Photos by ragesos/BocaDorada, flickr

A new study about the use of non-steroidal anti-inflammatory drugs (NSAIDs) made news recently in the Los Angeles Times. The British Journal of Sports Medicine study showed a prevalence of NSAID use among triathletes, who had limited awareness of the potential side effects. (NSAIDs include aspirin, ibuprofen, Advil, Motrin, Nuprin, Naprosyn, and other prescription and over-the-counter drugs.) The study was performed on athletes competing in the 2008 Brazil Ironman Triathlon. Almost half of the athletes consumed NSAIDs the day before, immediately before, and during the race. Referring to the dangers of these drugs, the authors concluded that, “long-distance triathlon events [should] include in their programmes educational devices such as talks or folders about NSAID use, effects and side effects.”

A study conducted at the 2004 New Zealand Ironman triathlon showed 30 percent of the competitors used NSAIDs, and that it increased the risk of low blood sodium, a condition called hyponatremia, and interfered with normal kidney regulation of fluid balance. This is a recipe for water intoxication, or overhydration, and a condition called exercise associated hyponatremia (EAH), which can even result in death.

All types of athletes use NSAIDs. Unfortunately, more athletes use these legal drugs because a training partner takes them, they see or hear a catchy advertisement, or a free sample is offered at a race—not from the recommendation of a healthcare professional. In a 2010 publication of The Physician and Sportsmedicine, SJ Waren, Ph.D., from Indiana University’s School of Rehabilitation Sciences, states: “Data from many sporting fields have consistently demonstrated that many individuals self-administer NSAIDs prior to athletic participation to prevent pain and inflammation before it occurs. However, scientific evidence for this approach is currently lacking, and athletes should be aware of the potential risks in using NSAIDs as a prophylactic agent. These agents are not benign, and can produce significant side effects, including gastrointestinal and cardiovascular conditions, as well as musculoskeletal and renal side effects.”

Side Effects of NSAIDs

Among the many problems associated with NSAID use is gastrointestinal distress. In almost everyone taking them, bleeding occurs, even if it’s not noticeable. Blood loss in these athletes increases with harder intensities of training and racing. In addition to a gut injury, taking NSAIDs before training or racing can significantly increase nausea and vomiting. Some other problems associated with NSAID use include:

-Muscle dysfunction; they don’t necessarily reduce muscle pain associated with training and competition

-Reducing the body’s ability to recover from training and racing, especially in the repair of joints and bones

-Kidney damage, especially when you’re dehydrated

-Sleep disturbance

-Inability to reduce inflammation

-Immune system stress

-Contribution to injury

NSAIDs can also increase cardiovascular risk—some COX-2 inhibitors, including Vioxx, have been recalled due to their contribution of heart attack, stroke and even death in some patients. Because of these and other problems, Merck recalled Vioxx in 2004. In 2005, the U.S. Federal Drug Administration asked Pfizer to recall its drug, Bextra, due to similar side effects.

Mechanisms of Inflammation

By looking at how NSAIDs work, we can better understand how a healthy diet can control inflammation effectively—specifically, by eating adequate amounts of healthy fats and maintaining their proper balance.

The body normally produces both inflammatory and anti-inflammatory chemicals. These are made from different dietary fats and oils—omega-6 fats produce both inflammatory and anti-inflammatory chemicals, and omega-3 fats are anti-inflammatory. Both are important in everyday function. For example, inflammatory chemicals speed recovery from a workout or race, and help heal a potential injury. Anti-inflammatory substances do the same and maintain balance by turning off inflammation. Too much inflammatory is obviously not healthy. It also increases pain, bone and breathing problems, and even the progression of diseases such as cancer. The anti-inflammatory chemicals help prevent these problems. A healthy diet with adequate fat intake can help balance this important inflammatory-anti-inflammatory mechanism.

Conversion of the omega fats to inflammatory and anti-inflammatory chemicals relies on an important enzyme called cyclooxygenase, or COX. There are actually two COX enzymes, and many people are familiar with the term “COX-2 inhibitors.” Aspirin and other NSAIDs temporarily block the COX enzymes so much less of the inflammatory chemicals are formed. While this reduces the inflammatory chemicals, it also lowers the beneficial anti-inflammatory ones. In addition, the cause of the problem—fat imbalance—goes untreated. So, if NSAIDs makes you feel better, it usually indicates that your fats are not balanced.

Here are four ways to control inflammation by improving the balance of fats:

1. First, eat approximately equal amounts of omega-6 and -3 fats. It does not necessarily have to be at each meal, but in the course of a day or week, balance is key. While this 1:1 ratio of 6′s and 3′s is ideal, the typical Western diet is often 5, 10, or even 20:1. It’s no wonder there’s an epidemic of chronic inflammation and pain. One reason for this is the high intake of omega-6 vegetable oils like corn, soy, safflower, and peanut, and the low consumption of omega-3, especially from fish, which is the best source (beans, flax seeds, and vegetables contain smaller amounts).
2. By eliminating vegetable oils (substitute olive or coconut) and taking fish oil capsules (high in the most potent omega-3 fat, EPA), balance can improve. (The omega-3 flax oil is less effective.)
3. Refined carbohydrates, including sugar, can increase the conversion of omega-6 oils into inflammatory chemicals. (This does not include consuming these items during training or racing.)
4. A number of other dietary factors can impair the production of anti-inflammatory hormones and lead to inflammation. Try to get the right amount of vitamins B6, C, E, and niacin, and the minerals magnesium, calcium, and zinc Minimize trans fats, get enough protein, and try to avoid excess stress.

NSAIDs can cause significant health problems, especially when taken before, during, or after hard training or racing. Improving the intake of healthy dietary fats and eating better can maintain a balance of natural inflammatory and anti-inflammatory chemicals, improve recovery, reduce pain, and maintain optimal physical, chemical and mental balance. More details about this complex issue can be found in my books and other articles.

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A long-time fixture in triathlon, Dr. Philip Maffetone coached many of the sport’s best—including Mark Allen, Mike Pigg, and Colleen Cannon. He’s the author of more than a dozen books on fitness and health. His latest book is “The Big Book of Endurance Training and Racing” with a foreword by Mark Allen. Read his “House Calls” column here every month, or visit him on the web at www.philmaffetone.com