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

August 28, 2017

About the Author

photo of Robert H. Shmerling, MD

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio
View all posts by Robert H. Shmerling, MD


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September 10, 2017

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

Rob Shmerling
September 5, 2017

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.”

Rob Shmerling
September 5, 2017

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:

Ana Aitawa
September 4, 2017

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

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.

Ravi kumar
August 31, 2017

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

Stephanie Embrey
August 30, 2017

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.

August 30, 2017

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.

August 29, 2017

Thanks for the good article.

henry ndege
August 29, 2017

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

Philomena Aigbe
September 1, 2017

It does not sound true. ..but Fish is good source of Protein and vitamin E

Q.T. Kehyeng
August 29, 2017


August 29, 2017

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

August 29, 2017

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.

Kilty McGowan
August 28, 2017

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.

August 28, 2017

Way to go Ben

Silvia Gilbert
August 28, 2017

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

Boris Tong
August 28, 2017

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.

August 28, 2017

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

Gerhard Pukropski
August 28, 2017

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

Jeab Rose
August 28, 2017

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.

chih M Fan
August 28, 2017

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.

Alice DeVries
August 28, 2017

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

August 28, 2017

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.

Karen Orr
August 28, 2017

“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.


The Physicians Committee for Responsible Medicine: Foods & Arthritis

Dr. John McDougall: Diet & Arthritis

Dr. Michael Greger: Turmeric, the spice that helps ease rheumatoid arthritis pain

8 natural remedies for treating arthritis

Dorothy Conway Comeau
August 28, 2017

I agree full heartily!

Jeanne-kathe Remillard
August 28, 2017

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

Vincent E Friedewald
August 28, 2017

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.

Dr.Jamil Qasem
August 28, 2017

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.

August 28, 2017

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.

Melody Grandell
August 28, 2017

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.

Marie D B
August 28, 2017

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.

A. Goldstein
August 28, 2017

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.

August 28, 2017

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
August 28, 2017

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.

August 28, 2017

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?

August 28, 2017

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.

August 28, 2017

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

August 28, 2017

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

August 28, 2017

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 also means they are well, and so am I and you..all alive by His grace! May God bless all!

August 29, 2017

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 Publishing.

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