Rheumatoid Arthritis Improved with Lower Ratio of AA to EPA

Published on December 17, 2021

Study shows that decreasing AA and increasing EPA through diet and supplementation improved symptoms of RA

Key Points

Rheumatoid Arthritis (RA) is an autoimmune disease presenting with pain and inflammation in the joints
Omega-3 fatty acids (such as EPA) have anti-inflammatory effects, while omega-6 fatty acids (such as AA) can be pro-inflammatory
A study on RA patients showed that a diet low in AA and supplemented with fish oils (increasing EPA) resulted in the greatest, significant improvements in RA symptoms
Lowering the AA:EPA Ratio can be one way to help manage inflammation and improve symptoms of chronic, inflammatory diseases

Rheumatoid Arthritis (RA) is an autoimmune disease that causes inflammation and pain in the joints. RA can affect other organs in the body, increasing the risk of diseases such as cardiovascular disease, gastrointestinal disorders, infections, osteoporosis and depression.

Both vitamin D and omega-3s have been shown to benefit individuals with chronic, autoimmune diseases such as RA. A recent analysis using VITAL trial data recently reported a 25-30% decreased incidence of autoimmune diseases, including RA, among participants taking vitamin D and/or omega-3s vs only placebos. This effect may likely be due to the anti-inflammatory actions of vitamin D and omega-3s within the body.

Study Investigates Anti-Inflammatory Diet and Omega-3 Supplementation for RA Patients

A study by Adam et al. compared the effects of an anti-inflammatory diet, fish oil supplementation, and the combination of both for patients with RA. 68 patients were divided into two groups:

Group 1 followed a western diet for 8 months
Group 2 followed an anti-inflammatory, modified lacto-vegetarian diet for 8 months; this diet provided less than 90 mg/day of arachidonic acid (AA), a fatty acid that has been shown to have pro-inflammatory effects

Both groups were also given either fish oil capsules (30 mg/kg of body weight) or placebo for 3 months at a time. RA symptoms and blood markers for inflammation and fatty acids were measured and tracked.

What did the study find?

60 patients were included in the analysis after the 8 month study. Patients on the anti-inflammatory diet had an AA intake of approximately 30% of the amount consumed in the western diet group. Blood work showed a significant correlation between AA intake and the percent of AA in the red blood cell membranes, resulting in a significantly lower percent of AA in the blood for those on the anti-inflammatory diet.

Among those supplementing with fish oils, EPA (eicosapentaenoic acid, an anti-inflammatory fatty acid found in fatty fish) levels increased by 244% in the anti-inflammatory diet group compared to 217% in the western diet group. The anti-inflammatory diet group also saw a decrease in C-Reactive Protein (CRP) levels with fish oil supplementation, while the western diet group did not.

In terms of symptoms, the anti-inflammatory diet group saw improvements in joint swelling and tenderness, with and without the addition of fish oil supplements. Adding fish oil supplements significantly reduced the number of tender and swollen joints in both groups, by

28% and 34% in the anti-inflammatory diet group
11% and 22% in the western diet group

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Overall effects on joint symptoms in each group were as follows:

no improvement in the Western Diet group without supplements; a 17% overall improvement when fish oil supplements were added
a 14% improvement with the anti-inflammatory diet alone, and a 31% overall improvement with an anti-inflammatory diet plus fish oil supplements

This study indicates that lower intake of AA and/or increased intake of EPA may lead to improvement in RA, with the greatest benefit seen with a combination of lower AA and higher EPA.

Using the AA:EPA Ratio to Measure Inflammation Levels

Omega-3s and omega-6s play different roles in inflammation. Omega-6s (such as AA) are essential for initiating and sustaining the inflammatory response – a physiologic function necessary for healing from injuries and infection. Having too much of these omega-6s can suppress the immune system, promote blood clotting, and increase inflammation and inflammatory disease. On the other hand, omega-3s (such as DHA and EPA) are anti-inflammatory and promote the resolution of the inflammatory process.

The AA:EPA Ratio test measures the ratio of the amount of pro-inflammatory AA and anti-inflammatory EPA in the red blood cells, and can be an indication of the amount of cellular inflammation in the body. Desirable ranges for health are generally between 2.5 and 11, however, some experts recommend an even lower AA:EPA Ratio of 1 to 3 for the resolution of cellular inflammation. Measuring the ratio can help individuals take more specific steps to achieve an ideal ratio and lower overall inflammation levels, mainly by increasing omega-3s (EPA and DHA) intake and decreasing pro-inflammatory omega-6 intake (such as AA).

Add the AA:EPA Ratio to Your Custom Home Test Kit

Having and maintaining healthy vitamin D, omega-3s, and other nutrient levels can help improve your health now and for your future. Choose which to measure, such as your vitamin D, omega-3s with the AA:EPA Ratio, and essential minerals including magnesium and zinc, by creating your custom home test kit today. Take steps to improve the status of each of these measurements to benefit your overall health. You can also track your own intakes, symptoms and results to see what works best for YOU.

Enroll and test your levels today, learn what steps to take to improve your status of vitamin D (see below) and other nutrients and blood markers, and take action! By enrolling in the GrassrootsHealth projects, you are not only contributing valuable information to everyone, you are also gaining knowledge about how you could improve your own health through measuring and tracking your nutrient status, and educating yourself on how to improve it.

How Can You Use this Information for YOUR Health?

Having and maintaining healthy vitamin D and other nutrient levels can help improve your health now and for your future. Measuring is the only way to make sure you are getting enough!

STEP 1 Order your at-home blood spot test kit to measure vitamin D and other nutrients of concern to you, such as omega-3s, magnesium, essential and toxic elements (zinc, copper, selenium, lead, cadmium, mercury); include hsCRP as a marker of inflammation or HbA1c for blood sugar health

STEP 2 Answer the online questionnaire as part of the GrassrootsHealth study

STEP 3 Using our educational materials and tools (such as our dose calculators), assess your results to determine if you are in your desired target range or if actions should be taken to get there

STEP 4 After 3-6 months of implementing your changes, re-test to see if you have achieved your target level(s)

Enroll in D*action and Build Your Custom Test Kit!