Omega-3 + Curcumin: Potent, Gentle Pain Relief

James H. O’Keefe MD with Joan O’Keefe RD

We’ve all done it: awakened with a sore knee, aching back, or pounding headache, and reached—almost reflexively—for the familiar orange or blue bottle of ibuprofen or naproxen. Non-steroidal anti-inflammatory drugs (NSAIDs) are available over the counter (OTC) as Motrin®, Advil®, and Aleve®, or as prescription drugs like meloxicam, celecoxib, and diclofenac. Although NSAIDS have long been the standard quick fix for pain and inflammation, these drugs come with a cost—and it’s steeper than you might think. When my mother, Leatrice, was 91, she was prescribed celecoxib for arthritis pain, and it promptly caused kidney failure, very high potassium levels, and cardiac arrest. This is shockingly common. Twenty-nine million Americans regularly use OTC NSAIDs to treat pain. Every year in the United States, NSAID use causes 100,000 hospitalizations and 17,000 deaths.

On the other hand, omega-3 (the active ingredient in fish oil) and curcumin (the active ingredient in the spice turmeric) in combination provide an effective, natural, and gentle anti-inflammatory therapy that is safer than NSAIDs. Combining omega-3 with curcumin can calm joint and muscle pain, brighten your mood, and possibly help prevent Alzheimer’s. And importantly, omega-3 and curcumin don’t have potentially life-threatening side effects. Even so, taking omega-3 and curcumin on an empty stomach can cause nuisance gastrointestinal (GI) side effects in some individuals. 

NSAID Complications

Let’s start with the stomach. NSAIDs work by blocking enzymes called COX-1 and COX-2, which are involved in the body’s inflammatory response. Unfortunately, COX-1 also protects the lining of your stomach and intestines. When you block it, you risk damaging that protective barrier, potentially leading to ulcers, bleeding, and serious digestive issues.

Then there are the kidneys. NSAIDs reduce blood flow to the kidneys, especially when used frequently. This can lead to fluid retention, elevated blood pressure, and in some cases, kidney injury or failure. Older adults and people with pre-existing kidney disease, hypertension, or diabetes are particularly vulnerable. A steady NSAID habit is like putting the kidneys under chronic stress, and these drugs can even cause catastrophic kidney failure, like it did to my mother.

But perhaps most concerning for my fellow cardiologists is what NSAIDs do to the heart. Many people are surprised to learn that regular NSAID use can raise blood pressure, increase the risk of heart failure, and lead to heart attacks. In fact, a large meta-analysis published in the The BMJ (formerly the British Medical Journal) found that NSAID use—especially diclofenac and high-dose ibuprofen—was associated with a significantly higher risk of cardiovascular events like heart attack and stroke. Ironically, the very pills people take to ease the pain of aging joints may be speeding up the aging of their hearts, blood vessels, and kidneys.

Aspirin is the original NSAID, and at higher doses it can have all the same problems that other NSAIDs have. Yet low-dose aspirin, 81 mg daily—aka baby aspirin—remains one of our most prescribed meds in cardiology. At the baby aspirin dose, it is quite safe, although it slightly increases risk of bruising and bleeding. If you have a history of coronary disease, such as a heart attack, stent, or bypass surgery, or a CardioScan calcium score above 100, aspirin at 81 mg day is something you probably need. As always, it’s something you should discuss with your health care provider. Please note, never take NSAIDs on an empty stomach. Personally, like my dear grandmother Dorothy who lived to be 103, I take a baby aspirin every night at bedtime because I find that it helps me fall asleep faster and sleep more soundly.

Unique Health Benefits of Omega-3 + Curcumin

But if NSAIDs are so dangerous, what’s a sore, stiff, inflamed body to do? That’s where the dynamic duo of omega-3 fatty acids and curcumin come in. These natural, gentle anti-inflammatory therapies offer many of the benefits of NSAIDs—without the dangerous downsides. I take this combo every day: 2,500 mg of DHA + EPA (found in two or three purified fish oil capsules), and 600 mg of curcumin (as Theracurmin) twice a day with meals. When I forget to take them, my joints will remind me the next day.

Omega-3, found in fish oil and fatty fish—like salmon, trout, and sardines—have powerful anti-inflammatory effects. They’re especially good at taming the kind of chronic, low-grade inflammation that underlies joint pain, heart disease, depression, obesity, and Alzheimer’s dementia. EPA and DHA, omega-3 fatty acids found in fish oil, inhibit pro-inflammatory cytokines such as nuclear factor kappa B (NF-κB), tumor necrosis factor-alpha (TNF-α), and interleukins IL-1β and IL-6. Omega-3 also promotes the production of anti-inflammatory resolvins and protectins. Studies consistently have shown omega-3 supplementation can reduce joint pain, morning stiffness, and NSAID use in people with arthritis.

A 2020 meta-analysis in Nutrients found that omega-3 supplementation significantly reduced symptoms of major depressive disorder. Other omega-3 studies show improvements in rheumatoid arthritis symptoms and even protection against cognitive decline. One very well-established benefit from a chronically high intake of omega-3 is protection against age-related brain shrinkage. People who have high levels of omega-3 fats in their cell membranes are much more likely to maintain a plump and youthful brain rather than the shriveled-up organs commonly seen in older individuals, especially in those with dementia. 

Curcumin, the active ingredient in the spice turmeric, is perhaps the most potent nutritional weapon against chronic inflammation. Unlike NSAIDs, curcumin shuts down the inflammation right at the source, by reducing levels of NF-κB, TNF-α, and IL-1β and IL-6. These are master hormones that turn on the inflammatory cascade, so when curcumin reduces levels of these key chemical messengers, it does more than mask the symptoms, it reduces tissue inflammation and may prevent cartilage damage, joint destruction, and brain dysfunction or cognitive impairment, as reported in small randomized trials. A 2016 study published in Phytotherapy Research found that curcumin was as effective as ibuprofen for knee osteoarthritis—but without the GI side effects. It also appears to help cool down inflammatory pathways in the body and brain, improve insulin sensitivity, and support endothelial function in blood vessels.

My clinical experience with countless patients and my own body suggests that together, omega-3 and curcumin work synergistically to reduce markers and manifestations of inflammation more effectively than either alone. One study in Clinical Nutrition ESPEN found that a combo of curcumin and fish oil improved joint pain and stiffness in people with osteoarthritis, while other emerging research also hints at brain and overall longevity benefits.

When Is It OK to Use NSAIDs?

Now, I’m not suggesting you toss your NSAIDs in the trash. They’re still useful after acute injuries, surgeries, and dental procedures, and for other short-term pain, but even then, you should use them sparingly. These drugs, including naproxen, meloxicam, ibuprofen and Celebrex®, are generally safe for most people when taken as directed for a few days to a couple of weeks. But consider making omega-3 along with curcumin part of your daily regimen as an alternative for treating or preventing chronic aches and pains. You’ll be soothing your joints, protecting your heart and brain, and maybe even adding a few healthy years to your life without subjecting yourself to the toxic effects of chronic NSAID use.

Dr. James O’Keefe is founder and Chief Medical Officer of CardioTabs, a nutritional supplement company that creates and sells products including omega-3, curcumin, magnesium glycinate + taurate, and probiotics.