Fish consumption and rheumatoid arthritis: Natural remedy or just another fish tale?

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

Follow me on Twitter @RobShmerling

When I see patients with rheumatoid arthritis, I’m often asked about diet. Are there foods that can help? Should I avoid certain foods?

The role of diet in arthritis

Whenever I’m asked about diet for arthritis, my short answer is that with a few exceptions, there is no proven role for making dietary changes. In the case of rheumatoid arthritis, there is no clear evidence that eating more (or less) of any particular food will improve (or worsen) their symptoms or protect their joints. Of course, new research could change my answer.

And what about the exceptions? The most important is probably gout. Certain foods and beverages (such as organ meats and alcohol) can predispose to the condition or make it worse. Most people with gout are told to modify their diets, although for most the impact is small.

What about the microbiome?

There is enormous interest now in the role of the microbiome — the vast numbers of microorganisms living within us — in health and disease. And we know that diet affects the microbiome within the intestinal tract. It could turn out that what you eat may cause certain populations of bacteria in the intestinal tract to rise or fall. Since these bacteria may affect immune function, and since rheumatoid arthritis is an autoimmune condition, it’s possible that changes in the microbiome will affect the activity and severity of rheumatoid arthritis. Researchers are working hard to understand how the microbiome might affect autoimmune diseases, and how this new perspective could lead to better control of conditions such as rheumatoid arthritis.

Fish, fish oil, and rheumatoid arthritis

A number of studies have found that fish oil supplements or a diet rich in fish oils may be helpful in controlling the inflammation of rheumatoid arthritis. In addition, it’s possible higher intake of fish oil actually reduces the likelihood of developing the disease. Some studies have found that rheumatoid arthritis is less common in places where fish consumption is highest. However, fish oil is not routinely recommended, because its effect is modest and medications tend to be much more effective.

A new study resurrects the idea that fish oil (or at least fish consumption) might suppress the joint inflammation of rheumatoid arthritis. Researchers publishing in the medical journal Arthritis Care & Research report that the more fish a person consumes, the better the control of their arthritis. In this study, researchers analyzed data from 176 people with rheumatoid arthritis, comparing their reported intake of non-fried fish with the results of their joint examinations and blood tests. Here’s what they found:

  • Those with the highest fish consumption (more than two servings per week) had the best control of their arthritis.
  • There was a “dose effect.” For minimal, low, or high fish consumption, the higher the intake, the better the arthritis.
  • The findings were noted even after accounting for other factors that might affect arthritis control, such as duration of disease and fish oil supplement use.

The fine print

This was a small study that found an association between fish consumption and control of rheumatoid arthritis. That’s not the same as finding that fish intake actually caused the improvement in arthritis. This is an important point because factors other than diet could explain the findings. For instance, it’s possible that people who eat fish regularly are generally more attuned to their health and take their medications more reliably than people who eat fish less often. That’s why the authors of this study do not conclude that everyone with rheumatoid arthritis should start eating more fish. What they do say is that additional research is needed.

One other point: the improvement in arthritis control noted among those who ate the most fish was modest, and so small that most patients probably wouldn’t notice. Still, small improvements can add up, so even a small effect from a natural remedy that poses minimal risk is worth consideration.

What now?

I’m hopeful that in the near future we’ll have more definitive, larger, and long-term studies that examine the role of diet on rheumatoid arthritis and other types of joint disease. Until then, I think people with rheumatoid arthritis should consider increasing their intake of non-fried fish. It might be good for the joints. And eating fish may have other health benefits as well, especially if it replaces less healthy choices.

Comments:

  1. Ravi

    Fish consumption two times in a week. Please suggest, if somebody is vegetarian.

