3 natural alternatives to anti-inflammatory drugs: what the research shows

If you’ve got a toothache, backache, or joint pain, your first thought is probably to reach for ibuprofen or another non-steroidal anti-inflammatory drug (NSAID). These medications work, but they come with real downsides: gastrointestinal bleeding, kidney problems with long-term use, and cardiovascular risks that have become clearer over the past two decades [1].

This has led many people to wonder whether natural alternatives might help. The short answer is: some might, but the evidence varies considerably depending on what you’re trying to treat.

Understanding inflammation first

Before diving into specific supplements, it helps to understand what inflammation actually is and why it matters.

Inflammation is your body’s defence system. When you cut your finger or catch a cold, the redness, swelling, and warmth you experience are signs that your immune system is responding to injury or infection. This acute inflammation is beneficial, it helps clear pathogens and starts the healing process.

The problems arise with chronic inflammation, the kind that persists for months or years without a clear trigger. Research over the past few decades has linked chronic low-grade inflammation to conditions ranging from heart disease and type 2 diabetes to arthritis and possibly some cancers [2]. This is where the interest in anti-inflammatory supplements comes from.

But here’s the thing: simply taking an anti-inflammatory supplement isn’t going to fix underlying health problems. If you have chronic inflammation, there’s usually a reason, perhaps excess body fat (which produces inflammatory cytokines), poor diet, lack of physical activity, or an autoimmune condition. Supplements might help at the margins, but they’re not substitutes for addressing root causes.

With that caveat in mind, here’s what the clinical research actually shows about three commonly promoted natural anti-inflammatories.

1. Fish oil (omega-3 fatty acids)

Fish oil is probably the most well-researched natural anti-inflammatory, and it’s the one I’d say has the strongest evidence behind it, at least for certain conditions.

What fish oil contains

Fish oil provides two omega-3 fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). These are “essential” fatty acids, meaning your body cannot make them and must get them from food. The richest dietary sources are oily fish like salmon, mackerel, sardines, and herring.

How omega-3s affect inflammation

The mechanism here is reasonably well understood. Omega-3 fatty acids get incorporated into cell membranes throughout your body. When cells are damaged or stimulated, they release fatty acids from these membranes, which then get converted into signalling molecules called eicosanoids.

Here’s where it gets interesting: omega-6 fatty acids (abundant in vegetable oils and processed foods) tend to produce pro-inflammatory eicosanoids, while omega-3s produce anti-inflammatory ones. Most Western diets contain far more omega-6 than omega-3, sometimes at ratios of 15:1 or higher, when historically humans likely ate closer to 1:1 [3].

By increasing omega-3 intake, you shift this balance. EPA and DHA also inhibit the enzyme cyclooxygenase (COX), which is the same target as ibuprofen and other NSAIDs, though the effect is gentler [4].

What the clinical evidence shows

For rheumatoid arthritis, the evidence is reasonably good. A meta-analysis of 17 randomised controlled trials found that fish oil supplementation (averaging about 3.5 grams of EPA+DHA daily) significantly reduced joint pain, morning stiffness, and the number of painful joints in RA patients. Some participants were able to reduce their NSAID use [5].

For general pain, the picture is less clear. One study on non-specific neck and back pain found that taking 1,200 mg of omega-3 daily for 75 days led to 60% of participants reporting improved pain and no longer needing analgesics [6]. That sounds impressive, but this was an uncontrolled study, meaning we don’t know how much improvement occurred simply because people expected to get better.

For muscle soreness after exercise, a small study found that 3,000 mg of omega-3 daily for a week before exercise reduced delayed-onset muscle soreness [7]. Interesting, but hardly definitive given the study size.

My honest assessment

Fish oil is probably the most evidence-backed natural anti-inflammatory, but let’s be realistic about what it can do. If you have rheumatoid arthritis, it might modestly reduce your symptoms and could let you take fewer NSAIDs. For general aches and pains, the effects are likely subtle at best.

