Dr. Kurt Strecker, DC, CCSP
The New York Times recently ran an article on the risks athletes face when using Ibuprofen during training and racing. I want to share my thoughts on the article and on the widespread use of NSAIDS during athletic endeavors.
In my practice, I see many athletes who refer to ibuprofen as "Vitamin I," and that's not such a good thing. There's no question that the non-specific anti-inflammatories (e.g. ibuprofen) can be quite damaging to the gut, and while the COX-2 inhibitors (e.g. Celebrex) may be somewhat kinder to the tummy, they come with increased cardiovascular risks.
The primary role of the gut is to digest food, absorb nutrients and transport solid waste to be... er... deposited. As such, some permeability is required to allow the good stuff to enter the bloodstream while keeping the bad stuff out. Use of NSAIDS, especially chronic use, can make too much permeability and allow passage of undesirable things to enter the blood. The NYT article notes, "In a famous study from a few years ago, researchers found that runners at the Western States 100-Mile Endurance Run who were regular ibuprofen users had small amounts of colonic bacteria in their bloodstream. Ironically, this bacterial incursion resulted in higher levels of systemic inflammation." Uh... YUCK!
So, if strenuous exercise and nsaid consumption both contribute to gut leakage, why in the world would you want to do them simultaneously??? And if intestinal bacteria in the bloodstream results in higher levels of systemic inflammation, what would be the point of taking prophylactic anti-inflammatories???
In an online discussion about the issue with our triathlon team, one of our members, Kitima Boonvisudhi, MD, weighed in with her reaction. Her expert response response is particularly interesting in regards to the effects of NSAIDS on the kidneys during exercise. She said,
Taking NSAIDs in the setting of dehydration and rhabdomyolysis is damaging to kidneys. I see a lot of people at Ironman take NSAIDs at mile 18 of the run to either decrease the pain of being at mile 18 of an Ironman or some injury pain that has flared up. From an orthopedic standpoint and masking pain from an injury--that's a bad idea. No finish line photo or medal is worth that. From a renal standpoint, I can hear people's kidneys screaming. Will it result in renal failure someday? No one knows, but who wants to test it out and wind up on dialysis in 20 years?
Are there times when it is appropriate to use anti-inflammatory drugs? Absolutely. As an example, sometimes spinal discs and the surrounding tissues can become inflamed. Perhaps there is a disc bulge, tear or even a frank herniation. The fluid from that inflammation takes up space and can exert pressure on the spinal nerve roots and cause excruciating pain into the extremities. Anti-inflammatory drugs can be an important and effective part of treatment and provide symptomatic relief. Obviously, therapy would also aim correct the underlying cause of the problem with exercise, mobilization or whatever might be indicated, but sometimes those cannot be started until the pain is controlled or moderated.
Remember, too, that inflammation is the process by which we heal. In the acute stage when tissue damage occurs, the inflammatory response facilitates influx of the cells required for clean up and repair. No inflammation, no fix. NSAIDS slow that process and may result in poorer repair.
Another thing to remember is we are inundated with advertisements that suggest we should pop a few ibuprofen or naproxen whenever we are uncomfortable. Not a good idea. There are always risks and benefits. Listen to your bodies. If you "need" to take pain medication to get through an event, there's problem that must be addressed.
If nsaids are not the best option, what then should we do?
Ice is great in the first 48 -72 hours following acute injury. It can also be wonderful post-workout. (Just ask the Coach! In fact, you can read his thoughts here.)
Eating an anti-inflammatory diet is very effective. Stay away from sugar. Eating sugar is like throwing gas on the fire. Include in your diet foods like turmeric, cold water fishes, flax seed, nuts, avocado, olives and olive oil. Increase your consumption of omega-3 fats and shoot for a ratio of omega-6 & -9 to omega-3 of 3:1 or less.
I hope this is helpful. Eat well and have a great day!
~Dr. Kurt Strecker
Interested in joining the Pursuit Athletic Performance Triathlon Team? Now's the time! The off-season is the optimal time to set up your 2013 season for your best performance ever. Every athlete starts with a clinical gait analysis and we build your training from there. 20% off all gait analysis packages AND a FREE 30-days on the team! Here's the info.