NSAIDs Kill Tens of Thousands of People Per Year and Weaken the Joints They are Meant to Protect.
A wise man once said that as much as of 50% of what we call “fitness” may be pain tolerance. This may be true. In life it is sometimes necessary to continue on long after we exceed our comfort zone in order to do what we must. Whether you are a working person (kids or job) or an athlete we all have times that we do not “listen to our bodies.” We have those critical moments when we tell our bodies to shut their yaps and do as they are told. Anyone who has run 400 meters for time or has risen for a 5th time in the night to care for the needs of a child knows what I am saying. Whenever you push your body beyond its previous limits, it sounds the alarm. That sensation that your blood is on fire or that you are so tired that you feel stuck to the bottom of the ocean- that is your body panicking, having a tantrum: “STOP. YOU ARE CRAZY. YOU ARE GOING TO KILL US.” With training and experience we become familiar with this warning and decipher true alarms from the pangs of exertion.
The point to all of this is that we all bite off more than we can chew at times and in order to cope with the pain of injury or growth we do what we must to continue on with life. Most people reach without thinking for a bottle of NSAIDs to ease the pain. What do you reach for when you are in pain?
Disclaimer: I am not a pharmacist or a medical doctor. I do not prescribe drugs nor do I recommend changes to prescriptions that I don’t make. If you are self medicating with NSAIDs I’m about to give you some good reasons to stop. If they were prescribed to you, I’m going to give you some good reasons to discuss the necessity and safety of that prescription with your physician.
NSAID stands for nonsteroidal anti-inflammatory drugs. The most common over the counter versions that many of us have in our cupboards are Ibuprofen, Aspirin, Aleve, Motrin etc. These drugs act by counteracting the Cycloxygenase (COX) enzyme that produces prostaglandins that begin the body’s inflammation cycle which is the first stage of injury repair. Most people self-medicate common aches and pains or mild fevers with NSAIDs but they are also prescribed for cardio-protective and anti-inflammatory purposes. The intended effects of NSAID use are decreased pain and swelling.
The less desirable effects include:
Promotion of bone necrosis, cartilage destruction, and prolonged tissue healing time:
This is the horrible and ironic byproduct of NSAID use. The very joints that these drugs are effective at relieving the pain of inflammation in the short-term are degraded and weakened in the long-term. The mechanism of action is the interference by NSAIDs on chondrocyte function and thus cartilage formation within synovial joints.(7,3) This is likely the reason why NSAID use slows tissue healing time in athletes with severe muscle strains.(6) Think that over the next time you have a sore muscle. You can have relief from the bottle in the cabinet but it is relief on credit. It is relief that makes you weak and vulnerable to future injuries.
Gastric Ulceration and gastrointestinal bleeding: Nearly all NSAIDs promote gastric ulceration and gastrointestinal bleeding. Endoscopic studies indicate that among people who chronically use NSAIDs, up to 30% will develope gastroduodenal ulceration.(3,4) Conservative calculation estimates that approximately 107,000 patients are hospitalized annually for NSAID-related gastrointestinal (GI) complications. According to a research review article by Singh (5) 16,500 NSAID related deaths occur annually among arthritis patients alone.(3) There are no reliable warning signals for impending serious GI complications. – >80% of patients with serious GI complications had no prior GI symptoms and currently, limiting NSAID use is the only way to decrease the risk of NSAID-related GI events. (5)- These effects are compounded by the co-administration of or chronic use of alchohol.
Increased intestinal permeability due to damaged mucosa- “Leaky Gut” contributes to many rheumatic and musculoskeletal disorders by promoting the formation of immune complexes that are deposited into synovial tissues causing local inflammatory responses within the joints. (2,3) Anyone familiar with the Paleo Diet and the adverse effects of gluten on the small intestine is well aware of the importance of a patent intestine. For more information see my posting titled The New Balance Paleo Challenge: 30 Uncomfortable Days to Define Your Optimal Nutrition.
Kidney Disease: Chronic NSAID use is a critical risk factor in renal failure. (8,3)
Liver Disease: Liver disease is not as common in NSAIDs but is prevalent with Tylenol (Acetaminophen) this damage is especially likely when Tylenol is used with alcohol. The take home here is that Tylenol is not an acceptable solution for a hangover.
*All of the previously stated side-effects are compounded by the co-administration of alcohol or the chronic use of alcohol.
