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.

NSAIDs Can Help Decrease Inflammation and Pain but Impact Muscle Gains

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NSAIDs (non-steroidal anti-inflammatory drugs) including ibuprofen, naproxen, diclofenac, celecoxib and indomethacin can decrease pain. Take them for the shortest possible time as they can be harmful.

Should you use NSAIDs? If you must get back to work ASAP then consider the risks vs. benefits. Talk to your pharmacist and physician (MD).

NSAIDs can help decrease inflammation and pain

NSAIDs can Help Decrease Pain from:

  • Acute ligament sprain – use for < 5 days. NSAIDs reduce pain and swelling so you can return to activity faster.
  • Osteoarthritis (cartilage wear and tear)
  • Delayed onset muscle soreness. When taken for several days before muscle damaging exercise, NSAIDs may reduce soreness. Take with caution as they can wreck your strength gains (see below).
  • Muscle bruise (contusion). Short term use can decrease inflammation with no adverse effects on healing.
  • Tendonitis – reduces inflammation and helps recovery. NSAIDs may do more harm than good for chronic tendon issues.

How NSAIDs Impact your Strength Gains

  • Short-term low dose (400 mg ibuprofen) use may have no real impact on muscle strength or size.
  • Longer term, higher doses (1,200 mg ibuprofen) may compromise muscle growth and, when training was preformed with all-out max reps, strength gains were also compromised.
  • The elderly may benefit due to a decrease in inflammation from taking NSAIDs. Chronic inflammation, which is not uncommon in the elderly, impairs strength gains. NSAIDs help tame inflammation.
  • After muscle injuries, NSAIDs can help reduce strength loss, soreness and muscle markers of inflammation, particularly when lower body muscles are injured.

Why do NSAIDs Impact Training (Strength) Gains?

NSAIDs work by blocking COX enzymes. COX enzymes alter prostaglandin synthesis, mediators of inflammation and pain. Prostaglandins have other actions in the body including regulation of muscle protein metabolism. Decreases in the prostaglandin PGFare associated with decreased protein synthesis and reduced muscle fiber size. In one study, 1200 mg ibuprofen blocked protein synthesis after resistance training. Other studies show signaling responses in muscle are decreased for hours or days after resistance training when NSAIDs are used.

References:
Arthritis Res Ther 2013;15(Suppl 3):S2.
Annals of Phys and Rehab Med 2010;278-288.
Am J Sports Med 2004;32(8):1856-9.
Am J Physiol Endocrinol Metab 2002;282(3):E551-6.
Acta Physiol (Oxf) 2018;222(2).
J Physiol 2009;587(Pt 24): 5799-5800.
Am J Sports Med 2018;46(1):224-233.

 

Yikes! Are there Antibiotics or Hormones in Your Milk & Dairy Foods?

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milk

Are antibiotics and hormones used in dairy cows contributing to the obesity epidemic, early puberty and antibiotic resistance? Before going down that road, we have to first we have to first ask if there are any antibiotics or hormones in milk and dairy products.

In this blog post I will cover:

  • Why are antibiotics given to cows?
  • Antibiotics are not in milk, here’s why.
  • Why are growth hormones given to cows? Are there any hormones in my milk and dairy food?
  • What are the cows Eating?

Why are Antibiotics given to Cows?

Antibiotics are used on farms to treat animals who are sick just like you would give an antibiotic to your child if he or she gets sick or take one yourself. There is no reason for dairy farmers to give antibiotics to cows who are not sick. Doing so costs additional money,  serves no clear purpose and arbitrarily giving animals antibiotics could contribute to antibiotic resistance. Now imagine you are a farmer and your life depends on the health of your cows – would you want to run the risk of antibiotic resistance and your cows getting sick with fewer treatment options?

Some antibiotics are also used for animal growth. The FDA is phasing out this practice so medically important antimicrobial drugs (antibiotics) will no longer be allowed to enhance growth or feed efficiency. In the future antibiotics will only be allowed to treat, control or prevent disease and of course require a prescription from a licensed veterinarian. Regardless of whether or not the antibiotic is used for growth or treatment of disease, no traces of antibiotic residues are allowed in milk or dairy products.

Antibiotics are Not in Milk, Here’s Why.

Any cow that gets an antibiotic is milked separately from the rest of the herd and the milk is thrown out. That milk will never be sold or consumed. All antibiotics have a different period of time before all traces of the medication leaves the body (whether we are talking about a cow or a human). Once this period is up and the cow is completely healthy again, the farmer tests her milk. Milk cannot be sold until it is completely clear of all drug residues. Whether organic or conventional, all milk is tested several times before making it to market. It is tested on the farm and at the milk processing plant. Any milk that tests positive for any medication residue, including antibiotics, is thrown out (1).

