LifeCare Chiropractic

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NSAIDs Dangerous

Acute GI permeability responses to different NSAIDs – (11-05-01)

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Acute GI permeability responses to different NSAIDs

This is one of those topics regarding NSAIDs that has such a potentially harmful impact on our systemic health and yet is never address and few patients are aware of it. Note that the dosages used in this study were not large and changes were seen within two days. Worst in this class was naproxen (aka Alieve…) which also affected gastric permeability. Maintaining intestinal permeability is so important to keeping the immune response to things we eat to a minimum. With increased intestinal permeability (“leaky gut syndrome”) the immune system is very likely to react and overreact to food antigens; this abnormal response sets the tone for immune upregulation and autoimmune responses. All this from two days of anti-inflammatories. Do they seem so harmless now?

Gut — Abstracts: Smecuol et al. 49 (5): 650

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Celebrex Has No Safety Advantage Over NSAIDs, Panel Says – (02-15-01)

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Celebrex Has No Safety Advantage Over NSAIDs, Panel Says

Celebrex’s manufacturer’s are not going to like this. The new selective COX-2 inhibitors where designed to be safer on the stomach (don’t forget that NSAIDs can also damage the liver, kidneys, GI tract other than the stomach, as well as the joints themselves…). But post-marketing studies do not support the advocacy of safer stomachs, primarily with concomitant use of aspirin. And remember, the population that is most likely to be continued users of “arthritis drugs” will also be more likely to be taking an aspirin a day for heart disease prevention.

(article) A postmarket study of celecoxib, conducted by the drug firm Pharmacia, failed to establish the drug’s safety superiority to nonsteroidal anti-inflammatory drugs (NSAIDs), an advisory panel to the US Food and Drug Administration (FDA) determined on Wednesday. The Arthritis Advisory Committee met here to discuss whether findings from Pharmacia’s extensive Celecoxib Long-term Arthritis Safety Study (CLASS) trial proved that celecoxib is safer than ibuprofen and diclofenac, and whether COX-2 inhibitors taken with aspirin may pose a health risk that warrants further study. The panel agreed that Pharmacia had not established a “clinically meaningful” safety advantage over NSAIDs and that data from the CLASS study would not support a superiority claim at present. According to the committee, the ability of the CLASS study to demonstrate a better safety profile was hindered by one compelling factor: concomitant aspirin use. Although the trial showed an overall twofold reduction in gastrointestinal complications in celecoxib-treated patients, that trend was reversed among subjects who took also low-dose aspirin. Among aspirin takers, celecoxib did not demonstrate safety superiority over ibuprofen or over pooled NSAIDS da….

 

Ibuprofen Side Effects: Osteopororis Now on the List

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Ok. I’ll admit it—I’m no fan of anti-inflammatories. The list of side effects is far longer than most doctors realize.

Despite how long the list already is, there is always room for more negative effects when it comes to drugs that interfere with the way your body functions. (In case you’re not familiar with the long list already, feel free to check out my eBook on the dangers of NSAIDs)

This particular article adds bone density problems to the potential list of side effects of ibuprofen and its ilk. The author is looking at the physiological pathways by which NSAIDs could contribute to bone density problems and not summarizing an actual study linking anti-inflammatory drugs with low bone density. Because of this, we can’t say with certainty that ibuprofen side effects will include low bone density, but it certainly makes sense.

Here’s how it works:

Inflammation is needed for both new bone formation and old bone breakdown. Bone is essentially really tough soft tissue, and in a previous blog article I look at evidence linking NSAIDs and poor soft tissue healing after surgery. So it would make sense that NSAIDs would also effect bone healing.

The problem is that we are always breaking down bone and repairing it. Exercise causes microfractures in bone that the body then has to go in and repair. This is one way that exercise improves bone density.

In addition, chronic use of NSAIDs will, ironically, lead to inflammation in the gut. Inflammation in the gut will lead to more serotonin, which, in turn, has been linked to lower numbers of osteoblasts (the cells that build bone).

Pretty crazy web, huh?

Overall, you need to really understand that the use, acute OR chronic, of anti-inflammatoy medications comes with a price, and this price is likely to be far greater than what you took it for in the first place.

 

Nonsteroidal Anti-Inflammatory Drugs and Hypertension – (12-14-00)

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Nonsteroidal Anti-Inflammatory Drugs and Hypertension

It seems that we can now add elevation of BP to the list of side effects of NSAIDs use. This list also contains gastric erosions/ulcers, disruption of intestinal permeability, kidney damage and liver damage. I could accept the harm vs benefit logic for NSAIDs if there were not tens if not hundreds of natural options to curb inflammation without these side effects. Remember…NSAIDs do not fix whatever caused the underlying inflammation.

J Clin Hypertens 2(5):319-323, 2000 Nonsteroidal anti-inflammatory drugs are among the most widely prescribed medications. Their effect on blood pressure has been monitored, and many small studies have determined a potential relationship between their use and elevation of blood pressure. These drugs may affect blood pressure by inhibiting prostaglandin synthesis, which may affect arteriolar smooth muscle tone and natriuresis. Since many patients with conditions such as osteoarthritis require treatment and also have hypertension, even modest elevations in blood pressure or inhibition of antihypertensive medication efficacy resulting from non steroidal anti-inflammatory drugs can be of significant clinical and public health importance. This review finds that certain drugs (e.g., indomethicin, piroxicam, and naproxen) may cause clinically relevant elevations in blood pressure in hypertensive patients. Aspirin and sulindac do not appear to elevate blood pressure significantly, even in hypertensive patients. Ibuprofen and other nonsteroidal anti-inflammatory drugs appear to have an intermediate blood pressure effect. Cyclo-oxygenase-2 inhibitors such as refecoxib and celecoxib have been shown to cause mild elevations in blood pressure, but further studies are needed to evaluate the full magnitude and population distribution of this effect.

