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.
My life has changed since I started taking Ibuprofen two days per month for period pain. I can now actually function and not have to take a day off work as I did for around 30 years, when I was unaware of how this drug reduces prostaglandin release and therefore painful period cramps. I tried everything else, herbal, dietary, whatever. Now I just take the ibuprofen and problem solved. Everything has its place.
Sock Doc says
Thanks for your comment though I don’t agree. 🙂
What are some natural anti-inflammatory substances? Do you recommend Turmeric ?
Sock Doc says
See the end of the article – the link will point you there.
I am looking for the medical publication citations for your article. Are you an MD, or PHD? I was just talking about this with a chemist athlete that I wanted to point in that direction.
Sock Doc says
The reason I wrote “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.” is because these articles take me enough time so I don’t have more to put in the references. But here’s a good one with a lot of citations: http://bjsm.bmj.com/content/43/8/548.full
Dr. Gangemi failed to answer your question. He is a chiropractor.
Julia Jones says
Thank you for this article. I’ve been advising my athletes to stop popping anti-inflammatory pills for years, unfortunately most of the time it’s their own MD that prescribes them! Now I have a great article to point them to 🙂
Thank you for making the effort to write and share this important information.
A few years ago, with guidance from Dr. Phil Maffetone’s writings, I set out to balance my dietary fats…
Within 6 months I saw tremendous improvements – losing a long-time, recurring pain; vanquishing monthly cramps; and reducing recovery times/healing post-workout and injury.
I haven’t “needed” an NSAID since. And, last summer I purged my medicine stash of all NSAIDS (along with the PPIs / antacids their consumption required) – they’re no longer in my house, so not even a mid-night fallback option. I don’t miss them one bit!
Your article is very well written, with clear explanations – I’m looking forward this to sharing this piece with others.
Aileen Reid says
OK so what are you supposed to do when you’re old and worn out? This advice might be all very well for young folk but when your back and other joints are pretty stuffed what are you supposed to do. NSAID’s mean I can function, I can sleep. I don’t take them often but I do take them and I haven’t found any alternative that works.
Sock Doc says
Do you develop a NSAID deficiency at a certain age? Read this Sock Doc article: https://sock-doc.com/2014/06/aging-athletes/
When you have bare patches in your joints where the cartilage has worn away from overuse, diagnosed by MRI or x ray and in fact verified by recent surgery to repair a tendon in the case of my shoulder – whether it be work or sport………………………
I would like to hear from anyone who has kept their pain under control by diet. Speak up now!
Steven Oldale says
Dear Aileen, Sorry to hear your current situation. Although it is hard and the effect will not be as immediate as taking Nsaids, a change of diet to more alkaline foods, use of curcumins (turmeric supplement) taken with quality fish oils and bromelain to aid it’s absorption, in addition to a functional neurological approach to improve proprioceptive feedback and help central suppression of pain will help to reduce your symptoms. There is NO correlation between degree of degeneration seen on x-ray, MRI and pain. There are thousands of people with totally worn out knees who have little pain, just stiffness. Everyone will have degenerative changes somewhere in their body but not everyone will have pain. It is your bodies inflammatory response that needs to be modified. At the end of the day it is a lifestyle choice. Taking Nsaids long term will also contribute to a leaky gut. This in turn can trigger immune responses which at worst can develop into auto-immune problems. In effect taking anti-inflammatories will lead to a further inflammatory state. There is plenty of research out there to support this.
Donovan kearna says
When you get tuberculosis and than need antibiotics I will be sure to ask you when you developed a rifampin deficiency lol. Your line of logic is flawed and frankly just flat out wrong.
Sock Doc says
Thanks for your stellar insight. I didn’t realize that antibiotics were NSAIDs.
Also, NSAIDS can cause Tinnitus.
Joe B says
Thanks for these awesome articles you some how keep pumping out! I love the way you break down how to balance fats, and leave links to all your other articles. Your first aid series is so easy to read, get, and understand!
Quick question. In your opinion, is it ok to take turmeric for several months if it makes you feel really good? Or should it be used more supplemental for shorter periods. Is it a problem that it works so well for me, maybe some kind of imbalance?.. in a similar way that if NSAIDS work, you have a fat imbalance. Thanks again.
Sock Doc says
Well if you’re always feeling good with it (or not as good without it) then you should look into why you’ve got some inflammation and deal with that issue.
Super informative article, thanks so much for writing it!!!
I think one of the biggest frustrations with this type of stuff, is despite all the studies and the actual science behind how NSAIDS and the body works, why is there still not consensus from physicians? Why is this not being taught correctly in medical schools? Just blows my mind….you’d think people responsible for the health of others would want to make sure they have it right, versus just going with the status quo so to speak.
Adam Trainor says
Great read, Doc. You had me at “NSAIDs will also block the COX enzyme which forms a prostaglandin…” I just found, read your about section, and then read this article. Looks like I have some catching up to do. This one caught my attention due to the common practice in fitness of prescribing RICE for injuries, which I even hear from people I respect. I have have had great results in the field with just using flossing bands to wrap injuries and reduce pain. The question I always want answered from the RICE practitioner is what is this pill going to do to help my lymphatic system?
Chris Southby says
I accidently found an effective treatment for minor injuries when gardening. I walked into a patch of stinging nettle bare foot and found that the swelling and pain from a sprained ankle almost instantly dissappeared. Have since read that the romans used it to help their army with injuries.
I use it quite often now on minor aches and pains, works a treat.
I take a baby aspirin daily to help prevent strokes. I am protein S deficient and have had 2 strokes – One when I took birth control pills (30 years ago and prior to diagnosis) and one when my son was born. I would love to not take medication. Is an aspirin in addition to Plavix necessary?
Sock Doc says
That would be something to consult with your prescribing physician.
I have just had and ultrasound and Xrays and have been diagnosed with calcific tendonitis of the shoulder.
I have only been advised to take nsaids, and can have a cortisone injection.
To my mind this isn’t addressing the issue or giving me any suggestion of treatment.
I am a triathlete and now can’t swim because of the pain in my shoulder.
I have rolled using a hocky ball and foam roller, used voodoo floss bands to squeeze out inflammation
Should I continue with this protocall? Could you please point me to any resources on what I can do to break down this calcific build up in my shoulder?
p.s. I was turned onto your blog from your appearence on Endurance Planet.
Sock Doc says
Check out the shoulder video here on SD and then of course heed the info in this NSAID article.