According to national Milk Drug Residue Data Base compiled for the years 2013 to 2014, 0% of milk tested positive for drug residues. In 2015, the FDA’s Center of Veterinary Medicine surveyed 1,918 raw milk samples (before pasteurization) from across the country. Samples were tested for residues of 31 drugs including the antibiotics, NSAIDs (ibuprofen etc.) and an antihistamine. They found 99% of sampled milk was free of any drug residues. Keep in mind the 1% of milk with residues must be thrown out – it cannot be sold (1, 2).

Cheese and yogurt are made from milk and therefore, there are no antibiotics in your cheese or yogurt either.

If you want to learn more about what farmers are doing about antibiotic resistance, Minnesota Farmer Wanda Patsche wrote an excellent blog on this topic.

Growth Hormones in Dairy Cows

Growth hormones are approved for use in dairy cows to improve milk production. Greater milk production means fewer environmental resources used to raise cows for milk. Bovine somatotropin (bST; also called bovine growth hormone or rBGH) is perhaps the most well recognized growth hormone used on dairy farms. bST is “a protein hormone produced in the pituitary gland of animals, including humans, and is essential for normal growth, development, and health maintenance.” Very little bST is used in dairy cows and there is no test that can distinguish between cows treated with bST and naturally occurring bST (3). Humans do not have receptors for bST and therefore it is passed through your body intact without being absorbed (4). As a result, there are no known side effects or health issues associated with consuming dairy from cows treated with bST. IGF-1 (insulin like growth factor 1) concentrations are slightly higher in cows treated with bST. However, the human body synthesizes IGF-I and drinking 1.5 L of milk is equivalent to an estimated 0.09% of the IGF-I produced by adults each day (5, 6, 7, 8).

USDA organic dairy products are “produced without antibiotics fed or administered to the animal at any point in its life” (9). There are no meaningful nutrition differences between organic and conventional dairy products. I covered that topic in this post.

What are the Cows Eating?

Cows’ diets also vary depending on many of the same factors that influence your food choices. However, unlike humans, all cows have the benefit of seeing a nutrition expert (like dietitians, animal nutrition experts are specialists). Many consumers also have questions about how cows are fed. Cows are fed nutritious diet to ensure health of cow and nutrition of milk. Typical feed mixtures may include haylage (grass with a higher water content), corn silage, sugar beet pulp and a protein mineral mix.

Rest assured, your dairy products are safe. In fact, the dairy product that says it is made with cows not treated with antibiotics is the exact same as the one from a cow that may have been treated with antibiotics. Both contain no antibiotic residues. Growth hormones used in dairy also pose no known threat to human health. The human body does not even recognize the main hormone used in cows. So, regardless of what milk, yogurt, or cheese you choose, all have been produced and extensively tested to ensure they are safe for human consumption.

This post was written as part of my ongoing sponsored partnership with U.S. Farmers & Ranchers Alliance. All opinions expressed are my own and per the usual, took me hours to research and double check my facts.References (if not cited via a hyperlink in the text of this post)

References

1 Questions and Answers: 2012 Milk Drug Residue Sampling Survey. FDA.

2 NATIONAL MILK DRUG RESIDUE DATA BASE FISCAL YEAR 2014 ANNUAL REPORT October 1, 2013 – September 30, 2014 http://www.fda.gov/downloads/food/guidanceregulation/guidancedocumentsregulatoryinformation/milk/ucm434757.pdf

3 Bovine Somatotropin (BST) http://www.fda.gov/AnimalVeterinary/SafetyHealth/ProductSafetyInformation/ucm055435.htm

4 Bovine Somatotropin. National Institutes of Health, Technology Assessment Conference Statement. December 5-7, 1990. https://consensus.nih.gov/1990/1990BovineSomatotropinta007html.htm

5 Joint FAO/WHO Expert Committee on Food Additives (JECFA). 1998. Toxicological evaluation of certain veterinary drug residues in food; Summary and conclusions. 50th report of the Joint FAO/WHO Expert Committee on Food Additives. World Health Organization, Geneva, Switzerland.

6 Collier RJ, Bauman DE. Update on human health concerns of recombinant bovine somatotropin use in dairy cows. J Animal Sci 2013; 92(4): 1800 – 1807. https://www.animalsciencepublications.org/publications/jas/articles/92/4/1800

7 Recombinant Bovine Growth Hormone. http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/recombinant-bovine-growth-hormone                  

8 Report on the Food and Drug Administration’s Review of the Safety of Recombinant Bovine Somatotropin. Food and Drug Administration. http://www.fda.gov/animalveterinary/safetyhealth/productsafetyinformation/ucm130321.htm

9 Stacy Sneeringer, James MacDonald, Nigel Key, William McBride, and Ken Mathews. Economics of Antibiotic Use in U.S. Livestock Production, ERR-200, U.S. Department of Agriculture, Economic Research Service, November 2015. http://www.ers.usda.gov/media/1950577/err200.pdf