Getting Real About Chronic NSAID Use
by Dr. Mitchell Rasmussen, DC, CFMP, FRC-ms
First off – I think there is a time and a place for NSAID use. I think something like... for the first 48-72 hours after an injury, in heroic doses (400-800 mg, 2-3x per day), it likely has benefits for pain and the initial inflammatory response.
However, the literature calls NSAIDs, “Resolution Toxic”.
There are a lot of reasons but the main one that comes to mind for me is in its inhibition of Prostaglandin E2 (PGE-2). Once the local debris field has been created at the injury site, it needs to clear. Stuff needs to be eaten in a specific time window and other stuff needs to come get rid of that stuff . And it needs to happen without the cell bursting and sending its contents everywhere (this is you if you’re chronically inflamed). That part of the process is impeded when we inhibit PGE-2.
>>We get cell death by necrosis instead of apoptosis.<<
Necrosis sounds bad... cuz mostly it is.
Necrosis allows this little stunt by the immune system to continue forever... essentially.
Further Problems from NSAIDS...
After a couple weeks of use, there are all manner of problems occurring.
You have directly decreased mucous production and local bicarbonate production and
release, while necessitating systemic bicarbonate delivery.
We need that mucous and that bicarbonate to deal with the acidity of the stomach. Now it’s
all ulcerated and inflamed, which is causing massive amounts of local histamine release by
mucosal mast cells. We know what that’s gonna do – the allergy response – congestion,
edema, exudates.
>>This won’t feel good... somewhere... tummy, body, brain... everywhere...?<<
Picture a runny nose. Now picture that going on in a place where you can’t see it.
This mucked up tissue has now developed microvascular injury and begins its own immune
stimulation.
Since one of the other effects of the ibuprofen is increased leukotriene production (and
because we’ve lost prostaglandin production at the same time), we’ve lost vasodilation
ability. --> It’s a perfect storm. Prostaglandin E2 is a vasodilator. Gone.
NSAIDs will have a downstream effect SOMEWHERE. It may manifest as stomach issues (ulcers), unresolved body aches, or brain fog. Or Everywhere.
What about Leukotrienes?
Two of them are vasoconstrictors, and one of them is a powerful neutrophil chemoattractant. Now we get excess white blood cells to an area which will become activated once called and release destructive enzymes in the process. And it will be trapped there because of the vasoconstriction, because of the Leukotrienes, because of the ibuprofen.
Essentially, we are not getting the tissue debris cleared properly due to the micro-vascular occlusions mentioned earlier and only made more severe by the neutrophil influx, the vasoconstriction caused by the combination of leukotriene increases and prostaglandin E2 inhibition, in concert with a marked decrease in stomach mucous secretions driving increased inflammation,
ALL BECAUSE OF THE IBUPROFEN.
When it comes to inflammation, we find the best success when working WITH the immune system.
We must find the root cause of inflammation, help to resolve it and restore immune tolerance.
Taking ibuprofen is antithetical to that.
What we want to make understood is this:
Chronic NSAID use delays resolution of inflammation; it is "RESOLUTION TOXIC." It cannot and will not end the process of inflammation.
ABOUT THE AUTHOR:
Dr. Mitchell Rasmussen, DC, CFMP serves as Director of Functional Medicine at The Facility in Denver, CO. He sees patients in-person and via Telehealth to get to the root cause of dysfunction and restore a state of well-being using nutritional intervention, supplementation, and lifestyle change.
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