  2. Rob Shmerling

    Some additional comments:
    5) It’s true that seafood consumption is a risk factor for gout – one of many – but it’s relatively rare that rheumatoid arthritis and gout develop in the same person. Also, the actual risk of developing gout specifically due to increased fish consumption is not high. So, in my view, if you have RA, concerns about also developing gout should not discourage fish consumption.
    6) While we have no cure for RA and while no treatment for RA is risk-free, there are now a number of good therapies for RA. Even considering the results of this new research, it’s not recommended that a person with RA rely solely on diet to control their disease.
    7) Questions about “confounders” such as income, weight, and other factors are always relevant in a study linking diet with medical outcomes; in the study I described, income was accounted for; weight was not – the authors state that “While the group consuming fish ≥2 times per week had some baseline traits that might be associated with improved disease activity, such as lower BMI and higher socioeconomic status, the prevalence of smoking was also highest in this group, making it difficult to draw conclusions about the way that these potential confounders could affect the relationship between fish consumption” and control of RA.”

  3. Rob Shmerling

    Hi, all – thanks for your interest in this blog and for all the great comments. I’d make a few points in response:
    1) Single medical studies are very rarely definitive; this one is no exception. Perhaps the amount of certainty that a study of this sort can provide is overestimated – we’d all like to have more certainty, but the reality is that a study correlating dietary survey results with arthritis symptoms is highly unlikely to be definitive. One of my jobs in an article of this type is to explain why some headlines (“Eat more fish, cure your arthritis!”) should be taken with many grains of salt.
    2) The study I’m describing here did not look at the risk of developing RA based on fish consumption …it looked at how well RA was controlled in people with the disease. I included a link to the study in the article (and here) so if a reader would like more information, the key points (and statistics) are there; and just to be clear: it’s not my study and I have no vested interest in whether fish consumption does or does not help rheumatoid arthritis.
    3) I know of no convincing studies that fish oil helps osteoarthritis or that food allergies cause rheumatoid arthritis; as far as I can tell, the cause of RA is unknown.
    4) The issue of mercury exposure from eating fish was not addressed in the recent study; most advice about restricting fish consumption because of mercury is for children and women who are pregnant, may become pregnant, or are breastfeeding; see advice from the FDA: https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm

  4. Ana Aitawa

    The global rheumatoid arthritis drugs market expected to reach US$ 36.3 billion by 2021, growing at CAGR 8.5% over the forecast period 2017-2021, mainly due to number of promising RA therapies are in development and drug approvals.

    Browse Rheumatoid Arthritis Drugs Market by Drug Class – Disease-Modifying Anti-Rheumatic Drugs (DMARDs), Tumor Necrosis Factor (TNF) Inhibitors, Janus Kinase (JAK) Inhibitors, Other Biologics and Forecast 2017-2021 at https://www.ihealthcareanalyst.com/report/rheumatoid-arthritis-drugs-market/

    Major players operating in the global rheumatoid arthritis drugs market and profiled in this report include AbbVie,
    Ablynx, Alder Biopharmaceuticals, Amgen, Bristol-Myers Squibb, Centocor, Daiichi Sankyo, Eli Lilly, Galapagos NV, Genentech (Roche), Gilead, GlaxoSmithKline, Incyte Corp., Janssen Biotech, Johnson & Johnson, MedImmune, Merck & Co., Pfizer, Regeneron, Sanofi, and UCB.

  5. Ravi kumar

    My Mom has RA and she does not eat non-veg foods. Please suggest the diet for her.

  6. Stephanie Embrey

    Whenever a study indicates a correlation involving fish consumption, my first thought is, “Did it control for wealth/income?” Poverty correlates to countless bad health outcomes, and fish is expensive. It seems a far more likely cause is financial status with effects of fish consumption and condition improvement.

    In this case, I’m also wondering if the study controlled for weight/BMI? Seems obvious for a study examining joints, but this review doesn’t state so explicitly.

  7. Ana

    I definitely can say my diet totally changed my symptoms of RA. My diet choices include constantly whatever’s best for my gut bacteria. The levels of RA and Anti nuclear factor on blood test proves it, but it also closely related to stress levels. We cannot treat from only one perspective if we are a whole.

  8. Lake

    Thanks for the good article.

  9. henry ndege

    please advice if consumption of fresh fish oil can treat arthritis.

