If you’re injured, do you take an anti-inflammatory medication, commonly known as NSAIDs? After all, as you learned in Part III of the Sock Doc First Aid for Injuries, some inflammation is necessary and normal when you’re injured. Inflammation is all about balance. If it’s out of control, then you have several aggravating factors (discussed in Part I). Is it better to take an NSAID just in case? Should you take one as a “prevention” even if you’re not injured? This is the big question (I hope you didn’t forget), especially since athletes love to take NSAIDs. Before you decide, it is important to understand the effects of NSAIDs and how they work.
Now How About That NSAID?
In the 2008 Brazil Ironman, 60% of the athletes said they used some form of NSAID in the three months before the race. In the 2000 Olympics, 25% of the athletes used them up to three days before their event. Clearly, the majority of athletes are suffering from some type of injury often, or they feel as though the NSAID will give them a competitive edge. I once thought this too. Well, there’s one final thing to understand, and that’s why these NSAID drugs work, which has to do with an enzyme called cyclooxygenase, or COX for short. Once you understand this, you’ll see why taking an NSAID can be beneficial for some with injuries, but also how they can hinder healing and actually provoke more inflammation.
COX Enzymes and Inflammation
COX enzymes are important for the conversion of Group 1, 2, and 3 fats to their respective eicosanoids (review here in Part III). There are two COX enzymes, but it is the COX-2 that affects the eicosanoid production. NSAIDs simply block (inhibit) 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 improve) when you take an NSAID (aspirin, ibuprofen, naproxen), then your fats are out of balance; you’re feeling the effect of the NSAID lowering the high level of Group 2 (AA) because you have too much inflammatory AA in your body, which, as you learned in Part III, is from too much stress, refined carbohydrates, and vegetable oils—not the healthy fats from red meat, eggs, and dairy. You can also see that the NSAID will lower the anti-inflammatory eicosanoids production too, but typically when a person is dealing with inflammation, they have low levels of Groups 1 and 3 anyway, so they reap the “benefit” of the pro-inflammatory Group 2 inhibition.
This also means that if you take an NSAID to fight an inflammatory condition, you could actually make matters worse by increasing inflammation! This occurs when your levels of Group 2 AA fats are normal, as are your Group 1 and 3 eicosanoids. Taking an NSAID will now have an effect on Groups 1 and 3, essentially lowering anti-inflammatory levels while blocking normal and necessary anabolic action from the Group 2 AA fats.
Acute Trauma and the Effects of NSAIDs
How about an NSAID during the acute phase of an injury, especially trauma? Sure, NSAIDs can be of “benefit” here regardless of whether your fats are balanced or not. This is because the NSAID will block the COX enzyme that 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 (because you’re unhealthy). Prostaglandins are there to help repair that damaged tissue and form collagen—the building blocks of muscle tissue. Remember, you don’t want to mess around with this natural process, at least not too much, so more isn’t better and some isn’t necessarily advised. I never use NSAIDs (for myself or in my practice) because if the fats/eicosanoids are balanced, then your body can quickly adapt and adjust. Of course, if you sustained a very traumatic injury with widespread inflammation or life-threatening aspects, I’d surely consider using an NSAID to get out of the danger zone, but very little and only on a case-by-case basis. But you don’t just stay on these drugs as they can be, and are, dangerous.
NSAID Dangers
Yes, NSAIDs have their dangers. Many may remember back when Vioxx and other COX-2 inhibitors were pulled off the shelf only to be put back on the market later. Next, from trusty Wikipedia: “An estimated 10–20% of NSAID patients experience dyspepsia [that’s indigestion], and NSAID-associated upper gastrointestinal adverse events are estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United States, and represent 43% of drug-related emergency visits.” Wow. And think about how many more people have other adverse reactions from an NSAID—documented as well as undocumented.
Other types of GI symptoms can result from NSAID use as well as renal (kidney), cardiovascular, and nervous system problems. NSAIDs also deplete the necessary sulfur in your body that you need to repair your joints.
