Cod Liver Oil: A Natural NSAID-Sparing Agent for Rheumatoid Arthritis

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For the millions suffering from rheumatoid arthritis, new hope emerges from an age-old source - the humble cod. Groundbreaking research reveals that cod liver oil may be the key to reducing harmful NSAID use in RA patients

In a groundbreaking study, cod liver oil containing omega-3 fatty acids allowed 39% of rheumatoid arthritis patients to reduce their NSAID use by over 30% without disease worsening. This natural, food-based complementary approach may help RA patients decrease reliance on NSAIDs, which can have serious side effects.

In a significant development for complementary medicine, researchers have found that cod liver oil supplementation can substantially decrease the need for nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA)The study, led by B. Galarraga et al., discovered that 39% of RA patients who took cod liver oil containing omega-3 fatty acids for 9 months were able to reduce their NSAID intake by over 30% without experiencing worsening of disease activity.1

This finding is particularly relevant given the well-known side effects associated with long-term NSAID use, which can range from gastrointestinal bleeding to increased risk of cardiovascular events.2 As the authors note, "concerns about their side-effects have limited their use" and "with the recent finding that selective cyclo-oxygenase-2 (COX-2) inhibitors are associated with an increased frequency of cardiovascular (CV) events, concerns about the CV safety of the non-selective NSAID have been raised."3

The double-blind, placebo-controlled study involved 97 RA patients who were randomized to receive either 10g of cod liver oil (containing 2.2g of omega-3 fatty acids) or placebo daily.4 Remarkably, after 9 months, 19 out of 49 patients (39%) in the cod liver oil group were able to reduce their daily NSAID requirement by over 30%, compared to only 5 out of 48 (10%) in the placebo group (P = 0.002).5 The mean daily NSAID requirement reduction was also significantly higher in the cod liver oil group (26 ± 6%) compared to placebo (9 ± 3%) (P = 0.010).6

Importantly, this substantial decrease in NSAID use was achieved "without any worsening of their disease activity," and indeed, "there was a significant improvement in the pain VAS of those patients taking daily SSMO1 [cod liver oil]."7 This suggests that cod liver oil supplementation may provide a safer, more natural avenue for RA patients to manage pain and inflammation.

The potential for omega-3 fatty acids to modulate inflammatory pathways in RA has been previously noted. As the researchers explain, the most potent inflammatory prostaglandins and leukotrienes are derived from omega-6 fatty acids, while omega-3s competitively inhibit their production and give rise to less inflammatory mediators.8 By increasing omega-3 intake, "altering the EFA content in the diet, or by administration of supplements, can modify the type of PGs and LTs formed"9 in a favorable direction.

This study is the largest and only dual-centre trial to date investigating the effects of omega-3 fatty acids in RA.10 The use of a robust primary endpoint - the proportion of patients achieving a clinically meaningful NSAID reduction of 30% - sets it apart from previous studies that simply looked at statistical mean reductions in NSAID use.11 Despite a relatively high dropout rate, intention-to-treat analysis showed that 39% of all patients starting cod liver oil were still able to significantly cut back on NSAIDs.12

In conclusion, this groundbreaking research provides compelling evidence that a natural, food-based intervention like cod liver oil can serve as a powerful adjunct therapy for RA patients. By reducing the need for NSAIDs and their associated risks, cod liver oil supplementation opens up a safer avenue for managing this debilitating condition. In the search for more holistic approaches to treatment, this study marks an important step forward for complementary medicine in the field of rheumatology.

For more information on the health benefits of cod liver, visit our database on the subject here.

For more information on natural approaches to rheumatoid arthritis, visit our database on the subject here.



1. B. Galarraga et al., "Cod Liver Oil (n-3 Fatty Acids) as an Non-Steroidal Anti-Inflammatory Drug Sparing Agent in Rheumatoid Arthritis," Rheumatology 47, no. 5 (May 2008): 665–69,

2. Galarraga et al., 666.

3. Galarraga et al., 665.

4. Galarraga et al., 665-666.

5. Galarraga et al., 666.

6. Galarraga et al., 666.

7. Galarraga et al., 668.

8. Galarraga et al., 665.

9. Galarraga et al., 665.

10. Galarraga et al., 668.

11. Galarraga et al., 668.

12. Galarraga et al., 668.

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