  10. Q.T. Kehyeng

    I AM VERY GREATFUL TO SUBSCRIBE IN YOUR MAGAZINE, ITS VERY NFORMATIVE, I CAN FEEL EVERY ISSUE OR TOPICS ARE RELATED TO ME.THANK YOU VERY MUCH
    MORE AND MORE POWER TO YOU ALL
    GOD BLESS

  11. margie

    There is pleny of research out there that proves that food allergies and sensitivities are the leading causes for RA, why don’t you say that? It varies person to person and one will benefit from blood tests for such allergins, to avoid those foods and lessen their immune response of inflammation. That’s what RA is, inflamation. Stay away from pharmeceuticals, they’ll destroy your body and health. Doctors make money from prescriptions, do your own research

  12. Richard

    There is not a square mile of ocean from the poles to the equator that is not polluted and full of plastic.
    The chances that you will be consuming microplastic is 1/3 in the UK and 1/4 in the US.

  13. Kilty McGowan

    Those who offer real, live nutrition know far better than Allopathic doctors what is best for RA or other forms of Arthritis. Fish three times a week along with crustaceans helped resolve the problems of this disease in my family and others we know.
    It is inexpensive, available, no prescription needed. Also, it tastes good. We also take Salmon oil or Krill oil each day. Don’t tell my family it doesn’t work. Nothing offered my family by doctors made any difference yet my 83 and 76-year-old parents were able to get up out of their beds and become active productive individuals again.
    Try it, it won’t kill you like so many drugs offered to treat this disease.

  14. Fizzle

    Way to go Ben

  15. Silvia Gilbert

    Do you have health publications in Spanish. I would like to send some articles to my family, but I need them in Spanish, if you please can send me that link. Thanks so much

  16. Boris Tong

    Anyone who can give u a direct answer is either lying to u or not looking at articles critically enough.
    This article should probably give more stats though. Like how many time more likely to have arthritis under control. 1.5x or 50x.

  17. Opto

    Dear Ben, as a clinician in optometry, it makes me crazy what we don’t know; just as suffering from arthritis makes me crazy

  18. Gerhard Pukropski

    Ben is wright on target. This is stupid but tell me,what are you selling ?A very old but keen observant shoemaker once told me 60 years ago .They go to College to learn how to steal

  19. Jeab Rose

    RELIABLE information???????????? Telling those with RA they can eat more or less SUGAR–depending on their preference–and it won’t make a difference in their health. Pretty conclusive evidence that the Dr. needs to go back to school.

  20. chih M Fan

    It’s a good advice. No matter consuming more fish works or not,
    it’s better to increase fish consumption and cutting down red meat. It increases our awareness of our diet.

  21. Alice DeVries

    I appreciated the article! I see the “” maybes” and “mights” as precautionary which seems to be necessary. After all, each individual may react differently

  22. Mark

    I think it clarified that since the evidence is dubious you should save your money. It did say however that eating fish seemed to do more than supplements.

  23. Karen Orr

    “Plant-Based Diets: A Physician’s Guide,” a guide to teach physicians about the current recommendations for a plant-based diet, the science behind it, how to help patients implement it, and the research supporting it. This can be found in the U.S. National Library of Medicine National Institutes of Health.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662288/

    Dr. Michael Klaper: DIET, ARTHRITIS, & AUTOIMMUNE DISEASES
    http://doctorklaper.com/answers/answers07/

    The Physicians Committee for Responsible Medicine: Foods & Arthritis
    http://www.pcrm.org/health/health-topics/foods-and-arthritis

    Dr. John McDougall: Diet & Arthritis
    https://www.drmcdougall.com/health/education/health-science/featured-articles/articles/diet-only-hope-for-arthritis/

    Dr. Michael Greger: Turmeric, the spice that helps ease rheumatoid arthritis pain
    http://nutritionfacts.org/2015/01/27/the-spice-that-helps-ease-rheumatoid-arthritis-pain/

    8 natural remedies for treating arthritis
    http://snip.ly/XQ9d#http://livelovefruit.com/2014/09/8-natural-remedies-for-treating-arthritis/

  24. Dorothy Conway Comeau

    I agree full heartily!

