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For Athletes, Risks from Ibuprofen Use


December 21, 2012                           


Story at-a-glance                       

  • Taking ibuprofen before a workout in order to reduce muscle soreness has been linked to intestinal leakage and systemic inflammation; when used chronically, ibuprofen may lead to intestinal permeability, allowing bacteria and digestive enzymes to leak into your bloodstream regularly
  • Using ibuprofen chronically prior to your workouts may also reduce the absorption of key nutrients, particularly after exercise, which may make it harder for your muscles to regenerate; further, this practice has not been shown to reduce muscle damage or soreness
  • Separate research suggests the coating used on aspirin, another common pain reliever, which is there to help protect your stomach, may actually be interfering with its purported benefits
  • The best strategies to help reduce muscle fatigue and soreness are those that will help to address some of the underlying causes; drugs do not fall into this category

By Dr. Mercola

Ibuprofen (brand names Advil, Motrin) is a nonsteroidal anti-inflammatory drug (NSAID) commonly used by athletes, both before and after workouts.

While many people have used ibuprofen to alleviate pain caused by headaches, arthritis, menstrual cramps, toothache and so on, it's common for athletes to take a dose of the drug before their workout, under the assumption that it will help to reduce muscle soreness later on, allowing for a longer, harder training session.

This is actually not proven, but what is becoming apparent is that using ibuprofen prophylactically is fraught with risks that can seriously hamper your health.

Ibuprofen Plus Exercise Leads to Increased Intestinal Damage

Nearly every time you exercise intensely, blood gets diverted away from your digestive tract toward your muscles. This lack of blood flow causes trauma to some cells lining the small intestines, causing them to leak1 – although generally within an hour or so after the workout the cells return to normal.

When ibuprofen is added into the equation, researchers found that blood levels of a protein indicating intestinal leakage were noticeably higher in those who took the drug prior to exercise, compared to those who did not, or who took ibuprofen without exercising.2 And unlike the slight damage that occurs under normal exercise conditions, when ibuprofen was used the intestinal leakage appeared to continue for several hours after the exercise was stopped.

The finding isn't exactly surprising, considering the most common side effect of ibuprofen is gastrointestinal damage, including serious bleeding. However, the researchers noted that while the health implications of their findings are not entirely clear, regularly using ibuprofen prior to exercise may:

  • Compromise the integrity of the intestines, allowing bacteria and digestive enzymes to leak into your bloodstream regularly
  • Compromise the absorption of nutrients, particularly after exercise, which may make it harder for muscles to regenerate

Other studies have also linked ibuprofen use during exercise to intestinal problems, including one that found colonic bacteria in the bloodstreams of runners who used ibuprofen regularly, which resulted in higher levels of systemic inflammation.3 Adding insult to injury, the ibuprofen use did not even help with muscle damage or soreness … That study's author, David C. Nieman, a professor of health and exercise science at Appalachian State University, told the New York Times:4

"The idea is just entrenched in the athletic community that ibuprofen will help you to train better and harder … But that belief is simply not true. There is no scientifically valid reason to use ibuprofen before exercise and many reasons to avoid it."

Likewise, the authors of the new study echoed this advice:5

"This is the first study to reveal that ibuprofen aggravates exercise-induced small intestinal injury and induces gut barrier dysfunction in healthy individuals. We conclude that non-steroidal anti-inflammatory drug consumption by athletes is not harmless and should be discouraged."

Ibuprofen is Risky for Your Heart, Too

Many people don't think twice about taking a couple of ibuprofen for minor aches and pain, but chronic use of NSAIDs like ibuprofen is associated with significant, and very serious, side effects, including:

  • Cardiovascular problems
  • Gastrointestinal harm
  • Kidney and/or liver damage

If you are taking an NSAID and you have a history of heart disease, you are at a 10-fold increase in the risk of congestive heart failure (CHF).6 And even if you don't, your risk of CHF will still be increased by 60 percent if you take NSAIDs.

Ulcers are another major risk, and up to 60 percent of regular NSAID users will have gastrointestinal side effects related to these drugs, according to the American College of Gastroenterology (ACG).7 In fact, ACG notes that regular use of NSAIDs is the second most common cause for ulcers. Given the risks, regularly taking ibuprofen preventively to avoid post-exercise muscle pain is probably not a wise option – and you may also want to rethink your options if you're using it for other forms of pain relief.

Study Raises Questions on Coating of Aspirin

Aspirin is another type of NSAID pain reliever often used by athletes and non-athletes alike. It, too, is linked to serious medical problems such as ulcers and gastrointestinal bleeding, even when used at low doses for heart disease prevention (which I do not recommend). Whether or not aspirin truly is useful for your heart has been debated for years, and now new research suggests the coating used on aspirin, which is there to help protect your stomach, may actually be interfering with its purported benefits.8

The study set out to look into aspirin resistance, a controversial condition said to impact up to 40 percent of the population and possibly explain why aspirin does not appear to help prevent heart attacks and stroke in some people. While the research found not a single case of true aspirin resistance, they did find that the enteric-coated aspirin appeared to cause "delayed and reduced drug absorption," leading to what they called "pseudoresistance," which was not found with the uncoated aspirin.

