The Dark Side Of Chronic NSAID Use
“From the first day of use, all NSAIDs increase the risk of gastrointestinal (GI) bleeding, myocardial infarction, and stroke.”
Key Takeaways
NSAIDs are thought to be a harmless and effective means to reduce pain from a wide array of conditions ranging from headache and muscle soreness to fever.
Chronic use of NSAIDs can increase one’s risk for a host of chronic diseases, including GI complications and cardiovascular disease.
Specifically, long term NSAID use is not recommended because it may:
Cause damage to gastrointestinal tract
Increase risk of heart attack and stroke
Cause damage to the kidneys
Reduce adaptation to exercise
May increase risk of Dementia
NSAIDs are a potent class of drugs that serve a very important role in pain relief and inflammation control. If you’re in agony, take them to relieve your acute pain.
Whether it’s a Flintstone gummy or Advil, think twice before tossing an endless amount of pills down your gullet.
Full Story
NSAIDs, or nonsteroidal anti-inflammatory drugs, are the most common classes of over-the-counter drugs taken to reduce pain and inflammation. Aspirin, ibuprofen (Advil, Motrin), and Naproxen (Aleve) are among the most popular NSAIDs, widely available for unrestricted purchase at any CVS for people of all ages. Every day, NSAIDs are taken by over 30 million Americans (2).
NSAIDs work by blocking the enzymes Cox-1 and Cox-2, both of which aid in prostaglandin synthesis. Prostaglandins are a group of lipids that play a key role in the recovery process, helping the body fight off illness and heal injury by controlling processes such as inflammation and blood flow (3). Less prostaglandin, less pain.
Pain relief is pretty awesome, but there is no such thing as a free lunch in physiology - it turns out, inflammation is a necessary component of optimal healing and adaption. The mechanisms of NSAIDs temporarily relieve pain but, in return, have the potential to cause undue harm to the body over the long term.
Chronic use of NSAIDs has been shown to
damage the GI tract,
increase risk of heart attack and stroke
damage the kidneys
decrease the effectiveness of workouts
…and may even increase your risk of Alzheimer’s disease. But you won’t see that in big bold letters on your Advil label.
Here’s an evidence-based view of the 5 scariest NSAID side effects.
1. Damage to Gastrointestinal Tract
A few of the wide ranging side effects of acute NSAID use, including:
gas/bloating
heartburn
stomach pain
nausea/vomiting
diarrhea/constipation
…all hint at the most common negative effect of long-term NSAID - damage to the gastrointestinal tract (4).
Regular NSAID use is directly correlated with GI distress, ulcers and GI bleeding (5, 6). In fact, it is estimated that NSAID related GI distress accounts for 100,000 hospitalizations and 16,500 deaths in the U.S. each year (7).
2. Increase Risk of Heart Attack and Stroke
Cardiovascular disease is the leading killer in the United States by a wide margin. One of the most deadly effects of long term NSAID use is an increased risk of heart attack (8, 9) and stroke (10, 11).
This 2017 study that assessed over 28,000 people that had heart attacks found that over 3,370 of the patients had taken an NSAID within a month of the event. They also noted that taking any NSAID prescription in this population raised one’s risk of cardiac arrest by 31% (12).
“ The current message being sent to the public about NSAIDs is wrong. If you can buy these drugs in a convenience store then you probably think ‘they must be safe for me’. Our study adds to the evidence about the adverse cardiovascular effects of NSAIDs and confirms that they should be taken seriously, and used only after consulting a healthcare professional.”
In 2015 the FDA strengthened its warning that NSAIDs have been shown to increase risk of heart attack and stroke.
Specifically, NSAID labels were revised to include the following alarming warnings:
“The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID. The risk appears greater at higher doses.”
It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack."
There is an increased risk of heart failure with NSAID use” (14).
Additionally, NSAID use can significantly increase blood pressure levels, especially in those taking anti-hypertensives. In one study of elderly patients, NSAIDs increased blood pressure by an average of 5 mmHg (15). Increased blood pressure levels skyrocket rate of cardiovascular complications, even in those without heart disease (16).
