Are NSAIDs Safe for Cartilage and Health?

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NSAIDsNSAIDs can help decrease inflammation and pain from musculoskeletal injuries, menstrual cramps, rheumatoid arthritis and more. However, they come with some major potential side effects.

NSAIDs can Destroy Cartilage

NSAIDs (non steroidal anti-inflammatory drugs) like ibuprofen (Advil) and indomethacin may speed up the breakdown of cartilage in osteoarthritic joints. They might also inhibit tissue repair. But, not all studies show NSAIDs damage cartilage. It may depend on the specific NSAID. The best study I’ve seen to date (and also published in a very reputable journal) found older adults (a group that commonly has osteoarthritis) who used NSAIDs including diclofenac, ibuprofen, naproxen, ketoprofen and piroxican for an extended period of time had higher risk of cartilage defects and nonsignificant loss of cartilage compared to nonusers.

Osteoarthritis is very common (athletes, older adults, those who are overweight, those who have been very active their whole life) and is “wear and tear” arthritis; symptoms include joint pain and stiffness.

If you have mild osteoarthritis look for other solutions including curcumin, glucosamine and chondroitin sulfate, and boswella serrata AKBA.

NSAIDs Can Lead to Major Side Effects:

In most cases the increase in risk is statistically significant but very small (see below in blue).

  • Increased risk of heart attack and stroke. Risk increases even with short term use (1 week) and increases more with higher doses of NSAIDs used for a longer period of time.

The increase in risk is about 20 – 50% higher if using NSAIDs vs. not using them. What does this mean? If you take NSAIDs the risk of heart attack is about 1% per year. 

Aspirin does not increase risk.

  • Heart attack and stroke risk is greatest in those who already have heart disease though people without heart disease are at risk.

“Patients treated w/ NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to those not treated with NSAIDs” (FDA).

  • Increased risk of a bleeding ulcer in the stomach or intestines. Bleeding often comes without symptoms. Bleeding could lead to death. Risk increases in those who drink alcohol, smoke, take corticosteroids and anticoagulants, those who are older and people in poor health.
  • Kidney damage
  • Liver damage; very low risk
  • Anemia; when used for a prolonged time due to wearing of the stomach lining and therefore decreased absorption of iron and / or an increase in bleeding.
  • High blood pressure
  • Central nervous system issues headache, fatigue
  • Asthma attacks in those with asthma
  • Risk of bleeding
  • Hives

Safer Use of NSAIDs

Lower your risk of harmful side effects from NSAIDs by doing the following:

  • Take the lowest effective dose.
  • Take your NSAID for the shortest possible time.
  • Don’t take more than one NSAID at a time!
  • Find other solutions for pain (see my previous and upcoming posts, especially on Instagram).
  • If you notice any other symptoms including black tar like poop, skin rashes, stomach pain, yellow skin or eyes, nausea, feeling tired, swelling or vomiting, call your doctor ASAP.
  • Call 911 ASAP if you experience any heart attack, stroke or allergy symptoms including but not limited to shortness of breath, pain in chest, arm or neck; difficulty speaking, headache, blurred vision, droopy face, swelling in throat or face.

Tylenol may be a better option though it can cause liver damage if taken in doses > 4 g per day

NSAIDs (non-steroidal anti-inflammatory drugs) might be okay for very short-term use if you have:

  • No bleeding history
  • You are well hydrated, healthy and without renal issues.

Types of NSAIDs:

There are many different NSAIDs on the market and each one has a generic name and sometimes several trade names.

Types of NSAIDs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Keep in mind, NSAIDs are not a long-term solution to pain. Also, most NSAID safety data is not from athletes.

References:
FDA
Br J Clin Pharmacol 2010;69(6):689-700.
Ther Clin Risk Manag 2015;11:1061-1075.
Eur J Rheumatol Inflamm 1993;13(1):7-16.
J Prolotherapy 2010;(2)1:305-322.
Arthritis Rheum 2005(52):3137-3142.
Inflammation 2002;26:139-142.
Am J Med 2009;122(9):836-842.
World J Gastroenterol 2010;16(45):5651–5661.

