NSAIDs – I Still Say Never

Nonsteroidal anti-inflammatory drugs – the infamous NSAIDs – touted by many to curtail inflammation, accelerate healing time, and even improve performance. But over the past several years there’s been more and more research supporting why you probably shouldn’t take an NSAID, due to the inherent dangers and the fact that they really don’t address the root of the problem.

As with most things, the athletic community thinks of certain situations where perhaps NSAIDs are sometimes advised and then they find some ridiculous research to back it up with hopes that nobody will verify its relevance or accuracy. One study being pushed around by many well-respected coaches is this one that compares two medications, only one of which is an NSAID, over a placebo when treating an ankle sprain, and concludes that the drugs are relatively equal. I’m not sure how this justifies that taking an NSAID for an acute injury is beneficial in the first few days post-trauma as it’s often being cited, but people eat this BS up and pop another pill.

Everyone has their reasons for taking a drug like an NSAID, but I don’t. I would never advise anyone, including an athlete, to take NSAIDs, aside from perhaps a very rare systemic inflammatory life-threatening health crisis. No, your chronic or acute pain and inflammation is not life-threatening.

What is an NSAID?

If you’re interested in taking a drug (any drug), it’s important to first understand what you’re taking and then how it works. NSAID stands for nonsteroidal anti-Inflammatory drug. Pretty much this is aspirin, ibuprofen, and naproxen. NSAIDs help to relieve pain, reduce inflammation, and to some extent they can help lower a fever. Many athletes experience pain and inflammation often, so NSAIDs might seem like a good idea to help you push through the tough times. But it’s really not a good idea…

How Do NSAIDs Work?

To understand how an NSAID works, we need to learn a bit about something called an eicosanoid, (pronounced: eye-kah-sah-noid). An eicosanoid is a hormone-like substance made from two long chain essential fatty acids. The primary role of the eicosanoids is to regulate immunity and inflammation within the body.

There are three groups of eicosanoids that are important to understand the NSAID mechanism. Two of these groups are more anti-inflammatory and for simplicity I’ll call them Group 1 and Group 3. The other group, Group 2, is more pro-inflammatory. Some inflammation is necessary if you want to heal an injury.

Group 1 eicosanoids are derived from the omega-6 fat gamma-linolenic acid (GLA) which are commonly found in vegetable oils and nuts/seeds (the oils of such), whether raw or refined. They are typically a more anti-inflammatory eicosanoid.

Group 3 eicosanoids are derived from the omega-3 fat eicosapentaenoic acid (EPA) which another fat, alpha-linolenic acid (ALA) can create. ALA is abundant in flax seed oil and walnuts while EPA is commonly found in the oil of fish and other sea creatures (algae). They are also a more anti-inflammatory eicosanoid.

Group 2 eicosanoids are derived from what is known as arachidonic acid (AA), a pro-inflammatory eicosanoid. AA is obtained in the diet from red meat, dairy, shellfish, and eggs. The amount of AA is greatly dependent on the diet of the animal which produced that food, or is that food. However they can also be made from eating excessive omega-6 vegetable oils and a high carbohydrate diet. The AA which you make this way is thought to be harmful in your body as opposed to obtaining naturally occurring AA from foods which can actually help heal an injury via necessary inflammatory processes. More on that in a bit.

There’s one final player here which is an enzyme called cyclooxygenase, or COX for short. COX enzymes are important for the conversion of Group 1, 2, and 3 fats to their respective eicosanoids. NSAIDs simply block the COX enzymes from forming all three eicosanoids – both Group 1 and 3 (anti-inflammatory) as well as Group 2 (pro-inflammatory, usually).

If you feel better, (your symptoms are improved), when you take an NSAID, then your fats are out of balance. You’re feeling the effects of the NSAID lowering the high level of Group 2 (AA) because you have too much inflammatory AA in your body. You can also see that the NSAID will lower the anti-inflammatory eicosanoids production too. However, typically when a person is dealing with inflammation they have low levels of Groups 1 & 3 anyway so they reap the “benefit” of the pro-inflammatory Group 2 inhibition.

The Dangers of NSAIDs

This also means that if you take an NSAID to try to fight an inflammatory condition you could actually make matters worse by delaying the healing process. This occurs when your levels of Group 2 AA fats are normal as are your Group 1 & 3 eicosanoids. Taking an NSAID will now have an effect on Group 1 & 3 essentially lowering anti-inflammatory levels while blocking normal and necessary anabolic action from the Group 2 AA fats.

How about NSAIDs during the acute phase of an injury, especially trauma? NSAIDs will also block the COX enzyme which forms a prostaglandin, which is one type of eicosanoid. Prostaglandin levels are increased naturally in response to trauma so limiting or lowering their formation via an NSAID may help only if there is excess inflammation or your body doesn’t know when to shut-down the inflammatory process. Prostaglandins are there to help repair that damaged tissue and form collagen – the building blocks of muscle tissue. You don’t want to mess around with this natural process, so more isn’t better and some isn’t necessarily advised. I never advise NSAIDs because if the fats/eicosanoids are balanced then your body can quickly adapt and adjust. The prostaglandins are necessary as some inflammation is vital in order to heal an injury.

Gastrointestinal symptoms can result from NSAID use as well as kidney, cardiovascular, and nervous system problems. Ultramarathoners taking NSAIDs while racing have been found to have fecal material in their blood. (That sounds lovely.) NSAIDs also deplete the necessary sulfur in your body that you need to repair your joints.

Even a low dose NSAID can cause problems mentioned including slowing down the normal repair of muscle, bone, and other tissue. Additionally, NSAIDs may not only NOT reduce inflammation, but increase inflammation in your body by triggering a reaction of another type of eicosanoid that is made from AA – leukotrienes. Leukotrienes can be several hundred times more inflammatory than a prostaglandin and are known to be common triggers of asthma.

So don’t think that a NSAID will only help and never hinder; this is often not the case as they can have the very opposite effect/reaction. This is especially true if you’re healthy and your fats are balanced; hopefully they are!

Still Want to Pop That NSAID?

Last I checked, aspirin and ibuprofen were not essential nutrients in your body. So you can live without, and you should. There are many natural and healthier alternatives to NSAIDs as I write in Part IV of the SockDoc First Aid Series. There are more true dangers to taking an NSAID than there are actual benefits. The benefits, if any, are short lived, whereas the risks may not be. I’m not about to take the middle of the road on this one just to make everyone happy and toss in some crazy study to support the science behind it all. If you feel better from taking an NSAID then you need to figure out why you have pain and inflammation. Let’s stop thinking there are some true benefits out there with these drugs just because it’s the easy way to temporarily, at best, mask a health issue.

* The disclaimer for this article is this: NSAIDs are drugs, and like many drugs those taking them are taking either inappropriate amounts or taking them when they should not be. NSAIDs are no different. Their use is very abused. I’m not telling you to stop taking a NSAID if you’re taking one – I simply want you to understand how they work, why they work, and the risks involved. Often, as is the case with many medications, you may need to educate your prescribing physician, or find a new one if he/she is not open to a discussion about your health.

Dr. Stephen Gangemi "Sock Doc"

I'm a board-certified chiropractic physician and clinical nutritionist with a passion for true natural health care. I implement dietary & nutritional therapies, exercise & movement practices, and lifestyle changes along with manual therapy techniques to help the body heal and prevent illness and injuries.