Here’s an interesting fact: The body doesn’t like doing things that cause pain
. If it hurts a golfer’s lower back to stretch into a full backswing, their body will instinctively find ways to alter its biomechanics to prevent experiencing that pain again – even if it results in a few extra strokes on the scorecard. To resolve this crisis and maintain their game, golfers and other athletes will often turn to nonsteroidal anti-inflammatory drugs, or NSAIDs. Likewise, other athletes have turned to NSAIDs to deal with pain and inflammation that often is associated with playing sports at an elite or even recreational level. There’s more.
Pain and inflammation are associated with many common activities, such as headaches, arthritis and menstrual problems – and consider that on any given day, an estimated 20 percent of Americans suffer from back pain. As such, an estimated 30 million Americans take over-the-counter drugs daily to deal with pain and inflammation. This is not a good thing, as there are many consequences from using these drugs, especially if taken regularly. Let’s begin.
In 1999 The New England Journal of Medicine
published a report that extrapolated that the deaths per year from NSAIDs are 16,500 – that’s per year
– just from the gastrointestinal side effects. That was over a decade ago! And the FDA reported that in the first three months of 2008, there were over 2,700 deaths from NSAIDs. Even one dose has its risks. According to a 2009 report in the Annals of Medicine
, complications can occur from taking anti-inflammatory drugs and the risk is “is present from the first dose.” Side effects include liver problems, stomach upset, blood disorders, vision problems…well, you get the idea. That’s bad news.
Because of the widespread use of NSAIDs and the negative impact they can have on health, as part of my BioSignature Continuing Education program I invited Dr. Robert Silverman to the Poliquin Strength Institute in June 2011 to speak about the consequences of using NSAIDs as well as alternative methods to deal with inflammation and pain.
Silverman has many impressive academic qualifications, including graduating magna cum laude from the University of Bridgeport College of Chiropractic and a master’s degree in nutrition. He has worked with all levels of athletes, including many Olympians and professional athletes; he has a syndicated talk show, Get Healthy with Dr. Rob
, and he appears regularly on two local radio stations. His practice, New York ChiroCare, is located in White Plains, New York.
One of the key points in Dr. Silverman’s presentation at PSI was that there are many natural alternatives to NSAIDs that do not have the side effects associated with these drugs. Among these alternatives are products my colleague Dr. Mark Houston refers to as nutraceuticals
, a term that combines the words nutrition
and describes products that act like drugs without producing many of the side effects associated with drugs.
After the presentation, I asked my editor Kim Goss to interview Dr. Silverman about the problems associated with NSAIDs and his advice for using natural methods to deal with pain and inflammation.
KG: Isn’t inflammation a natural response to an injury, and as such can be considered a good thing?
Yes, as long as it’s not degenerative inflammation and not too abundant. In the February 2004 issue of Time
magazine, the editors made inflammation their cover story, calling it “The Secret Killer.” The reason this subject got the attention of the mainstream media is that high levels of inflammation are associated with virtually every chronic disease, and inflammation is a key component of the myofascial pain syndrome that a lot of athletes experience.
KG: How do you determine when inflammation has become excessive?
There are some telltale signs that you might have a major issue with inflammation, such as redness, puffiness, lost of range of motion and of course pain.
KG: Whenever you hear about inflammation, you often hear the word pain associated with it. What is the relationship between inflammation and pain?
They are different conditions but often can be related. If there is pain associated with inflammation, that can be a reason for concern – and the more pain there is, the more there is reason for concern.
KG: Why do surgeons have to wait for inflammation to go down before operating, such as with an ACL repair?
It’s difficult to operate on a joint when there is a lot of swelling, so surgeons prefer to wait until the inflammation goes down so they can more easily get at the joint.
KG: How effective is ice in dealing with inflammation?
There’s a big debate about ice. I’m a big proponent of ice when an injury is in an acute stage. If the injury and inflammation is new, I’m a proponent of a cycle of 20 minutes “on” and 40 minutes “off.” Many athletes go to the heat immediately, because the heat feels good; but if the tissue is inflamed, more blood comes to the area, and that can be counterproductive.
KG: What are the differences among the various types of NSAIDs?
From my perspective, I group them all together – and I do this because the public has been led to believe that NSAIDs are safe. Besides the health issues, studies have shown that all anti-inflammatory drugs delay complete healing of the tissues. That is to say that although NSAIDs may decrease pain, they can impair healing. For this reason I like the nutraceuticals that Charles Poliquin has developed because they not only decrease pain and inflammation but also promote healing.