Could Your Anti-Inflammatory Destroy Your Brain?

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I was teaching a class to doctors this weekend and, on a break, heard one of the doctors on the phone talking about a patient with costochondritis and telling the person on the other end to take an anti-inflammatory to fix the inflammation.

This is THE response in society and in medicine today.  Sure, most physicians and patients are aware of the risk of ulcers with anti-inflammatories but rarely understand the risks beyond this.  As the author of an ebook that covers the vast array of side effects from anti-inflammatories (click here to view the book on Amazon.com), I am always happy to add new, unexpected side effects to this dangerous class of drugs that we take so blissfully.

Diabetes and prediabetes is very bad for the brain.  This is one of the reasons we are seeing an increase in the rates of cognitive decline, dementia, Alzheimer’s dementia and Parkinsons disease.  These conditions are very strongly related to the diabetic spectrum.  Given the rate of prediabetes in this country, that means that well over half of us are already at risk.

This increased risk is likely due to some combination of blod flow to the brain (the diabetic spectrum is very bad for the health of your blood vessels) and a disruption in the way brain cells are able to use energy (brain cells require lots and lots of energy made from glucose in their mitochondria).  So, you can envision that anything that is going to negatively effect blood flow in the brain will be a bad thing ON TOP OF being diabetic.

Enter anti-inflammatories, specifically a particularly nasty one called indomethacin (Indocin).  This particular study looked at what happened to blood flow in the brain of a small group of diabetics in response to the administration of indomethacin.

Here’s what they found:

  1. Mean flow velocity (a good thing, higher = more blood flow to the brain) was reduced after indomethacin use.
  2. The researchers, however, seemed happy that, when indomethacin was taken, the blood flow in the brain was improved when the patients held their breath multiple times in a row.

Certainly I can see where the researchers may view the improvement in the brain blood flow with breath holding as a good thing.  However, given that most diabetics (or prediabetics, for that matter) don’t go around holding their breath multiple times in a row, I’m not entirely sure this overshadows the negative side of indomethacin’s effects on overall blood flow.

The bottom line is that, while indomethacin may show a benefit in those holding their breath, this is not a commonly done behavior in diabetics or prediabetics that I am aware of.  However, merely taking indomethacin slowed the flow of blood into the brain–a clearly damaging action that will do long term harm to the brain cells.

While I’ve said it before, let me re-iterate that you need to view taking ANY pill, although in this case we are looking at indomethacin, as a risk benefit scenario.  Is the reason you are taking this drug going to outweigh the long list of side effects that will inevitably come as a result of taking the drug?  Better yet, is there another route you could take (such as, maybe…chiropractic?) that does not have the associated side effects?

On the other hand, if your brain is not that important to you, than pop away.

 

A 10 Year Prospective Followup of Patients with Rheumatoid Arthritis – (01-03-02)

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A 10 Year Prospective Followup of Patients with Rheumatoid Arthritis

Let’s look at this…very toxic drugs, significant side effects, and NOW we find out that drugs for RA actually make the patient worse in the long run? While it does not surprise me, be really need to wake up in medicine. The “first do no harm” mantra seems to have fallen by the wayside. Treatment for arthritis with NSAIDs has shown progression of osteoarthritis and now this. What makes this article even more dis-concerning is that there are effective, safe natural methods for managing many autoimmune disorders. Lifestyle changes, elimination diets and unrefined diets are some of the most powerful medicines for these conditions. There are still, however, many patients who are not willing to even listen to take of lifestyle changes. I had a patient with scleroderma who took 15 minutes for her and her oxygen tank to make it the 200 yards from the parking lot to my table. Quality of life was zero and progression of the disease was imminent. And yet she thought I was crazy for suggesting that lifestyle changes may have an impact on her condition. No other doctor she had seen had mentioned this before, so it couldn’t possibly be true coming from a chiropractor… Abstract:

 

Read entire article here

Cyclooxygenase Inhibitors and the Antiplatelet Effects of Aspirin – (12-31-01)

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Cyclooxygenase Inhibitors and the Antiplatelet Effects of Aspirin

This study finds that taking NSAIDs (specifically ibuprofen) and aspirin together can lower the potential blood thinning effects of aspirin. Considering that these two drugs are frequently taken together this does cause some concern. However, I still question the use of aspirin for both primary and secondary cardioprevention. Studies do indicate that risk of heart attacks may drop, but risk of stroke increases. I guess you need to decide which you would prefer. Personally, I would focus on some of the 10 or so other lifestyle factors that can lower risk of heart attack without increasing risk of other diseases.

NEJM — Abstracts: Catella-Lawson et al. 345 (25): 1809

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Acetaminophen, Aspirin, and Chronic Renal Failure – (12-31-01)

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Acetaminophen, Aspirin, and Chronic Renal Failure

This study confirms previous studies on the increase in risk for renal failure with use of pain-modulating drugs. I would add to this list the use of NSAIDs as well, as an article several years back in this same journal found an increase with ibuprofen use. This previous study showed increased risk for LIFETIME consumption. That adds up quick by the time a child reaches 10 years of age. Hopefully this article will bring to light the dangers of many pain relievers. Too much attention has been focused on gastric ulcers and breakthrough bleeding leading to death. Let’s not forget renal damage, joint damage, alterations in gut permeability and liver damage.

NEJM — Abstracts: Fored et al. 345 (25): 1801

Read entire article here