a leading researcher on fish oil,
says that despite more than a decade of study, researchers still don’t know the
optimal dosage, or if a combination of oils might work better than one alone.
Taking oil supplements might help your symptoms, says Kremer, but you have to take a
lot of capsules – 10 to 20 per day, depending on the potency of the products –
to match the amounts used in studies, and it might take up to three months before you
notice any effects. Although oil supplements don’t cost more than most prescription
medications – fish oil and flaxseed cost about $30 a month, evening primrose oil $100
or so – they are not covered by insurance.
Supplements aren’t the whole story on oils, though. Kremer’s best advice, he
says, is to take some supplements, but also to lower your overall fat intake, change some
of the oils you eat and add oil-rich cold water fish to your diet at least twice a week.
Here’s why.
Good Fats, Bad Fats
It’s known that saturated fats from animal products contribute to many diseases.
Now researchers believe the balance of polyunsaturated fats in Western diets is out of
whack and may be contributing to an increase in inflammatory and autoimmune diseases. They
say we consume too many of the fats that promote inflammation and not enough of the fats
that produce the chemicals to counter it.
Our diets are overwhelmed by the omega-6 fatty acids called linoleic acid, the type
that’s in most vegetable and cooking oils and is the primary oil used in processed
and fast foods. In our bodies, some of this fat breaks down into arachidonic acid that
fuels the agents that contribute to inflammation.
Meanwhile, we are probably getting too little of the fatty acids – omega 3s and
others – that help reduce inflammation and improve circulation.
To get our fats back in balance, says oil experts, we need to cut down on dietary fats
from linoleic acid and increase our consumption of omega 3s and other beneficial fats
found in cold water fish, and some plants oils such as flaxseed, olive and canola oils.
Another type of "good" fat, called GLA, or gamma linoleic acid, is found
concentrated in borage seed oil and evening primrose seed oil and is not easily found in
food.
A Who’s Who of Oils
Here’s an overview of the oil supplements most-used for rheumatoid arthritis and
other forms of inflammatory arthritis.
Fish oil is perhaps best known for its heart-saving abilities, but the
same qualities help reduce RA and Raynaud’s symptoms. In some studies, those with RA
using fish oil were able to significantly reduce their use of NSAIDs, or even discontinue
them without increased pain and inflammation. In a study of 32 people with Raynaud’s
who took fish oil, researchers found that the oil improved the tolerance to cold exposure
among those who had primary but not secondary Raynaud’s.
How it’s used: Fish oil comes as a liquid and in softgel capsules. The
usual dose is about three grams, or 3,000 milligrams (mg), total of EPA/DHA (the key
ingredient in fish oil) per day. Be sure to check the labels: the capsules may say
"1,000 mg of fish oil," but will have varying percentages of EPA and DHA. If
they contain 300 mg, you’ll need to take 10 capsules a day. Look for high potency
capsules so you don’t have to take so many. A month’s supply costs about $45.
Evening primrose seed oil and borage seed oil also eased RA symptoms
in studies – some say better than fish oil in terms of relieving joint tenderness.
Evening primrose oil is better known, but borage oil has a higher percentage the
beneficial acid GLA. Some folklore recommends rubbing these oils on your aching joints, or
on the hands for those with Raynaud’s, but there is no evidence that this helps.
How it’s used: These oils are available as liquids but are most
often taken in softgel capsules. The usual dosage for RA is about 1.8 grams (1,800 mg) of
GLA a day. Again, check the ingredients on the label and see how much GLA is in each
capsule, then do the math. If the capsules have 300 mg of GLA, you will need to take six a
day. Evening primrose oil may contain 130 mg of GLA, so you’ll need 14 capsules per
day. A month’s supply of borage oil is about $60; evening primrose oil is about $100
a month.
Flaxseed oil is believed by some to help arthritis, but so far there
aren’t any good studies that prove this. The belief it may reduce inflammation in RA
comes from its composition, and from studies that show it increases levels of the
beneficial fatty acid EPA. In a study of healthy men who limited "bad" fats in
the diet, researchers found flaxseed oil worked as well as fish oil. It’s also
possible flaxseed might help with lupus. In a small study of nine people with lupus
nephritis (kidney inflammation), 30 grams of flaxseed a day significantly lowered
cholesterol, thinned blood, reduced inflammation and improved kidney function.