The typical therapeutic dose in studies ranges from 2,000 to 4,000 mg of combined EPA and DHA daily, which is considerably more than the 300-500 mg in a standard fish oil capsule. You’d need to take several capsules daily or use a concentrated product.

Fish oil is generally safe, but higher doses can cause fishy burps, loose stools, and increased bleeding tendency. If you’re on blood thinners like aspirin or warfarin, talk to your doctor first.

For more detail on fish oil’s full range of effects, see our complete guide to fish oil.

2. Curcumin

Curcumin is the yellow compound in turmeric that’s responsible for both the spice’s colour and most of its purported health benefits. It’s become enormously popular in recent years, and there’s actually some decent science behind the hype, though with important caveats.

The absorption problem

Before discussing what curcumin does, I need to mention its biggest limitation: your body absorbs it very poorly. When you eat turmeric or take a basic curcumin supplement, most of it passes straight through your digestive system without entering your bloodstream [8].

This is why most curcumin research uses enhanced formulations, products that include piperine (black pepper extract), phospholipids, or nanoparticle technology to improve absorption. If you’re considering curcumin, you’ll likely want one of these formulations rather than plain turmeric powder.

How curcumin works

In laboratory studies, curcumin inhibits multiple inflammation-related pathways. It suppresses NF-κB, a transcription factor that turns on inflammatory genes. It reduces production of pro-inflammatory cytokines like TNF-α and IL-6. And it inhibits COX-2, similar to how NSAIDs work [9].

The question is whether these effects translate to meaningful benefits in humans when curcumin is taken orally.

Clinical evidence

For osteoarthritis, curcumin has shown promise. A 2016 meta-analysis of 8 randomised trials found that curcumin significantly reduced pain scores compared to placebo in osteoarthritis patients, with effect sizes comparable to ibuprofen in some studies [10]. Most trials used 1,000 mg of curcumin daily in enhanced formulations.

For rheumatoid arthritis, the evidence is thinner. A few small trials suggest possible benefit, but larger confirmatory studies are needed.

For inflammatory bowel disease (IBD), curcumin has been studied as an add-on therapy to standard treatment for ulcerative colitis. A randomised trial found that patients taking curcumin alongside their usual medication were more likely to achieve remission than those on medication alone [11]. However, curcumin isn’t a replacement for standard IBD treatment.

In cancer patients undergoing chemotherapy, some studies have found that curcumin reduces inflammatory markers like C-reactive protein and IL-6, which might improve quality of life, though this isn’t the same as treating cancer itself [12].

My honest assessment

Curcumin appears to have genuine anti-inflammatory effects in humans, at least when taken in bioavailable formulations at adequate doses. For joint pain from osteoarthritis, it may be worth trying as an alternative or complement to NSAIDs. It has a better safety profile than long-term NSAID use.

However, don’t expect miracles. The benefits in studies are modest, typically a reduction in pain scores rather than complete relief. And if you have serious inflammatory conditions like rheumatoid arthritis or IBD, curcumin is at best an adjunct to proper medical treatment, not a replacement.

Typical doses in studies range from 500 to 1,000 mg of curcumin daily in enhanced formulations.

For a comprehensive look at curcumin’s benefits and safety considerations, see our detailed curcumin article.

3. Resveratrol

Resveratrol is a polyphenol found in grape skins, red wine, berries, and some other plants. It gained fame from the “French paradox,” the observation that French people had relatively low rates of heart disease despite diets high in saturated fat, which researchers attributed partly to their red wine consumption.

The French paradox and reality

The French paradox is probably more myth than reality. French heart disease rates aren’t actually that exceptional when you account for reporting differences between countries, and multiple factors beyond wine explain their cardiovascular health, including meal patterns, smaller portions, and more walking [13].

That doesn’t mean resveratrol is worthless, though. It does have some biological properties worth looking at.