Still, scientific studies have failed to prove that low-dose aspirin offers safe and effective protection from cardiovascular disease, despite its vast popularity among physicians. Many studies suggest it may be doing more harm than good. There are studies showing aspirin's connection with 51 different diseases!9 The most well established side effect of aspirin is bleeding, which results from aspirin's interference with your platelets—the blood cells that allow your blood to clot. According to one scientific article, 10 long-term low-dose aspirin therapy may DOUBLE your risk for gastrointestinal bleeding. Routine use of aspirin has been associated with the following problems:

  • Bleeding, especially in the gastrointestinal tract
  • Duodenal ulcers, GI damage, and diverticular disease
  • Increased risk of ER/PR-negative breast cancer in women
  • Increased risk of kidney failure
  • Cataracts, hearing loss and tinnitus

5 Natural Tips for Preventing and Relieving Sore Muscles

For some, the discomfort associated with delayed-onset muscle soreness (DOMS), which generally occurs about 24 hours after exercise, is enough to make you think twice before going back to the gym or engaging in activities you would otherwise enjoy. Naturally, if given the option, most would choose to prevent the muscle soreness that follows intense exercise or physical activity, but using risky drugs is not the only, or the best, solution. The best strategies to help reduce muscle fatigue and soreness, whether you're a professional athlete or not, are those that will help to address some of the underlying causes. Among them:

  1. Using acceleration training

Whole Body Vibrational Training (WBVT), also known as Acceleration Training using a Power Plate, works by stimulating your white muscle fibers—which are your fast- and super-fast muscle fibers. The Power Plate kick-starts your pituitary gland into making more growth hormone (HGH), which helps you build lean body mass and burn fat, as well as accelerate tissue healing.

    Acceleration Training is quite different in that the vibrating plate targets your entire body, focusing on fully integrated motor and neurological patterns, which allows you to work ALL your muscles, and nerves, all at the same time.

    It's a truly revolutionary approach to fitness because it addresses your neuromuscular system as a whole, rather than one limb or muscle group at a time. The net result is a dramatic improvement in strength and power, flexibility, balance, tone and leanness, along with reduced pain and soreness.

    They aren't cheap but I am fortunate to have access to one virtually year-round, and it is my first therapy that I use when I get a muscle injury from an accident or over training.

  1. Eating ginger

Ginger contains anti-inflammatory compounds and oils known as gingerols, which have pain-relieving effects. In one study on people who did exercises meant to induce muscle pain, those who ate two grams of ginger a day had a 25 percent reduction in exercise-induced muscle pain 24 hours after their workout, compared to those who took a placebo.11

  1. Cold water immersion

Cold-water baths appear to be significantly more effective than rest in relieving delayed-onset muscle soreness when used just after exercise. Cold works by lowering the damaged tissue's temperature and locally constricting blood vessels. Using cold therapy immediately after an injury helps prevent bruising and swelling from the waste and fluid build-up. Cold also helps numb nerve endings, providing you with instant, localized pain relief.

  1. Eating a diet that includes naturally occurring carnosine, i.e. animal protein such as organic grass-fed beef or free-range chicken

Carnosine is a pluripotent dipeptide composed of two amino acids, beta-alanine and histadine, found in many tissues but most notably in your muscles. It serves several important roles, two of which are:

  1. Buffering acids in your muscle
  2. Serving as a potent antioxidant

Carnosine appears particularly useful for improving anaerobic high intensity exercise performance, but both of the functions mentioned above also explain how it may help reduce muscle soreness. As mentioned in Steady Health, damaged muscles become inflamed, which can cause soreness. Since carnosine is a potent anti-inflammatory antioxidant,, its presence in your muscle can serve to quell muscle inflammation. 12

    The foods with the highest amount of useful dietary dipeptides like carnosine would be animal proteins, like eggs, whey protein, poultry and beef. If you are considering using carnosine as a supplement it is important to realize that carnosine itself is probably not that useful because enzymes rapidly break it down to its constituent amino acids (beta-alanine and histidine), which are then absorbed by your muscles and re-formed back into carnosine.

  1. Taking a beta-alanine supplement

As explained above, if you do decide to take a supplement, instead of taking carnosine, I recommend taking its primary precursor, beta-alanine, based on the science in this area. Beta-alanine has also been shown to be helpful for preventing muscle soreness when working out.

    For those of you who are using ibuprofen or aspirin for other types of pain, including arthritis, back and neck pain or headaches, I've outline more than a dozen natural, non-drug approaches to pain relief here.

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Tags: Advil, Athletes, For, Ibuprofen, Motrin, Risks, Use, from, intestinal, leakage


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