  25. Jeanne-kathe Remillard

    Cod liver oil has helped me getting rid of swollen and painful knees and fingers.
    Turmeric capsules and fresh ones, garlic, and lemon juice from fresh lemons each morning taken before breakfast, has totally cured my Arthritis, and kept all Flu and colds away for years.
    It takes an effort, but it worked

  26. Vincent E Friedewald

    Disagree with Ben. My patients are constantly reading about/asking questions about effects of diet on everything from ADHD to cancer. When we don’t know, any answer other than “we don’t know” would be a lie. If the newsletter published only definitive answers, it would likely be a very scanty publication.

  27. Dr.Jamil Qasem

    I advice people to eat at least 2 serves of fish weekly, whether you have Rh. Arthritis or not. It is good for general health. This is a nice article.

  28. Katharine

    You don’t mention osteoarthritis but I have found following Dr. Vad’s anti-inflammatory diet most helpful along with an hour long walk first thing upon rising. Lots of sardines, salmon and tuna in the diet.

  29. Melody Grandell

    I agree with Ben. Unless your research is backed by studies and peer reviewed, why put it out there? McDougall and his doctor friends all base their comments on well-researched studies and is always peer reviewed.

  30. Marie D B

    I find it helpful to know these doubts for when I read other articles on the subject that might be less scrupulous. It’s also useful to know that eating fish, which has other benefits, could possibly be of benefit to rm, increasing the motivation to eat more fish. Couldn’t hurt, if you’re careful about the mercury.

  31. A. Goldstein

    I would like to emphasize the point in the article that eating non-fried fish might show beneficial effects in other bodily systems. There are several types of food that may improve, prevent or delay deleterious biological processes. Surely, not all of them will prove worthless.
    We must eat to live and so it follows that if you eat better you will live better. The better the quality of energy consumption, the better that life is supported.

  32. Ben

    If you do not have a difinitive answer on fish consumption regarding rheumatoide arthritis, then why put the article in and waste our time reading about nothing.
    This seems to go on virtually all the time, like might, may, could,
    your articles have very little in the way of conclusive comments
    like “yes” this will happen or “no” this will not happen or work.
    I am tired of reading about all the “maybe, the mights, the coulds, and the shoulds.

    • A. Goldstein

      Some “maybes” or “mights” will likely turn out to be “definites .” I like to know about those things early on, in the maybe stage. It’s called putting the odds a bit more in favor of a healthier and more satisfying life. I’m convinced I am doing just that.

    • GE

      I believe that fish oil and naturally oily fish should be helpful for many reasons, but isn’t fish also a high purine food which can bring on a gout attack the more often you consume it? I already know that sardines can be a big problem for that, but my experience is also with Ocean Pollock. How do you choose?

    • Jaclyn

      I think the key reason he wrote the article is that it’s a question a lot of patients have. I think Dr. Shmerling did an excellent job of explaining what we do and don’t know about fish consumption and RA to help patients make sense of the risks (minimal to non-existent) and benefits (maybe some effect) of increasing fish in the diet. There’s not a lot of good treatments for RA or a good understanding of the underlying cause(s), so patients inevitably try dietary changes and do their own experimentation to see if any of these lifestyle changes help. And it’s good to have this article out there which sets right expectation for patients, and possibly counterbalances the oversimplified assessments rampant in other publications.

    • rich

      I agree with you wholeheartedly. This is a bunch of nonsense !

    • jim

      I know. This is absolutely a waste of my time to read this nonsense when they tell you absolutely nothing!

    • Inday

      It is something to read..and what is written depends on researches of others..slolutiin is stop reading all articles from harvard? me, i thank the Lord they hepl people, free of charge, in disseminating their acquired knowledge. And I thank the Lord..it also means they are well, and so am I and you..all alive by His grace! May God bless all!

    • Alba

      Of course, but that’s the way science improves our lives, not a simple way, a hard work that it begins with “maybe”, “could” and so on. It’s not all so fantastic as some may say when they want to pay your attention.
      That’s why it’s worth to read Harvard Health Publications.

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