They are sold off the counter and found in all medicine cabinets. We reach out to them for any ache and pain, from simple headaches to tooth or back pain. Their packaging comes with a note that includes all side effects, but if you are honest with yourself, you never read it. On the other hand, the writing is so tiny that it is not meant to be read, so cut yourself some slack.
Because NSAIDs are so commonly used and because I want to inspire my clients to make informed decisions before making any lifestyle choices that implicate their bodies, I decided to tackle the topic of NSAIDs’ pros and cons.
What are NSAIDs?
Non-Steroidal Anti Inflammatory Drugs are the most prescribed and used medicine in America. Some of the brands of NSAIDs you might recognize are Aspirin, Ibuprofen, Advil, Motrin, and Aleve.
NSAIDs work by blocking the production of COX, an enzyme that builds prostaglandins, thus reducing inflammation, pain, and fever.
What is inflammation
Inflammation is the adaptive immune system response to tissue damage and infection. When cells sense tissue damage, they send immune messengers that trigger an immune response.
The immune response includes:
- Redness – Capillaries are dilated so more blood carrying nutrients and white blood cells can reach the injured area, leading to red color and puffiness.
- Swelling – The tissue close to the injury is flooded with fluids that can whisk away toxins, which further increases the swelling.
- Heat – The cleaning and fixing efforts require a lot of energy, which increases metabolism in and around the injured tissue, producing heat.
- Pain – results from fluids pressing on nerves, increasing their sensitivity.
Remember! Inflammation is the body’s healthy response to tissue damage.
A Tidbit Physiology
To better understand how NSAIDs work, we need to look at the chemical cascade that happens when tissue is damaged and how NSAIDs interfere in that chain reaction.
The membrane of every body cell is built from two layers of phospholipids. The presence of lipids in the cell membrane of all your cells is an excellent reason to eat healthy fats.
When a cell gets injured or infected, it releases some of these lipids from its membrane to form messengers, informing other cells in the neighborhood that an alarming event is occurring, so they better get ready to protect the hood.
The lipids released by the cells are called arachidonic acid or Omega 6 fatty acids. Arachidonic acid is the building block for two enzymes, Cox and Lox.
NSAIDs block the production of the COX enzyme.
Cox enzyme is produced in inflammation. To understand how NSAIDs work and their downside, you need to understand COX enzymes.
There are two types of COX enzymes: COX 1 and COX 2. (How creative is that?)
COX 1 Enzyme:
COX 1 enzyme has a protective role in the body. You might want to think of it as the housekeeping personnel making sure that everything runs smoothly.
Some of the things that COX 1 does in your body are
- Building a protective mucus layer around the gut to help protect your gut from the digestive acids and food bumping against the walls of the digestive tract and creating tissue damage.
- Producing substances that allow blood platelets to stick together, leading to blood clots.
- In the kidneys, COX 1 enzymes ensure smooth blood flow constricting blood vessels.
- Play a role in constricting blood vessels.
NSAIDs inhibit the COX 1 enzyme production. What does it mean?
When you inhibit the COX 1 enzyme production, you reduce the protective layer over your digestive system, increasing the risk of peptide ulcers.
Inhibiting the COX 1 enzyme production will reduce the body’s ability to create clots. If you consider using NSAIDs following surgery to reduce pain, keep in mind that clotting is part of the body’s way to stitch itself together. NSAIDs might not be your medicine to go for after surgery.
If COX 1 enzyme is your housekeeping crew, COX2 is activated in emergencies and functions as your police and fire department. (just the opposite, they build the fire)
Some of the things COX2 does in your body:
- COX2 is the messenger that recruits the body to produce the inflammatory response, AKA redness, swelling, heat, and pain.
- COX2 produces messengers that dial up the brain’s temperature thermostat, creating fever.
- COX2 enzyme plays a role in the kidneys, mostly in high blood pressure and kidney disease by dilating the blood vessels.
- COX2 is involved in ovulation, in which an egg is released from the ovary. It’s also important in the implantation of the fertilized egg in the uterus and in the development of the fetus.
NSAIDs inhibit the COX 2 enzyme production. What does it mean?
COX2 enzymes are the alarm bells of your immune system; without inflammation, the body can’t heal itself, and without alarm bells, you don’t even know something is wrong. Shutting down your alarm bell is not in your best interest.
One more side effect of NSAIDs
When you block the COX pathway, your body is left with all this arachidonic acid, meaning it will produce more LOX enzymes.
LOX enzyme produces Leukotrienes that will increase mucus and inflammation in the airways, which might lead to constriction in the airways.
Therefore, using NSAIDs could be really problematic for people with asthma.
Like with any decision you make, there is always a price to pay. I am not suggesting you never use NSAIDs, but make an informed decision and consider when they will provide the most benefits for the more minor side effects.
As always, I suggest that you use this information to open a discussion with your PCP.
But generally, I would recommend:
- Avoid using NSAIDs for more than a couple of days.
- If you have an acute disease, feel uncomfortable, and are having difficulty resting, use NSAIDs to help your body get the rest it needs to heal.
- Avoid NSAIDs if you have asthma or you are post-surgery.
- Use bone broth and demulcent herbs to restore the gut barrier when using NSAIDs