NSAIDs (Non-steroidal Anti-Inflammatory Drugs)

On the website Amateur Endurance.com, 2 articles have been published in 2010 regarding the use of NSAIDs by endurance athletes and runners. One is about muscle inflammation and the use of NSAIDs by endurance athletes. The other is about their negative affect on muscle healing. Not only are there health consequences and risks if you use them, but it's also not the way to get the most out of your workout or training. Inflammation is part of muscle work and you don't want to stop the inflammation process too soon. It is part of a process that starts with catabolism, the breaking down of large molecules like polysaccharides, lipids, nucleic acids and proteins into smaller  units like monosaccharides, fatty acids, nucleotides, and amino acids. These are broken down and used, in part, to make ATP (adenosine triphosphate). ATP is the energy used for anabolism, the process of maintaining and growing cells.
Below are the full articles, including the opinion that taking fish oil will help control inflammation and aid in recovery:
Inflammation and the Endurance Athlete
There are litanies of inflammation based ailments that can negatively affect an endurance athlete’s performance. Some of these ailments include but are not limited to the common cold, arthritis, tendinitis, depression and DOMS (Delayed Onset Muscle Soreness).


A common method of fighting inflammation is the use of NSAIDs (Non-steroidal Anti-Inflammatory Drugs). The most prominent players in this group of drugs are aspirin, ibuprofen, and naproxen, partly because they are readily available over-the-counter. But, research indicates that the overuse of prescription and non-prescription NSAIDs could lead to larger health issues such as the development of ulcers, autoimmune dysfunction, bleeding in the GI tract, congestive heart failure, photosensitivity and renal failure.

The use of NSAIDs other than (low-dose) aspirin is associated with a doubled risk of symptomatic heart failure in patients without a history of cardiac disease. (Henry.D, 2000) Research has also shown that sustained exercise while using NSAIDs can compromise renal function and potentiate the risk of developing acute renal failure. NSAIDs are widely used in the endurance community, and athletes should be warned of the potential danger of their use when renal function may be compromised. (Walker, R. et al 1994) This data provides compelling evidence to support the use of alternative treatment options when battling chronic inflammation based ailments.

Fish Oil
So, if Ibuprofen is a no-no, what should I be using? Well, currently Omega-3’s offer an excellent alternative to NSAIDs. Polyunsaturated fatty acids (PUFA), better known as Omega-3’s act as a powerful anti-inflammatory agent. Regular supplementation of Omega-3 fatty acids can easily be achieved by oral consumption of a fish oil product. Fish oil has been shown to improve brain function, decrease inflammation, reduce the incidence of fatal heart attacks and ischemic strokes, improve the outcome of autoimmune diseases, and improve vision. (Blaylock, 2008)

It’s important when purchasing fish oil to make sure it has been refined properly through molecular distillation. From there you’ll need to check the most biologically potent component found in fish oil – Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA). It’s imperative to ascertain the amount of EPA and DHA found in each serving, since large disparities do exist. Unfortunately, there is no FDA recommended dosage for fish oil. But, the FDA does say that the average healthy person (age 5+) should not take a fish oil dosage of more than 3000 mg per day. However, the average person only consumes the woefully inadequate amount of 120-130 mgs each day. (Simopoulos, 2009)

So, what dosage of fish oil should you take? The World Health Organization and numerous other authorities recommend 300-500 mg per day. It’s recommended that you slowly ramp up your consumption of fish oil to see what your body feels comfortable with and to make sure you don’t experience any fish oil side effects, like allergies, diarrhea, heartburn or nausea.

When should you consult a doctor for fish oil recommended dosage? Individuals who have diabetes, people taking insulin, people at risk for bleeding, people with congestive heart failure (or any other condition where the heart is receiving insufficient blood flow), people with high levels of low-density lipoprotein (LDL), people who bruise easily, people who are taking blood thinners, people with fish allergies, young children and women who are breast-feeding or pregnant should always consult their doctor before taking any fish oil. You should also talk to your doctor if you’re a healthy individual and plan on taking a dosage of more than 3000 mg a day of fish oil. (Snow, 2007)

Fish oil supplementation has helped many of our athletes experience faster recovery times, less overuse injuries and better overall body compositions. These anecdotal findings coupled with the current scientific literature, suggest that fish oil can offer a suitable alternative to NSAIDs for the endurance athlete.