How it’s used: Flaxseed is sold as a liquid, whole seeds and a meal or
flour for baking. Some sources recommend taking 1 to 3 tablespoons a day of the oil or
about 30 grams (one-fourth of a cup) of the meal or flour. You can use the meal or flour,
which costs about $1 a pound, in bread, pancake and waffle recipes: One quick-bread recipe
uses 2 cups of flaxseed flour with 4 cups of regular flour. It has a nutty flavor and the
oil, which costs about $15 for 16 ounces, is used in salad dressings.
How to Buy and Store Oils
These medicinal oils can become rancid after exposure to heat, light and oxygen. To
prevent this:
- Read supplement labels carefully. Buy only plant oils that are certified organic (or
grown without pesticides); that are packaged in opaque plastic containers; and that have
an expiration date. Look for products that have been "expeller-pressed;"
expeller pressing means no heat or chemicals were used in the process of squeezing the oil
out of the seeds.
- Look for liquid oils displayed in a refrigerated case; store oils and capsules in the
refrigerator.
- Remember: The products are not pure GLA or EPA/DHA. Check to see how much of the active
ingredients you are getting. Look for high dosage capsules, and be prepared to do some
calculations to figure out how many you need to take. If you aren’t sure, ask a
pharmacist.
Not Ready for Prime Time?
In spite of the evidence for these oil supplements, they aren’t routinely
recommended. That may be because they are not FDA approved or covered by insurance, says
Robert B. Zurier, MD, chief of rheumatology at the University of Massachusetts and a
leading researcher in GLA oils.
According to Dr. Leventhal, who has also conducted research on GLA oils,
"Physicians are naturally skeptical about a diet therapy."
There are also some unanswered questions: Which type of oil is better? Would it help to
take more than one? And what’s the best dosage?
"Both GLA and fish oil have been shown to help, and they might be good
together," says Kremer. "But we don’t know – it hasn’t been
studied enough."
Until more is known, proceed with caution. "I don’t want my patients to think
this is the way to go, and give up conventional treatments," says Dr. Leventhal.
"People who want to try this should talk to their doctor."
Cautions and Good Advice
If you decide to try oil supplements, tell your doctor and keep a daily diary to note
any changes.
- Fish oil and the GLA oils thin the blood, which means they could increase your risk of
bleeding if you are also taking NSAIDs, blood thinning medication, or herbs such as ginger
or turmeric that also slow clotting. Although no one has had a bleeding incident in any of
the studies, it’s best to be cautious. Check with your doctor.
- If you use the old fish oil standby, cod liver oil, be sure it has been stripped of
vitamins A and D: These vitamins are toxic in large doses.
- Allow three months for the oil supplements to take effect. If you don’t see any
changes by then, the supplements may not be working for you.
- It’s rare, but some people may get intestinal upsets or gas when they start taking
oils. Start with a one-third dosage and increase it gradually to reduce the chances of
stomach upsets or gas.
- Fish oil capsules are tasteless, but burping may bring up a fishy taste or odor, so take
them right before meals.
- Some people who take high doses of fish oil have reported that their body odor takes on
a fishy smell.
Fish that Give Good Fat
- Mackerel
- Herring
- Sardines
- Anchovies
- Albacore tuna
- Salmon
The colder the water they live in, the more omega-3 oil in the fish: A half a pound of
salmon yields 3 to 4 grams of omega-3 oil. Frozen and canned fish are fine. However, be
sure the fish is wild: Farm-raised fish (such as salmon) are fed commercial products
resulting in lower omega-3 levels.
Is it Time to Change Your Oil?
Consider changing the balance of oils in your diet to improve your whole health
picture. Here’s what some experts suggest.
- Toss the cooking and salad oils in your house except for those high in beneficial fatty
acids such as flaxseed, olive and canola oils.
- Cut your meat and other animal product consumption to no more than 4 to 6 ounces per day
(about the size of two decks of playing cards).
- Eat cold water fish two or three times a week (see list above).
- Add flaxseed products to your diet. The oil can be used in salad dressings and the flour
can be cooked into muffins or pancakes for breakfast.
- Watch your overall fat intake: no more than 30 percent of your daily calories should
come from any kind of fat.
Judith Horstman writes regularly about alternative and complementary therapies for
Arthritis Today. Her book on alternative and complementary therapies was published by the
Arthritis Foundation.
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