3. Damage to Kidneys
Chronic NSAID use can result in decreased blood flow to the kidneys. As the primary function of the kidney is to filter blood and other bodily fluids, decreased blood flow can result in a slew of negative effects including:
Electrolyte imbalance
Sodium retention
Edema
The reduced blood flow may also cause decreased glomerular perfusion, decreased filtration rate, and, ultimately, renal failure. Nearly 2.5 million people in the United States experience kidney issues each year as a result of NSAID use and there is a correlation between high dose of NSAIDs and both acute and chronic kidney disease (17, 18).
4. Reduce Adaptation to Exercise
This harmful effect of prolonged NSAID use hits a closer to home for those of us that love to train – decreased adaptation to exercise (translation – less GAINS)!
After an extra strenuous workout, you may be tempted to pop an Advil or Aleve to alleviate soreness and try to boost recovery before your next session. Don’t do that. Post-workout inflammation is a critical component of the recovery process, signaling to your body that the tasks you just performed require increased muscle size, strength, and endurance if you plan to do them again (19, 20).
The last thing we want to do, if we want bigger and stronger muscles, is to inhibit the rebuilding process after a workout, yet that is the exact mechanism of action of NSAIDs. For instance, one of the ways NSAIDs decrease pain is by blocking the production of Prostaglandin E2, an important mediator of muscle stem cell synthesis. Researchers found in this study that, after the use of NSAIDs, there was both less activity and less production of these muscle stem cells and muscle tissue was not as strong as the tissue that had not been treated with the drugs (21).
Even though this particular was performed on cells in a petri dish, similar studies have been conducted on mice and others have concluded that the muscle-inhibiting effects are likely similar in humans. (22, 23, 24). This 2017 study in young men and women, who had not been consistently resistance training, found that daily consumption of 1,200 mg of ibuprofen (about 3 pills of Extra Strength Advil) reduced muscle growth by nearly 50% in just 8 weeks (25).
Additionally, NSAIDs can reduce subjective feelings of soreness but not reduce muscle cell damage (26). In other words, when you load up on Advil to mask an injury you are more likely to push past warning signs from your body and cause even greater harm.
The bottom line - chronic, high-dose NSAID use has the potential to reduce the effectiveness of your workouts and interfere with your progress.
5. May Increase Risk of Dementia
To be clear, thus far in the scientific literature there is no relationship between NSAID use and risk of Dementia. To speculate, though, there may be reason to believe that but chronic use may increase the likelihood of developing cognitive disease.
Max Lugavere, a well known health and nutrition journalist and creator of “The Genius Life” podcast, has made the following logical, albeit non-research backed, jump -
“Non-steroidal anti-inflammatory drugs disrupt enzymes that protect the gut barrier, negatively affect the mitochondria of cardiac tissue, and easily cross the blood-brain barrier—and we know that mitochondrial dysfunction of neurons is one of the earliest problems associated with Alzheimer’s disease.”
Now, it’s above my pay grade to dive into the feasibility of this argument, but it makes sense. If nothing else, it is an interesting hypothesis that provides more support to think critically about the substances you put into your body on a consistent basis.
Wrap Up
NSAIDs are a potent class of drugs that serve a very important role in pain relief and inflammation control. By all means, if you’re in agony, take them to relieve your acute pain.
However, they are not a long term solution. They are a temporary band aid that can culminate in insidious harmful effects. Contrary to the message portrayed by the media and big drug corporations that they are a harmless panacea, they are a beneficial tool only when used in the safe frequency and correct context.
Whether it’s a Flintstone gummy or Advil, think twice before tossing an endless amount of pills down your gullet. Now that you’re an informed consumer, proceed with caution.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809680/#:~:text=All%20NSAIDs%20double%20the%20risk,in%20the%20next%2030%20days.&text=NSAIDs%20can%20precipitate%20bronchospasm%20and,in%20symptoms%20after%20taking%20NSAIDs.
https://www.webmd.com/arthritis/features/pain-relief-how-nsaids-work#1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081099/
https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60900-9/fulltext
https://www.sciencedaily.com/releases/2017/03/170315094550.htm
https://www.sciencedaily.com/releases/2017/03/170315094550.htm
https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-warning-non-aspirin-nonsteroidal-anti-inflammatory
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158445/
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724772
https://pubmed.ncbi.nlm.nih.gov/28834248/
https://www.sciencedirect.com/science/article/pii/S1877065710000576
https://www.sciencedaily.com/releases/2017/08/170828125123.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1478782/
https://podcastnotes.org/mind-pump/max-lugavere-endocrine-disruptors-light-organic-salt/
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