Written by By Eric Auciello, ACSM, CPT

References:
WALKER, ROBERT J.; FAWCETT, J. PAUL; FLANNERY, ERIN M.; GERRARD, DAVID F. Indomethacin potentiates exercise-induced reduction in renal hemodynamics in athletes. Medicine & Science in Sports & Exercise. 26(11):1302-1306, November 1994.

Henry, D (March 2000). Consumption of NSAIDs and the development of congestive heart failure in elderly patients: an under recognized public health problem. Archives of internal medicine 160 (6): 777–84.

Russell L. Blaylock, MD, DHA Supports Brain Development and Protects Neurological Function, LE Magazine January 2008

Artemis P. Simopoulos, MD, FACN, Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases Journal of the American College of Nutrition, Vol. 21, No. 6, 495-505 (2002)

Wyn Snow, Fish Oil versus Flax Seed Oil—Which Is Better?, Dietary Supplement Quality Initiative, 2 March 2007

Craig Weatherby, Can Fish Oil Cause Bleeding Risks?, Vital Choices Newsletter, Monday, June 23, 2008 Issue 220 VOLUME 5 ISSUE 220

NSAIDs and Running: Is It Smart?
Anti-inflammatory drugs (NSAIDs) are grouped into two categories. Cox-1 and Cox-2 inhibitors. These medications were designed to limit the inflammatory response of the body the injury. Unfortunately for us there are many negative effects that accompany these medications. A review of current medical literature has caused us to caution patients and runners taking these harmful drugs.


In 1999 the New England Journal of Medicine released a landmark study. They estimated that a minimum of 16,500 people die every year due to side effects associated with these drugs. To put that number in perspective, that same year 16,685 people died of AIDS. It seems that these harmful medications are absorbed in your stomach ultimately resulting in a bleeding ulcer which causes you to slowly bleed to death. The journal SPINE in 1994 stated “NSAIDs are the most frequently prescribed medications worldwide. NSAIDs continue to be one of the most common drugs associated with serious adverse events.” Some of the more serious adverse events include asthma, high blood pressure, kidney failure, hepatitis and death. In fact the journal Physical Medicine and Rehabilitation Clinics of North America in 2000 questioned the efficacy and validity of prescribing NSAIDs for muscle trauma and pain. They state “NSAIDs are often prescribed in the treatment of acute (and chronic) muscle trauma, despite a relative lack of scientific data supporting their use. In fact recent studies have suggested that the recovery process and rate of muscle fiber regeneration may be delayed when NSAIDs are prescribed.”

These findings were recently validated when researchers for the journal of Bone and Mineral Research found normal tissue healing failed due to the adverse effects of Cox-2 inhibitors (NSAIDs). Their findings state that “Cox-2 activity is necessary for normal healing.” These findings indicate that by taking NSAIDs following injury that not only is the repair process slowed but that normal healing does not occur. In fact the tissue was studied and found to be pathological (abnormal) in nature. Meaning, it was weaker and more prone to injury. The significance of this for runners and chronic injuries can not be underestimated. Imagine you develop knee pain. Your doctor prescribes Ibuprofen. It takes the pain away but does nothing to solve the reason for the pain in the first place. Now you run on your injury actually making it worse. Not only that but as your body is attempting to heal it is slowed due to the adverse effects of the drug and the new muscle tissue that is being made is weaker and abnormal!

The journal Arthritis and Rheumatism explained back in 1993 that these drugs actually accelerated the progression of knee arthritis. They stated that “analgesic medications such as NSAIDs and opiates may be effective in pain relief, NSAIDs actually increase knee torque during walking, and this may tend to accelerate the progression of the disease (arthritis). Some physicians while well intentioned have actually given patients the advice to take aspirin or Ibuprofen before, during or after a run as a preventative measure. This is directly opposed to current research. The journal Medicine and Science in Sport and Exercise stated that “muscle inflammatory concentrations were unaffected by treatment with Ibuprofen or Acetaminophen when compared with placebo 24 hours post exercise.”

Written by Dr. Victor J. Runco, DC