How resveratrol works

In laboratory studies, resveratrol inhibits COX-1 and COX-2, the same enzymes targeted by aspirin and other NSAIDs. It also activates SIRT1, a protein linked to cellular longevity and metabolism, and suppresses NF-κB signalling [14].

There’s been enormous interest in resveratrol for anti-ageing, fuelled by studies showing that it extends lifespan in yeast, worms, and sometimes mice. Whether any of this translates to humans is another question entirely.

Clinical evidence

For inflammation specifically, the human evidence is mixed. A meta-analysis of 11 randomised trials found that resveratrol significantly reduced C-reactive protein (a marker of inflammation) and TNF-α levels, though the effect sizes were small [15].

For cardiovascular health, despite the French paradox narrative, clinical trials of resveratrol supplements have been largely disappointing. Most haven’t shown meaningful improvements in blood pressure, cholesterol, or other cardiovascular markers [16].

For metabolic health, some studies suggest resveratrol might improve insulin sensitivity and blood sugar control in people with type 2 diabetes, possibly through its anti-inflammatory effects [17]. But the evidence isn’t consistent enough to make strong recommendations.

For pain conditions, there’s very limited direct evidence. Unlike fish oil and curcumin, resveratrol hasn’t been well studied specifically for arthritis or other pain conditions.

My honest assessment

Resveratrol is an interesting compound with plausible mechanisms, but the clinical evidence doesn’t support the hype it often receives. If you’re looking for a natural anti-inflammatory with practical benefits for pain or arthritis, fish oil or curcumin have better evidence.

The doses used in human studies typically range from 150 to 500 mg daily, far more than you’d get from drinking red wine (a glass of red wine contains perhaps 1-2 mg of resveratrol). If you want to try it, you’ll need supplements.

Resveratrol appears safe at typical doses, but it can interact with blood thinners and should be used cautiously if you’re on medications that affect clotting.

For more information, see our resveratrol guide.

Other natural anti-inflammatories worth mentioning

While fish oil, curcumin, and resveratrol are the most popular, a few other natural compounds have some anti-inflammatory evidence:

Boswellia (frankincense extract) has shown benefit for osteoarthritis in several trials, possibly by inhibiting 5-lipoxygenase rather than COX [18]. It’s worth considering if you’re interested in joint health. See our boswellia article for details.

Ginger contains gingerols that have anti-inflammatory properties in laboratory studies, though human evidence is limited mostly to nausea rather than pain or inflammation.

So which one should you try?

If you’re dealing with osteoarthritis, curcumin has reasonable evidence, and fish oil may help too. These are worth trying if you want to reduce how much ibuprofen you’re taking. See our osteoarthritis supplements guide for more options.

For rheumatoid arthritis, fish oil has the best evidence as something to take alongside your prescribed medications. Don’t stop what your rheumatologist gave you.

If you’re just looking to reduce general inflammation because you’ve read it’s bad for you, fish oil is probably your best option, particularly if you don’t eat much oily fish anyway.

For chronic pain conditions, I’m less optimistic. The evidence for natural anti-inflammatories is weaker here. They might help a bit, but don’t expect dramatic results.

Whatever you try, give it adequate time, at least 8-12 weeks for most supplements, and use evidence-based doses rather than what’s cheapest. And remember that supplements are exactly that: supplements to a healthy lifestyle, not replacements for it.

Safety considerations

Natural doesn’t mean safe. All three of these supplements can interact with blood-thinning medications. Curcumin may worsen gallbladder problems. Fish oil at high doses can cause bleeding issues. If you have chronic conditions like interstitial cystitis or chronic prostatitis, which involve inflammation, discuss supplements with your healthcare provider before starting them.

Pregnant women should be cautious with all supplements, and these three are no exception.

Related reading

• Fish oil: benefits, side effects, and contraindications
• Curcumin: what the research actually shows
• Aspirin: benefits, risks, and interactions

References

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