KG: Aspirin is often used to treat muscle soreness. How effective is it for this purpose?
Its actions, unfortunately, do not allow for muscle regeneration, and there is research that suggests that NSAIDs may create a higher level of oxidative stress and as such can actually increase muscle soreness. To deal with muscle soreness I would look for proteolytic enzymes, such as trypsin and bromelain, and some nutrients to help relax the muscles, such as calcium and magnesium. All these nutrients are provided in Poliquin’s Joint Task Force Px.
KG: What do you consider the major side effects of NSAIDs?
Where do I begin? Ulcers, constipation, heartburn, nausea, rash, headache, kidney failure, liver toxicity – the list goes on. The primary ingredient in Tylenol® is acetaminophen, which has been shown to deplete co-enzyme Q10, so people who take it are depriving their bodies of critical nutrients. That is a problem. And the side effects may be worst with children and adolescents. Parents of athletes, especially at the high school level and younger, should look closely at giving their kids nutraceuticals instead of NSAIDs.
KG: What about cortisone injections? Does this drug have adverse effects on other areas of the body?
It can, but the effects tend to be more localized. My problem with cortisone is that it can weaken the tendinous muscular insertions
KG: What is the role of diet in inflammation?
A poor diet can be a potentiator of inflammation. In fact, a major survey of primary care physicians found that 96 percent believe that our health care system does not place enough emphasis on nutrition to treat and manage chronic disease.
KG: What types of foods are inflammatory?
Some highly inflammatory foods are fried foods and those that contain trans fatty acids. We’re also finding that a lot of inflammation can be traced to the consumption of wheat, corn and soy and possibly dairy. Gluten is a major problem, because gluten contains a protein to which 1 in 100 people are outright allergic, and for which about 40 percent of the population show antibodies.
KG: Let’s say an athlete pulls a hamstring and consumes a diet high in foods that are inflammatory – could this delay the healing process?
Absolutely. When I first see an injured athlete, I often put them on an anti-inflammatory diet.
KG: Is there any specific type of diet that is considered anti-inflammatory? Perhaps the Paleo diet by Dr. Loren Cordain?
The Paleo diet is interesting in that there is no wheat or dairy, so you could say that the Paleo diet is anti-inflammatory.
KG: What is your overall approach to dealing with soft-tissue injuries that involve inflammation and possibly pain?
My priorities within the first 72 hours of an injury are to manage pain, reduce excessive swelling, relax tight muscles and use strategies to restore motion. This would be considered the acute phase of an injury. The priorities in the next phase, which is called sub-acute and can last up to eight weeks, are to reduce scar tissue formation, aid in connective tissue remodeling, and reduce the risk of reinjury and degeneration. The final phase consists of continuing with tissue remodeling and wellness support to help the tissue return to its original histological and mechanical features – and this phase would include strength and conditioning methods.
KG: What is your opinion about frequency specific microcurrent?
This is a very useful modality, and has been shown to be very effective in dealing with inflammation.
KG: What are some of the best supplements you recommend for both treating and preventing inflammation?
My absolute top supplements would be a multivitamin/mineral, omega 3 fish oil, vitamin D3 and, to help the gut, HCL and a probiotic.
KG: What about for pain?
I’ll tell you two products I like. One is Omega 3 6:1
, which has the essential fatty acids EPA and DHA in a 6 to 1 ratio; and the other is Mobility Px
, which is an herbal formula with ingredients such as quercetin, turmeric, boswellia, ginger rhizome and cayenne. I use these products for postsurgical ACLs.
KG: What is the benefit of a probiotic?
About 60 to 80 percent of our immune cells can be found in our gut; and NSAIDs, stress, poor diet, and antibiotics all affect the distribution of the proper flora in the gut. A probiotic will help populate the gut with good bacteria and strengthen the GI barrier. One of my favorite mottos is “Do you have the guts to be healthy?”
KG: Is there anything else anyone who has used NSAIDs in the past should know?
Taking NSAIDs may seem like a simple solution to dealing with pain and inflammation, but the risks of using these drugs often far outweigh the benefits. There are better alternatives. They may not be as simple as swallowing an NSAID, but my mantra is “Treatment is a process, not an event!”