I’ll add my personal story of the days when I used to take NSAIDs. I used to take NSAIDs during my early years racing Ironman, particularly the mid-late 1990s. In 1999, while I was racing Ironman USA (the inaugural Lake Placid, NY, race), I crashed my bike at the start of the second loop, right at mile 56. The bike wasn’t in bad shape, but I had some good cuts and road rash on my thigh, arm, hand, and ankle. Back then, I carried Aleve while I raced (yeah, I didn’t know any better). So I took the Aleve (naproxen), and I took more, and more. I continued to take the Aleve throughout the rest of the race, and I raced well enough to qualify for Hawaii. So it was a good day, despite all the pain, which was dampened by the Aleve and high level of cortisol while racing. The next day my urine was bright red, and there was blood in my urine for the next several days (that I could see, anyway). I clearly caused some (temporary) kidney damage, made worse by “normal” Ironman race dehydration. I’ve never taken an NSAID (or any other medication) since.
Even a low-dose NSAID can cause the problems mentioned, including slowing down the normal repair of muscle, bone, and other tissue. Additionally, NSAIDs may not only NOT reduce inflammation, but they can increase inflammation in your body by triggering the reaction of another eicosanoid 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 an NSAID will only help and never hinder; that 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, and hopefully they are!
Balance Your Eicosanoids—You Don’t Have an NSAID Deficiency
To make “natural NSAIDs” in your body, you need to balance your eicosanoids. As you have learned, much of this is achieved through diet and lifestyle stress management. This article, long as it may be, could be a book in itself, but I’ll end this with 10 key points/steps you can take to achieve healthy levels of anti-inflammatory Group 1 and 3 eicosanoids and healthy levels of pro-inflammatory anabolic Group 2 arachidonic acid so you’re naturally anti-inflamed and ready to heal.
1) Limit or eliminate those refined omega-6 vegetable oils (corn, safflower, soy, sunflower, peanut, and even canola to a degree). Get your healthy omega-6 fats from vegetables and unrefined raw nuts and seeds. (Don’t go crazy on nuts and seeds and “eat them all day” either.) Taking a supplement high in GLA may sometimes be of benefit—the best sources being borage and black currant oils.
2) Eliminate all partially hydrogenated “trans” fats from your diet. These actually block Group 1 and 3 eicosanoids but not Group 2, and you know what that means (I hope).
3) Lower carbohydrates, especially the refined carbs. Lower carbs means lower insulin, and that means less inflammatory AA.
4) Lower cortisol (stress) levels. Lower stress means lower cortisol, and that means less inflammatory AA. Read the Sock Doc Training Principles to understand aerobic vs. anaerobic (and so much more!).
5) Consume pasture-fed beef, free-range eggs, cream, and butter to achieve healthy and desirable levels of AA. Extra virgin olive oil is also a great fat to consume. Although it is monounsaturated and not an essential fatty acid (EFA), it’s still important for good health, as are fats found in coconut oil, coconut milk, and 80% or higher cocoa chocolate. Eat them up!
6) Consider a fish oil supplement to increase Group 3 eicosanoid levels. Flax may work too, but it has to be converted by the body to EPA, and there are many ways this can be blocked, some of which are genetic. And too much EPA can create oxidative stress and even inhibit healthy levels of AA, neither of which is good. So don’t go crazy on fish oil supplements: I typically recommend the healthy athlete take one teaspoon or a couple capsules a few times a week.
7) Sesame seed oil contains a compound called sesamin, which is great at blocking LA from being converted into AA, especially in the presence of high insulin levels. I use unrefined sesame seed oil a lot with patients with this problem, but I also make sure that they correct the problem by not continuing to eat a lot of carbs (sugar) and vegetable oils. One to two teaspoons a day can help.
8) Certain nutrients, such as vitamin B6, magnesium, zinc, vitamin C, and niacinamide, are needed for proper eicosanoid production. A deficiency can mean you don’t make them!
9) Herbs such as turmeric, boswellia, and quercetin can help fight inflammation too—naturally!
10) Aspirin, or any other NSAID, is NOT a vitamin. You will never have an aspirin deficiency!
This concludes the four-part Sock Doc First Aid for Injuries series. I hope you learned a lot and have made further progress in your overall health and fitness potential!
