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Could NSAIDs actually cause inflammation?

This one is for you exercisers out there. You know me; I love to write about dogma-busters.

I’ve got a good one for you tonight. For endurance exercisers, runners and cyclists alike, few myths have been more persistent.

Imagine: We actually think taking non-steroidal anti-inflammatory drugs (NSAIDs) before exercise improves performance and relieves post-effort soreness. It’s tantalizing, isn’t it? You are about to inflame yourself, why not pre-medicate with anti-inflammatory pills? (Full disclosure: Guilty.)

Well…just as in Medicine, what makes intuitive sense doesn’t always pan out to be true.

Last week, prolific health and exercise journalist, Gretchen Reynolds of the NY Times, publicized a small but compelling study that helps bust the myth of pre-exercise NSAID use.

Before I tell you about the study, we must review two related rules of health and Medicine:

  • Minimize inflammation.
  • Poop needs to stay inside the bowels. Few things are more inflammatory than gut bacteria leaking into the body.

On to the study (free): Researchers from Netherlands set out to measure the gut-busting effects of exercising while under the influence of NSAIDs. As background, they knew what most runners and cyclists have experienced: that intense exercise often leads to abdominal distress. I don’t know a runner that hasn’t had the trots. And honest cyclists will all admit to occasional bottom-burning ‘accidents’ miles from home. That’s inflammation!

It’s true; previous studies have shown intense exertion alone can cause minor increases in gut leakage. Given the well-known adverse effects of NSAIDS on the gut, the researchers figured that combining NSAIDs with exercise would constitute an especially inflammatory brew. They were right.

In a nifty bit of science, the Dutch researchers had nine cyclists serve as their own controls. The nine were studied in the resting state, after 60-minutes of exercise with, and then without NSAIDs.

(I learned something about how one measures gut injury. It turns out it’s similar to measuring heart damage; there is an enzyme called human intestinal fatty acid binding protein (I-FABP) released when the gut is injured. I understood it as the gut’s equivalent of troponin (which rises during heart injury.)

The results were worrisome. When athletes exercised with NSAIDs in their system, measures of gut injury (and permeability) were significantly higher. Said another way, NSAIDs increased the risk of leaking poop.

Two words here: Not good.

The thing about myth-busing science is that it’s disruptive. Believers don’t want to believe. Endurance peeps need more than just one study of nine Northern European cyclists. They know stuff–like covering your knees in cold weather with lycra actually does something. (That’s just a joke.)

So Ms Reynolds smartly quotes another similar trial. In this study of Western States 100 finishers, pre-race NSAIDs proved unhelpful and inflammatory. Not only did NSAID use not prevent muscle soreness or reduce muscle enzyme release, those athletes who took the drugs had higher blood measures of bacteria and inflammation.

Taken together, these two modest studies support the conclusion that NSAID use before and during exercise may be hazardous to your health. To me, risking poop leakage just isn’t worth it.

The bottom line:

NSAIDs are labeled as anti-inflammatory. That’s a dubious claim. In many cases, it appears to be the opposite.

I’ve got a better anti-inflammatory plan:

  • Be fit and rested.
  • Be strong and balanced.
  • Be mindful of what your body can and cannot do.
  • Enjoy the ride.
  • If you have to take a pain pill to do it, maybe you should…

I’m telling you folks; these pain elixirs are not to be taken lightly. Be afraid.


2 replies on “Could NSAIDs actually cause inflammation?”

I can’t say that I am sorry to hear that pre-exercise NSAIDs are not helpful to athletes. In my primary care experience – NSAIDs were probably the most overused (and inappropriately used) drug of all. Granted – NSAIDs can be very helpful to many patients with arthritis – but properly dosed acetominaphen has been shown to be nearly equally effective for treatment of osteoarthritis with far fewer adverse effects (and at far less cost).

Potential problems from taking NSAIDs are legion. They include fluid retention, exacerbation of heart failure and hypertension, increased risk of MI, GI distress (perhaps “leaking poop” per Dr. John) – and renal impairment. Most of these adverse effects are LESS of a problem for otherwise healthy less-than-older individuals when a short course of NSAIDs are taken for a truly “inflammatory” condition – but the most common population to receive longterm (continual) NSAIDs is the elderly (they are the ones with the worst arthritis) – and to me the “balance” between pros and cons of longterm NSAIDs for patients with chronic arthritis who have never tried adequate acetominophen is not positive …

I like Dr. John’s “anti-inflammatory plan” that he gives at the end of his post.

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