A different take on Viamin I

[madizazzo]

From today's New York Times:

September 1, 2009, 11:59 pm Phys Ed: Does Ibuprofen Help or Hurt During Exercise?

By Gretchen ReynoldsDan Saelinger/Getty Images
Several years ago, David Nieman set out to study racers at the Western States Endurance Run, a 100-mile test of human stamina held annually in the Sierra Nevada Mountains of California. The race directors had asked Nieman, a well-regarded physiologist and director of the Human Performance Laboratory at the North Carolina Research Campus, to look at the stresses that the race places on the bodies of participants. Nieman and the race authorities had anticipated that the rigorous distance and altitude would affect runners’ immune systems and muscles, and they did. But one of Nieman’s other findings surprised everyone.

After looking at racers’ blood work, he determined that some of the ultramarathoners were supplying their own physiological stress, in tablet form. Those runners who’d popped over-the-counter ibuprofen pills before and during the race displayed significantly more inflammation and other markers of high immune system response afterward than the runners who hadn’t taken anti-inflammatories. The ibuprofen users also showed signs of mild kidney impairment and, both before and after the race, of low-level endotoxemia, a condition in which bacteria leak from the colon into the bloodstream.
These findings were “disturbing,” Nieman says, especially since “this wasn’t a minority of the racers.” Seven out of ten of the runners were using ibuprofen before and, in most cases, at regular intervals throughout the race, he says. “There was widespread use and very little understanding of the consequences.”
Athletes at all levels and in a wide variety of sports swear by their painkillers. A study published earlier this month on the website of the British Journal of Sports Medicine found that, at the 2008 Ironman Triathlon in Brazil, almost 60 percent of the racers reported using non-steroidal anti-inflammatory painkillers (or NSAIDs, which include ibuprofen) at some point in the three months before the event, with almost half downing pills during the race itself. In another study, about 13 percent of participants in a 2002 marathon in New Zealand had popped NSAIDs before the race. A study of professional Italian soccer players found that 86 percent used anti-inflammatories during the 2002-2003 season.
A wider-ranging look at all of the legal substances prescribed to players during the 2002 and 2006 Men’s World Cup tournaments worldwide found that more than half of these elite players were taking NSAIDS at least once during the tournament, with more than 10 percent using them before every match.
“For a lot of athletes, taking painkillers has become a ritual,” says Stuart Warden, an assistant professor and director of physical therapy research at Indiana University, who has extensively studied the physiological impacts of the drugs. “They put on their uniform” or pull on their running shoes and pop a few Advil. “It’s like candy” or Vitamin I, as some athletes refer to ibuprofen.
Why are so many active people swallowing so many painkillers?
One of the most common reasons cited by the triathletes in Brazil was “pain prevention.” Similarly, when the Western States runners were polled, most told the researchers that “they thought ibuprofen would get them through the pain and discomfort of the race,” Nieman says, “and would prevent soreness afterward.” But the latest research into the physiological effects of ibuprofen and other NSAIDs suggests that the drugs in fact, have the opposite effect. In a number of studies conducted both in the field and in human performance laboratories in recent years, NSAIDs did not lessen people’s perception of pain during activity or decrease muscle soreness later. “We had researchers at water stops” during the Western States event, Nieman says, asking the racers how the hours of exertion felt to them. “There was no difference between the runners using ibuprofen and those who weren’t. So the painkillers were not useful for reducing pain” during the long race, he says, and afterward, the runners using ibuprofen reported having legs that were just as sore as those who hadn’t used the drugs.
Moreover, Warden and other researchers have found that, in laboratory experiments on animal tissues, NSAIDs actually slowed the healing of injured muscles, tendons, ligament, and bones. “NSAIDs work by inhibiting the production of prostaglandins,”substances that are involved in pain and also in the creation of collagen, Warden says. Collagen is the building block of most tissues. So fewer prostaglandins mean less collagen, “which inhibits the healing of tissue and bone injuries,” Warden says, including the micro-tears and other trauma to muscles and tissues that can occur after any strenuous workout or race.

The painkillers also blunt the body’s response to exercise at a deeper level. Normally, the stresses of exercise activate a particular molecular pathway that increases collagen, and leads, eventually, to creating denser bones and stronger tissues. If “you’re taking ibuprofen before every workout, you lessen this training response,” Warden says. Your bones don’t thicken and your tissues don’t strengthen as they should. They may be less able to withstand the next workout. In essence, the pills athletes take to reduce the chances that they’ll feel sore may increase the odds that they’ll wind up injured — and sore.
All of which has researchers concerned. Warden wrote in an editorial this year on the website of the British Journal of Sports Medicine that “there is no indication or rationale for the current prophylactic use of NSAIDs by athletes, and such ritual use represents misuse.”
When, then, are ibuprofen and other anti-inflammatory painkillers justified? “When you have inflammation and pain from an acute injury,” Warden says. “In that situation, NSAIDs are very effective.” But to take them “before every workout or match is a mistake.”

