Ditch your NSAID meds
I am writing this post as we hurtle along I-680, the freeway bypass around San Francisco. We are on our way back home to Incline Village and it is simply amazing that the technology exists allowing me to do this. I’m using my laptop with Verizon Wireless National Broadband Service, which, although not as fast as my cable at home, still works plenty fast considering the circumstances. The other astounding thing about this experience is that I’m able to focus on what I’m doing with MD at the wheel in heavy traffic–it’s a real testament to my superhuman powers of concentration.
Today’s post is going to be a little bit soft on the science and long on the anecdotal, which is anathema to me, but since it’s my anecdote, I know it can be trusted. Plus, I have a bit of sort of soft science to back it up.
A few months ago I decided to quit taking Advil, my NSAID (non-steroidal anti-inflammatory drug) of choice, because of all the reports of that class of drug causing heart disease. I’m not a big advocate of any kind of medication use that can otherwise be avoided, so it was a good excuse for me to ditch my almost daily use of Advil. Since I’ve been hurtling pell mell toward my dotage I’ve noticed that I’ve begun to have a few aches and pains after a round of golf. A couple of years ago I started taking an 800 mg ibuprofen (the generic for Advil), which is a prescription dose and is comparable to four of the 200 mg non-prescription Advil, before every round I played, or if I forgot, I would take one immediately after. It seemed to do the trick as far as the aches and pains were concerned.
Once all the reports came out, however, I decided to seek an alternative. I began fooling around with various doses of fish oil and krill oil and came up with a combo that works very well for me. I take two ProOmega caps made by Nordic Naturals along with two krill oil caps (all krill oil originates in one place–Neptune Technologies–so they are all the same. Mine comes from Thorne.) along with a 500 mg curumin capsule (curcumin is a potent anti-inflammatory derived from turmeric). This combo I take the same way as I did the Advil: before if I remember; after if I forget. If anything it works better for me than the 800 mg ibuprofen without the potential for GI problems or heart attack. And not only does it not have the potential for causing these problems, it actually prevents these and many other disorders, so healthwise it’s really a win/win. I got such benefit from this regimen that I ran a medical search to see if anyone had tried it or anything resembling it on a research basis.
I found a recent paper in the neurosurgical journal Surgical Neurology entitled “Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.”
The authors began their paper with an overview of the prevalence of and problems caused by NSAID usage.
More than 70 million NSAID prescriptions are written each year, and 30 billion over-the-counter NSAID tablets are sold annually. It is estimated that 5% to 10% of the adult population and approximately 14% of the elderly routinely use NSAIDs for pain control.
This multibillion dollar industry, however, does not come without risk. NSAID-associated dyspepsia occurs in up to 50% of users. Almost all patients who take the long-term nonselective NSAIDS [Advil, for example] will demonstrate subepithelial gastric hemorrhage, and 8% to 20% more will have ulceration. In addition, 3% of patients will develop serious gastrointestinal side effects, which results in more than 100,000 hospitalizations, an estimated 16,500 deaths, and an annual cost to treat the complications that exceeds 1.5 billion dollars annually. Indeed, NSAIDS are the most common cause of drug-related morbidity and mortality reported to the FDA and other regulatory agencies around the world.
Recently it was found that the COX 2 inhibitors (Vioxx, Celebrex), designed to alleviate the gastric side effects of COX 1 NSAIDs, are not only associated with an increased incidence of MI and stroke but also have no significant improvement in the prevention of gastric ulcers.
As you can see, despite these drugs being available over the counter, they are not without the potential for serious side effects.
The authors of the study thought the same thing and decided, as I did myself, to look for a safer alternative. They decided to try fish oil and ended up using a Nordic Natural product that had a little different formulation than the one I used. They used ProEPA whereas I used ProOmega. I think they would have gotten a little better results had they used the ProOmega instead, but, hey, they’re neurosurgeons. What do they know about fish oil?
For the study the researchers selected 250 patients who had back pain that was due to degenerative arthritis and not reparable by surgery, all of whom were taking NSAIDS and about 75% of whom were on COX 2 inhibitors. These patients were instructed to start taking the fish oil (4 capsules per day) for 2 weeks then to reduce the dosage to 2 capsules per day. After the initial lead-in two weeks the patients were instructed to taper off their NSAIDs over the next one to two weeks. After one month the researchers sent a questionnaire to the patients inquiring as to the degree of subjective improvement they had experienced, any side effects they may have had, and to what extent they had been able to discontinue their NSAID dosage.
125 patients returned the questionnaire after about 75 days on the fish oil regimen. (This is what I mean about soft science: this is hardly a double-blind, placebo-controlled study.) 78% of the respondents were taking the 2 capsule dose, 22% were taking the 4 capsule dose. 59% reported to have discontinued their NSAIDs entirely. 60% reported that their overall pain had improved. 80% stated that they were satisfied with their improvement and 88% said they would continue to take the fish oil. There were no side effects reported other than two patients who reported loose stools.
All in all a pretty positive experience, I would say. I can’t help but wonder at what happened to the other 125 patients who didn’t respond. My guess is that they probably didn’t seriously adopt the fish oil regimen and therefore didn’t respond to the questionnaire, but that’s only a guess.
One thing I did (that I always do anyway) that probably made my regimen work even better is that I avoided omega-6 fats as much as possible. Omega-6 fats are those found primarily in vegetable oils and are themselves inflammatory and act in opposing fashion to the omega-3s. They are best avoided whether you decide to adopt this regime or not.
If you are taking NSAIDs for any reason, I urge you to give this regimen a try. Use my specific formula or fiddle around with your own. Whatever you do, let me know how it works out.
She’s still driving; I’m still posting; ain’t technology grand?