Exactly How Safe Are Over The Counter Meds (NSAIDs)?
There is a common misconception that over the counter meds are safe and not very strong, mostly because they don’t require a prescription. This is a dangerous thought. It is estimated that 16,500 people die per year from NSAID overdose, and 100,000 people are hospitalized. That’s more deaths per year than HIV or AIDs.
What are NSAIDs?
Herbal remedies aside, there are two main categories of anti-inflammatories. Steroidal and non-steroidal. Steroids have two sub-groups: anabolic and catabolic. One adds tissue (the illegal ones-anabolic) and the other takes away tissue (catabolic). Steroidal anti-inflammatories are like a nuclear bomb for inflammation and are very effective. Examples are prednisone and cortisone. The problem with these meds are that they are like pacman. They go around eating at tissue. There is a correlation between long term steroid use and achilles tendon tears.
Then there are NSAIDs which stand for “nonsteroidal anti-inflammatory drug’. These include aspirin, ibuprofen, naproxen, and acetaminophen. The work by blocking the action of COX-1 and/or COX-2. These are enzymes that are mediators in prostaglandins and thromboxanes (inflammation and clotting). The problem with blocking these enzymes is that they serve a purpose and blocking them comes with side effects. COX-1 inhibitors are correlated with gastrointestinal bleeds. COX-2 inhibitors are associated with increase in clots and therefore cardiovascular disease.
Another large problem is interaction. This is a grossly overlooked topic when it comes to diet and supplementation. For example, grapefruit is known to interfere with cardiovascular medication. Supplementation use is on the rise and there many interactions with NSAIDs and supplements. NSAIDs have potential to interact with: ginkgo, garlic, ginger, bilberry, dong quai, feverfew, ginseng, turmeric, meadosweet, willow, coumarin, chamomile, motheworth, horse chestnut, fenugreek, red clover, and tamarind, all increasing the risk of bleeds.
What about baby aspirin? Many healthy aging adults take it to reduce the risk of heart attack and dementia. A recent longitudinal study concluded that the risk outweighs the benefit. The study looked at 19,000 people from the U.S. and Australia for five years. They found that compared to the placebo group, there was an increase in death rate, surprisingly by cancer. The authors admit this may have been a fluke finding but there was also no benefit. In fact, the FDA has reversed its position on baby Aspirin and no longer recommends it if you haven’t had a heart attack.
We may need to rethink our constant attack on inflammation. There is a general fear of inflammation in this country. Remember, it is not all bad. Inflammation is our bodies natural process and is the one of the first stages of healing. There are certainly times when it gets out of control or just becomes unbearable. I personally will only take an NSAID if I have a head-splitting migraine or can’t sleep at night because of pain. For minor aches and pains, I wouldn’t even think of using an NSAID. It’s not worth the side effects.
1. (2013, November 20). Quantifying the Impact of NSAID-Associated Adverse Events. Retrieved September 17, 2018, from https://www.ajmc.com/journals/supplement/2013/a467_nov13_nsaid/a467_nov13_fine_s267
2. (2018, July 11). U.S. Statistics | HIV.gov. Retrieved September 17, 2018, from https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics
3. "Achilles tendon rupture as a result of oral steroid therapy. - NCBI." https://www.ncbi.nlm.nih.gov/pubmed/12070236. Accessed 17 Sep. 2018.
4. (n.d.). Prevention of NSAID-induced gastroduodenal ulcers. - NCBI. Retrieved September 17, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/12519573
5. (n.d.). Selective COX-2 inhibitors, NSAIDs and cardiovascular events – is .... Retrieved September 17, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376081/
6. (2017, July 18). Consumer Updates > Grapefruit Juice and Some Drugs Don't Mix - FDA. Retrieved September 17, 2018, from https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm292276.htm
7. (2002, December 11). Herbal medication: potential for adverse interactions with analgesic .... Retrieved September 17, 2018, from https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2710.2002.00444.x
8. (2018, September 16). Study: A Daily Baby Aspirin Has No Benefit For Healthy Older People. Retrieved September 17, 2018, from https://www.npr.org/sections/health-shots/2018/09/16/647415462/study-a-daily-baby-aspirin-has-no-benefit-for-healthy-older-people
9. (2014, August 4). FDA Reverses Its Position on Daily Aspirin Use - Dr. Mercola. Retrieved September 17, 2018, from https://articles.mercola.com/sites/articles/archive/2014/08/04/daily-aspirin-side-effects.aspx