I’ve been keeping tabs on the use of ibuprofen –– known as “Vitamin I” among some runners –– since reading years ago that downing the popular painkiller before a run was hard on the kidneys. Do a Google search on over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS) and you’ll find that there is some consensus on the necessity of being very careful about which NSAIDS you use and to avoid taking them while running. If you feel a need to pop some ibuprofen (Advil or Motrin) during the latter stages of your next marathon –– don’t. According to some recent studies, overusing ibuprofen can actually contribute to systemic inflammation, essentially doing the opposite of what you would like it to be doing. In 2009, New York Times health columnist Gretchen Reynolds reported that athletes who used ibuprofen shortly before or during strenuous running (the study was done during the Western States Endurance 100 Miler) showed signs of mild kidney impairment and endotoxemia, a condition in which bacteria leak from the colon into the bloodstream. (http://well.blogs.nytimes.com/2009/09/01/phys-ed-does-ibuprofen-help-or-hurt-during-exercise/) I don’t like the sound of endotoxemia.
Take it easy on the “Vitamin I”
I imagine that for many runners, the context of the Western States study could give them some leeway to continue taking ibuprofen immediately before and during a run. These were ultramarathoners, after all; who knows how many ibuprofen they were taking during a 100-mile race? When you’re running 100 miles in one go there are probably a whole lot of bodily issues –– to put it mildly –– that might contribute to endotoxemia and kidney impairment. Ominously, however, Reynolds pointed out in 2009 that enthusiastic ibuprofen use was not limited to ultramarathoners and that other athletes were using it as a prophylactic. I have been at several races where I witnessed runners passing out ibuprofen pills and joking with each other about how many they needed to take that morning. I have a feeling that potential ibuprofen abuse might be widespread among runners and we need to heed the warnings. According to the researchers that Reynolds cited, ibuprofen was not shown to reduce soreness in runners who took it ahead of time and it did nothing to lessen the perception of pain during competition. Additionally, ibuprofen works by inhibiting the production of prostaglandins, which are crucial in creating collagen, the building block of most tissues. Those who take ibuprofen before and during a run might actually be reducing the training stimulus by undermining the body’s creation of the collagen necessary to repair tissues and strengthen bones. Remember, that the stress of the training stimulus creates microtears in muscles. When they repair after rest, they come back stronger. It is clear that ibuprofen undermines the relationship between stress, damage repair, and strengthening.
Reynolds followed up her first discussion of ibuprofen and running several years later in “For Athletes, Risks From Ibuprofen Use” (http://well.blogs.nytimes.com/2012/12/05/for-athletes-risks-from-ibuprofen-use/?smid=fb-share) that provided good evidence that endotoxemia was not limited to ultramarathoners using ibuprofen and that seventy percent of endurance athletes use ibuprofen in the mistaken belief that it will help them train harder and recover faster –– it won’t. The recent examination of ibuprofen’s effects on endurance athletes used male athletes riding stationary bikes. Test subjects took 400 milligrams of ibuprofen the night before, as well as the morning of, a one-hour stationary bike ride. On other days, the same test subjects didn’t take ibuprofen, or they scrapped the bike ride. When researchers assessed the results, it was clear that when the men rode and ingested ibuprofen, there were much greater signs of intestinal leakage than when they biked without ibuprofen or had ibuprofen without exercising. Researchers’ concluded that a year of regular ibuprofen use in conjunction with exercise could result in compromised intestinal integrity and that there were no legitimate reasons to use it before exercise and that there were several good reasons to avoid it. Furthermore, the Food and Drug Administration just strengthened its warning that NSAIDS increase the risk of heart attack and stroke.
It’s clear that runners need to be extremely careful when using ibuprofen. Don’t take it prophylactically before running and definitely not while running. You might then logically ask, “What am I supposed to do if I am getting some pain and soreness while running.” There are some NSAIDS that are better than others. Naproxen sodium (Aleve), for example, is associated with a lower heart-attack risk and provides longer-lasting relief that ibuprofen. If you have pain before running, such as a headache (be sure to assess whether you are dehydrated), or a muscle strain, you can use acetaminophen (Tylenol) to relieve aches without an adverse affect on the kidneys or stomach. Tylenol acts as an analgesic, but is not an anti-inflammatory. It can, however, have an adverse affect on your liver if taken too frequently, or with alcohol. If you must take a painkiller before a can’t-miss race or workout (I would probably argue against such a category…) you should turn to acetaminophen. Aspirin also has its uses for the runner. It is an anti-inflammatory that inhibits blood clotting to protect against heart disease and stroke. It doesn’t put excessive stress on the kidneys, but it can play havoc with your stomach because it blocks an enzyme that produces a layer of mucus used to protect your stomach lining. Is there a time when runners can use ibuprofen? If you have sustained an acute injury –– twisted an ankle on a trail run –– or are suffering severe soreness, take some ibuprofen. Be sure, however, only to take it 2-3 hours after running and after you have fully hydrated. A. C. Hilton, writing for Runner’s World, recently published a piece entitled, “The Right Pills to Pop” (http://www.runnersworld.com/health/the-right-pills-to-pop) –– take a look for further guidance. Remember that it does appear that overusing ibuprofen can actually lead to more inflammation.
After reading this, you might wonder if I have just helped to launch a soreness epidemic among runners. The bad news is that it really does appear that some soreness is actually good for you and this is sign that your body is repairing tissues and strengthening bones. Soreness indicates that the training stimulus is working. The good news is that there are some other anti-inflammatories that runners can use to address pain and soreness. Quercetin and polyphenol, for example, are found in foods such as onions, apples, berries, grapes, plums, and coffee, and can reduce inflammation. They are also available in supplement form, but most of these only contain “single polyphenols” and recent research indicates that polyphenol effectiveness requires a mixture of polyphenols. Here, however, is where the news really gets good. It turns out that beer (!) is a fantastic source of polyphenols and provides up to fifty polyphenols from barley and hops. Luckily, non-alcoholic beer also provides a high polyphenol count. In fact, the author of a recent study on polyphenols described non-alcoholic beer as an “isotonic sports drink.” (http://www.runnersworld.com/peak-performance/the-lowdown-on-beer-polyphenols-and-runner-health)
Another great source of polyphenols are colorful fruits and vegetables. Remember, as well, that if you want to avoid NSAIDS, you can use ice to address muscle soreness. Ice does not directly affect any of the body’s enzymes and works by cooling the tissues, temporarily reducing inflammation, and flushing the wound. If you ice for a longer time, it increases blood supply that creates a further flushing effect. Ultimately, ice can dramatically improve the speed of healing.
To wrap up, what can we take away from the new research regarding NSAIDS, running, and muscle soreness?
- Take ibuprofen 2-3 hours after running –– make sure you are hydrated
- Take aspirin or acetaminophen before running –– beware stomach issues
- Soreness is a necessary part of the training stimulus –– building collagen
- Beer and colorful fruits and vegetables can do wonders for soreness
- Remember to ice (oh, joy…)