Low Omega-6 to Omega-3 Ratio May Keep Knee Arthritis Pain in Check

by Chris Centeno, MD /

omega-6 to omega-3 ratio for knee arthritis pain

I religiously take high-dose, high-quality fish oil on a twice-a-day basis. If I stop, it’s because I’m out, and it takes a few days, but I begin to feel like every other 50-some-year-old guy who usually pops Motrin just to get a good workout going. Is this effect for real? Many studies have shown that the omega-3 fatty acids in fish oil may be able to help joints, so let’s look at a new one.

Understanding Omega-6 and Omega-3

Omega-6 and omega-3 are polyunsaturated fatty acids that are essential for the health benefits they provide to our cells, brain, bones, skin, and heart for starters. Unfortunately, however, our bodies can’t self-produce either, so they must be obtained through the diet. Sources of omega-3 include foods such as salmon, sardines, eggs, walnuts, flaxseed, olive oil, and vegetables such as spinach. Sources of omega-6 include foods such as chicken, pork, grain-fed beef (grass-fed beef tends to be higher in omega-3), eggs, walnuts, sesame seeds, mayonnaise, and many vegetable oils (e.g., sunflower oil, corn oil, canola oil).

High levels of omega-3 are associated with less inflammation, but there’s a kicker with omega-6; high levels of omega-6 are associated with more inflammation in the body. In the American diet, the overconsumption of omega-6 is fairly typical as it’s found in abundance in most junk foods: corn chips, potato chips, popcorn, fast foods (chicken nuggets, French fries, onion rings—anything fried in vegetable oils), candies and baked goods (e.g., brownies, cookies, cake, etc.), shortenings and margarine, and so on. Junk foods, as we know, keep our bodies chronically inflamed, leading to health problems down the road, such as diabetes and other metabolic diseases, cardiovascular disease, and even cancer, which research has shown thrives on sugar.

Here’s where it gets tricky. While healthy sources of both omega-6 and omega-3 are essential, it’s not necessarily in how much of each we consume but in the proper ratio of the two. The general consensus seems to be that the omega-6:omega-3 ratio should average around 4:1—that’s four parts omega-6 to one part omega-3. In other words, if you consume 640 mg of omega-6, you should consume at least 160 mg of omega-3). Some recommend an even lower ratio; 2:1 or 1:1 for example. Due to the high consumption of junk food, however, Americans average somewhere around a 16:1 ratio or higher. So to emphasize, in understanding omega-6 and omega-3, it’s not about the raw numbers; it’s about the ratio.

Knowing this, let’s take a look at the new study examining omega-6 to omega-3 ratios for knee arthritis pain.

Is There an Optimal Omega-6 to Omega-3 Ratio for Knee Arthritis Pain?

The new study consisted of 167 subjects aged 45–85 with knee arthritis. Based on omega-6 to omega-3 ratios in blood samples, each subject was categorized into one of four 6:3 omega ratio levels. Finally, pain, function, and perceived stress were compared between the lowest 6:3 ratio group and the highest 6:3 ratio group. The result? The subjects in the high 6:3 ratio group experienced more knee arthritis pain and more limitations in function and were under a higher degree of stress than the low 6:3 ratio group.

So how do you lower your omega-6 to omega-3 ratio? Consuming foods that are rich in omega-3s and eliminating junk foods is a good start. The goal isn’t to eliminate omega-6, after all it is an essential fatty acid; however, the goal is to obtain it in moderation and from healthy sources. In addition, lowering your intake of omega-6 and increasing your intake of omega-3 to achieve or exceed the recommended 4:1 or lower ratio is key. Some suggest a Mediterranean diet is one way to help you get these ratios in line.

What Is a Mediterranean Diet?

Today’s feature study falls right in step with a study I covered suggesting that a Mediterranean diet may lower the risk of knee arthritis. Many of the high-inflammatory (a key feature of arthritis is inflammation in the joint) foods listed under omega-6 above—vegetable oils, margarine, processed foods, and fast foods for example—are not included in a Mediterranean diet. Mediterranean diets heavily consist of anti-inflammatory foods, such as whole vegetables and fruits, fish, poultry, nuts, and olive oil. Many of the foods in a Mediterranean diet are rich in omega-3s and have a healthier omega-6:omega-3 ratio.

So once again, the research is showing us to ax the processed and junk foods, focus less on the raw numbers, and put more effort into the right combinations and ratios of healthy foods.

Fish Oil Dose

How much fish oil is enough? Just popping the average fish-oil cap from Costco isn’t likely to offset your high omega-6 levels. Instead, read this piece on how to get to the higher quality and bigger doses of fish oil needed to control inflammation.

If you don’t want to read the bigger piece on the correct dose of fish oil to control inflammation, here’s what I do. For our super-concentrated fish oil, I take 3–4 pills twice a day. If you don’t want to take our brand, then Nordic Naturals has a high-quality product. Try the EPA Xtra or ProEPA Xtra and take similar doses.

The upshot? You can offset those burgers and fries (which you should only be eating very rarely) and much of the rest of the American diet! So take your fish oil regularly—your knees will thank you!

Category: Knee, Nutrition

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4 thoughts on “Low Omega-6 to Omega-3 Ratio May Keep Knee Arthritis Pain in Check

  1. H Saraway

    I have been discussing stem cells therapy for brain injury with my London based neurologist – a professor-. He warns that there are ‘ a lot of charlatans out there’ And advised me that for stem cell therapy to successfully work on brain injury one would need to kill all existing cells with chemotherapy first amd replace with stem cells.

    Anyone for chemo????

    Thought not!

    1. Regenexx Team

      H Saraway,

      Unfortunately, there are some less than reputable in the stem cell space.

  2. Chad Freeman

    I lost 110 lbs on the mediterranean last diet and am keeping it off. Too little too late for the knee arthritis but maybe it won’t get worse.

    1. Regenexx Team

      Chad,
      Whow! That is very impressive – congrats!

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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