Inflammation is a necessary step in the tissue healing process- it is how broken materials are cleared out of the area before new tissues are laid down. That being said, the healing process is faster and more effective when this step is reigned in. In an on-line lecture Kelly Starette recently likened the degree of inflammation that the body mounts in a common injury to ripping a building down to its foundation to begin the process of fixing a small dent in one of the walls. This excessive and reactionary response was likely useful and necessary for our ancestors who had no access to sterile dressings or clean hot water to manage possible infection that often comes with tissue damage.
So what to do to reign in the inflammation process and speed healing time without the harmful and counterproductive effects of NSAIDs? Stay one step ahead of acute inflammation with an anti-inflammatory lifestyle that includes: Paleo Nutrion and regular supplementation of fish oil and glucosamine sulfate.
Prevention is key but sometimes sprains and strains happen. Then what?
The inflammatory phase of the tissue healing process lasts approximately 72 hours. For quicker healing times and stronger recovery from injury, follow a combination of these suggestions for the initial 3 Days post-injury:
1) Ice. Yes ice. It is almost too simple to take seriously, but seriously, take ice. You know the routine, now use it. That muscle that is sore after a workout/ game/ bout with lawn maintenance- ice it down through a towel for 20 minutes of every hour for the first 3 days following injury. If you are unwilling to make the time for icing try ice massage instead. It only takes 5 minutes of rubbing an ice cube directly into the injured area to achieve the effect of 20 minutes passive icing through a towel. While you’re at it, you may as well compress and elevate the area as well.
2) What to put in your cupboard after you clear out the NSAIDs? Start with Proteolytic Enzymes such as Bromelain. Bromelain has been shown in recent studies to have measurable anti-inflammatory effects for acute injury (9,10) and the only major side-effect for those without pineapple allergies is an anti-tumor and anti-cancer effect. (11,12)
There are several other well researched and well established herbal and natural anti-inflammatory products on the market but each deserves its own posting. Look out for future postings on Citrus Bioflavinoids, Boswellia, and Arnica etc. to guide you in the acquisition and administration of your own gym bag injury kit.
(1) Brandt KD. J Rheumatol Suppl. 1991 Feb;27:120-1. The mechanism of action of nonsteroidal antiinflammatory drugs.
(2)Inman RD. Antigens, the gastrointestinal tract, and arthritis. Gheum Dis Clin North Am. 1991 May; 17(2): 309-21
(3) Vasquez, Alex. Integrative Rheumatology 2007 :147
(4) Blower AL. Scand J Rheumatol Suppl. 1996;105:13-24; discussion 25-7. Considerations for nonsteroidal anti-inflammatory drug therapy: safety.
(5) Singh G. Am J Med. 1998 Jul 27;105(1B):31S-38S. Recent considerations in nonsteroidal anti-inflammatory drug gastropathy.
(6) S Afr Med J. 1995 Jun;85(6):517-22. Non-steroidal anti-inflammatory drugs fail to enhance healing of acute hamstring injuries treated with physiotherapy.
(7) Brandt KD. Am J Med. 1987 Nov 20;83(5A):29-34. Effects of nonsteroidal anti-inflammatory drugs on chondrocyte metabolism in vitro and in vivo.
(8) Segasothy M Br J Rheumatol. 1995 Feb;34(2):162-5. Chronic nephrotoxicity of anti-inflammatory drugs used in the treatment of arthritis.
(9) Walker AF, Bundy R, Hicks SM, Middleton RW Phytomedicine. 2002 Dec;9(8):681-6. Bromelain reduces mild acute knee pain and improves well-being in a dose-dependent fashion in an open study of otherwise healthy adults.
(10)Walker JA, Cerny FJ, Cotter JR, Burton HW. Med Sci Sports Exerc. 1992 Jan;24(1):20-5. Attenuation of contraction-induced skeletal muscle injury by bromelain.
(11) Chobotova K, Vernallis AB, Majid FA Bromelain’s activity and potential as an anti-cancer agent: Current evidence and perspectives. Cancer Lett. 2010 Apr 28;290(2):148-56. Epub 2009 Aug 22. Review.
(12) Bhui K, Prasad S, George J, Shukla Y. Bromelain inhibits COX-2 expression by blocking the activation of MAPK regulated NF-kappa B against skin tumor-initiation triggering mitochondrial death pathway.
Cancer Lett. 2009 Sep 18;282(2):167-76. Epub 2009 Mar 31.