[Two Speed]

Interesting. A nurse practitioner recommended that I take one Advil or aspirin at the beginning of every day on the trail to help address some severe shin splints. Seemed to work for me.

[Pedaling Fool]

I never take these products, but I wished I had bought some stocks.

[Cookerhiker]

I stopped taking Vitamin I about 3 years ago because I figured it wasn't good to load the body with drugs. I've only taken one long (>100 miles) hike since then - the Long Trail in 2007 which was a rigorous hike but I had no lasting knee pain from the steep ups and downs. I've taken glucosamine/chondroitin and natural anti-inflamatory products such as ginger and green tea and feel my knees have actually strengthened - perhaps from regular workouts on the elliptical.

[Lyle]

I always carry Ibuprofin. I only use it when a persistent issue arises. It is very helpful then. I would not suggest anyone take it regularly, or prophylactically. The exception may be for a more chronic condition like Two Speed speaks about.

Maybe it's time for me to check out the glucosamine/chondroitin and natural anti-inflammatory products such as ginger and green tea.

[Doctari]

Yea, if I take my Glucosamine regularly, I find I don't "need" the painkillers nearly as much. And if I drink enough water during the day, by morning my legs are almost pain free as they have spent the night healing not CRAMPING!!
That said, I still sometimes toss in an aspirin or an Aleve at night. But only sometimes.

[Blissful]

VIt I got me through my hike. My legs would ache so bad halfway through the day - I had to take something. And it worked.

[Jim Adams]

I find it interesting that there is no mention of how the non-users finished or placed as opposed to those that did use.
I carry and use it on my hikes and it definitely helps. It mentions that it should only be used for acute injuries related to trauma ( such as those caused by the everyday abuse to your muscles and bones from the daily grind of thru hiking?) yet it also states that it prohibits or slows healing of micro tears and other trauma to muscles and tissues....seems to contradict itself at times.
I use the product and it helps me but don't get me wrong...I do understand how hard it is on the kidneys and liver and don't live on the stuff...still wonder about those finishing positions though!

geek

[emerald]

The article is contradictory? The explanation offered may warrant repeating:

“NSAIDs work by inhibiting the production of prostaglandins,” substances that are involved in pain and also in the creation of collagen, Warden says. Collagen is the building block of most tissues.

Maybe it's time for me to check out the glucosamine/chondroitin and natural anti-inflammatory products such as ginger and green tea.

There are others which may be worthy of further investigation. I have been reading lately on the subject of foods which are thought to either inhibit or promote inflammation. I believe this may be an area of research which may attract more attention and is apt to be of increasing interest generally and particularly to our more senior citizens and those who care for them.

[Jim Adams]

The article is contradictory? The explanation offered may warrant repeating:

My point exactly! If it prohibits healing then how is it good for acute trauma. Inflamation inhibits healing (hence the immediate use of ice on injuries) so as a result, it relieves inflamation yet inhibits healing?
BTW, Vitamin I is the only medication that I take.

geek

[emerald]

I believe the point Lyle made and to which I alluded is there might be better ways to go about reducing inflammation and thus speed healing in some cases compared with what may be accomplished with NSAIDs. It's possible there may one day be better anti-inflammatory drugs than what are now available too.

[Jim Adams]

I believe the point Lyle made and to which I alluded is there might be better ways to go about reducing inflammation and thus speed healing in some cases.

I agree totally, but in a small pill for 180 days on the trail?

geek

[emerald]

Sorry, I don't have any for sale, but the idea of incorporating anti-inflammatory foods into one's diet at home and on the trail is attractive.

[Pedaling Fool]

My point exactly! If it prohibits healing then how is it good for acute trauma. Inflamation inhibits healing (hence the immediate use of ice on injuries) so as a result, it relieves inflamation yet inhibits healing?
BTW, Vitamin I is the only medication that I take.

geek

I think it's a matter of moderation, many people pop them like m&m's.

I don't take them and I experienced severe pain at the beginning in Georgia; I just took it easy and then started getting better. Well before I got to Katahdin I was feeling stronger than ever in my life. And now I run reguarly and still no pain....well, no lasting pain, there's always pain to contend with.

I wonder how much money I saved by not using this product...not that it really matters, it was all spent on beer

[Cookerhiker]

I agree totally, but in a small pill for 180 days on the trail?

geek

For anti-inflamatory protection: your small pill could be fish oil or flax oil - both high in Omega 3s. I bring fish oil tablets and use flax oil in my pre-mixed oatmeal which I send in maildrops. Yeah, I know some consider maildrops a PITA but that's the trade-off for better quality trail meals. No, I haven't thruhiked but I've done several hikes >100 miles with numerous maildrops.