Are Your Muscles Sore and Joints Hurting? Here’s What You Should be Eating

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When I first started cross country in high school I would go to sleep in a homemade pajama of Ben Gay slathered all over my sore legs. And then each morning at 5 am my sister would have to pry me out of bed for our newspaper route. As I threw one sore leg after the other off the bed I absolutely dreaded the thought of running, a necessary task since she made me go to the houses with the dogs that chased us and the sketchy places by the woods (I’m the youngest). If you too have tried Ben Gay, massage, ice packs or any other modality for trying to decrease muscle soreness and keep your joints moving, it’s time to fight exercise-induced inflammation through your diet.

Here’s what I’ll cover in this post (and as shared on Talk of Alabama this morning – see their website for more information):

  • The top two foods you need to decrease muscle soreness
  • Foods that keep your joints healthy

Talk of Alabama

Decreasing Muscle Soreness

When it comes to exercise, some inflammation is good and actually essential for muscle growth and repair. But, excess inflammation can lead to muscle cell damage and that feeling like you couldn’t possibly get off the couch for days. So, I recommend athletes include tart cherry juice into their regular nutrition regimen as a preventative measure. Research shows **tart cherry juice can help decrease exercise-induced muscle soreness and inflammation. Try it in a shake or check out my gelatin chews below.

Research from the University of Georgia found 2 grams of ginger, either fresh ginger or in spice form (they tested McCormick ginger), helps reduce muscle pain when consumed daily for 11 days prior to exercise testing. I have a few recipes below you might want to try. Also, check out Reed’s Ginger Brew (it is like ginger ale but made from real ginger with 17 grams per bottle!).

Keeping Your Joints Moving

Fatty fish including salmon, mackerel, herring, anchovies etc. contain long chain omega-3 fatty acids that have modest anti-inflammatory effects and have been shown to decrease cartilage breakdown (cartilage is like a sponge that cushions your joints so they can easily glide on top of one another) and inflammation in cell culture studies. In addition, research studies show these fatty acids can improve several symptoms associated with *rheumatoid arthritis and possibly even decrease the need for anti-inflammatory drugs. *Always talk to your physician if you have a disease such as rheumatoid arthritis.

Plus, there are two types of plant-based foods you should focus on. Foods rich in vitamin C including citrus, bell peppers, broccoli, strawberries, cauliflower, pineapple, kiwi. Vitamin C is necessary for repairing and maintaining cartilage and higher intakes are associated with less severe cartilage breakdown. In addition to vitamin C, yellow and orange fruits and vegetables contain an antioxidant that may improve bone formation and decrease bone breakdown. And finally, ginger is also effective for reducing joint pain though you have to consume it regularly over several weeks (500 mg ginger extract was used). 

Cherry Ginger Smoothie

Ingredients
8 oz. vanilla soymilk
1 scoop unflavored or vanilla whey protein (if using unflavored you may need to add a sweetener)
½ cup frozen tart cherries
2 tsp. (or more if desired) fresh cut ginger
Ice as desired

Directions
Add vanilla soymilk to blender followed by the rest of the ingredients in order. Blend until smooth.

Honey Ginger Salmon

Ingredients
4 salmon fillets (4-6 oz. each)
2 tsp. finely grated fresh ginger or 1 tsp. ginger spice
3 Tbsp. honey
2 tsp. olive oil
¼ cup soy sauce

Directions
Mix all ingredients except salmon in a bowl. Place marinade and salmon in large resealable plastic bag so that marinade coats salmon fillets. Refrigerate for 30 minutes or longer. Remove salmon fillets and grill 6 to 8 minutes per side or bake at 350°F for 15-20 minutes.

Fig Cherry Ginger Chews

Ingredients
13 dried figs
1/2 cup dried tart cherries
3 tsp finely grated fresh ginger

Directions:
Place all ingredients in a food processor and mix throughly. Take small portions out and make small balls. If you want them even sweeter, roll finished balls in cane sugar or powdered coconut sugar.

Tart Cherry Gelatin

Ingredients
2 packets gelatin mix
2 cups tart cherry juice
3 tsp fresh ginger

Directions
Boil 1.5 cups tart cherry juice. While juice is boiling place remaining 1/2 tart cherry juice in a bowl and mix in gelatin packets. Let sit for at least one minute. When juice is finished boiling mix it into juice & gelatin mixture until throughly blended. Add 3 tsp. fresh grated ginger and 1 – 2 Tbsp. sugar if desired. Place mixture in an 8×8 pan and refrigerate for at least one hour. Remove from refrigerator and enjoy!

** TV segment, but not post, sponsored by the Cherry Marketing Institute