Also, bring garlic on your hike (a 2005 thruhiker taught me this one). It keeps well enough for the time it takes to use a clove every night with your dinner. Even if you're resupplying solely from Trail Towns, you can usually find garlic.

Ginger? You can buy dried ginger and include it in your trail mix or eat it separately. Also, bring some for your oatmeal.

[Jim Adams]

For anti-inflamatory protection: your small pill could be fish oil or flax oil - both high in Omega 3s. I bring fish oil tablets and use flax oil in my pre-mixed oatmeal which I send in maildrops. Yeah, I know some consider maildrops a PITA but that's the trade-off for better quality trail meals. No, I haven't thruhiked but I've done several hikes >100 miles with numerous maildrops.

Also, bring garlic on your hike (a 2005 thruhiker taught me this one). It keeps well enough for the time it takes to use a clove every night with your dinner. Even if you're resupplying solely from Trail Towns, you can usually find garlic.

Ginger? You can buy dried ginger and include it in your trail mix or eat it separately. Also, bring some for your oatmeal.

Fish oil doesn't work for me, neither does flax oil. I eat garlic always and did carry cloves with me on the trail. I have yet to find anything that works better for me than ibuprofin.

geek

[Kerosene]

I switched from ibuprofen (Motrin) to naproxen sodium (Aleve), mostly so that I only have to take it every 12 hours. I've found it very useful to get me through moderate pain (pulled muscles, sprained ankles, bruises), but I try to gut out any pain from soreness or over-exertion. I've found that my fine motor skills are impacted if I take a heavy dose (before a soccer game for example). I'll generally take it for a week, starting with a double dosage for intense injuries and tapering off. Definitely stay hydrated, and ideally take the pills with something that can coat your stomach like milk.

[Rockhound]

I highly recommend vitamin M over vitamin I. The pain relief is instantaneous without the kidney damage or collagen depletion. It always amazes me how people have no problem popping a wide assortment of pills because the powers that be have declared it safe but would never consider a much better, safer, natural, herbal remedy. Western medicine seems to have a pill for everything now but somehow I feel the drug companies are benefiting far more than their customers. In fact it seems that the number of ambulance chaser commercials soliciting business from people who have had very negative side effects or even died due to their medication are catching up to the the number of pill pushing drug commercials I see. Why are prescription drugs even advertised on TV, often with the tag line, "tell your doctor". Tell your doctor? Um....no. Your doctor should tell you. He went to college for 8 years to get a medical degree, you did not.

[Mrs Baggins]

The article doesn't state exactly how many Ibuprofens these people were taking per day. It repeatedly states that the athletes "popped a few pills" before their workouts/competitions. How many exactly is "a few"? I see this study being the same type that says "(fill in the blank) Causes Cancer!" and then finding out that the substance, let's say wine for instance, was fed to some mice at the rate of the equivalent of 50 bottles per day. Or it was 100 cheeseburgers per day or 100 cups of coffee per day........If these athletes are gulping down "a few at a time" (and what's "a time" - before and after activity? 3 times a day? 4 times?) and on a daily basis then of course there may be problems. I seriously doubt that taking one or two Advil on those days when the pain is bad is going to cause all of this damage. And my doctor, who is also a hiker, told me "No reason to wait for the pain. Take the Advil before you get started" and it works.

[Rockhound]

The article doesn't state exactly how many Ibuprofens these people were taking per day. It repeatedly states that the athletes "popped a few pills" before their workouts/competitions. How many exactly is "a few"? I see this study being the same type that says "(fill in the blank) Causes Cancer!" and then finding out that the substance, let's say wine for instance, was fed to some mice at the rate of the equivalent of 50 bottles per day. Or it was 100 cheeseburgers per day or 100 cups of coffee per day........If these athletes are gulping down "a few at a time" (and what's "a time" - before and after activity? 3 times a day? 4 times?) and on a daily basis then of course there may be problems. I seriously doubt that taking one or two Advil on those days when the pain is bad is going to cause all of this damage. And my doctor, who is also a hiker, told me "No reason to wait for the pain. Take the Advil before you get started" and it works.

Amazing how much trouble the FDA and pharmaceutical companies will go through convincing the public that the plethora of pills out there are perfectly safe while at the same time our government will spend millions convincing the public about the dangers and evils of vitamin M. Imagine if everyone investigated these questions for themselves rather than just accepting whatever disinformation the government spoon feeds them. There was a time when the people were told that partaking in Vitamin M would turn people into rapists and murderers or cause men to grow breasts or cause sweet innocent girls to turn into nymphos. People may have wised up a little so now the lies have changed to the "gateway" drug myth and if you smoke you are supporting the terrorists etc.... If you believe this crap you must be on drugs.