Fact: Non-steroidal anti-inflammatory medications (NSAIDs) can be deadly in the first week of use.
Last July the U.S. Food and Drug Administration (FDA) strengthened an existing label warning that non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) – both prescription and over the counter (OTC) – increase the chance of a heart attack or stroke. 1
Based on an FDA review in combination with the Arthritis Advisory Committee and Drug Safety and Risk Management Advisory Committee the following warnings were issues regarding use of NSAIDs:
- The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.
- The risk appears greater at higher doses.
- NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease.
- In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
- Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
This is not new information.
The risk of heart attack and stroke with NSAIDs, either of which can lead to death, was first described in 2005 in the Boxed Warning and Warnings and Precautions sections of the prescription drug labels for these medications.
Kidney and gastrointestinal (GI) side effects, such as increased blood pressure and stomach ulcers, have long been known.
Calculating the cost of NSAID side effects: 2
- Conservative estimates suggest 100,000 patients hospitalized annually for GI complications
- Direct costs range from $1800 to $8500 per patient hospitalization
- 16,500 persons die annually from these complications
- In the elderly, medical costs from GI side effects associated with NSAID use exceed $4 billion per year.
Despite the potential for deadly side effects, NSAIDS continue to be prescribed, bought and used at record numbers. In 2013, Advil ($490 million sold) and Aleve ($364 million) were in the top 5 OTC medications purchased in the U.S. 3
I rarely endorse short, and never advocate long-term use of oral NSAIDs in my practice. The only form I will utilize is topical, as systemic absorption (and potential for side effects) is thought to be only maybe 5-6%. Although better, it does not however eliminate total risk of NSAIDs as described above.
Are there alternative to NSAIDS for pain and inflammation?
The most effective substitute I have found is curcumin.
Curcumin is a component of the spice turmeric (about 5% by weight). It is known to have several biological effects:
- Neuroprotective – helps maintain nerve health and aids in nerve injury recovery
- Anti-carcinogenic effect for cancer prevention, specifically colon cancer, and possibly breast cancer (research ongoing).
For our purposes we are focusing on the first two effects – anti-inflammatory, antioxidant – to help with the inflammation and pain related to the underlying chemical reactions in your joints.
Turmeric, or curcumin, has an excellent safety profile with few known side effects, other than the potential to be a mild blood-thinner at high dose.
Here is the problem.
Turmeric alone in whole or powdered form has low bioavailability, meaning it is poorly absorbed into the body, or takes a bunch in order to get to blood levels that can have a clinical effect.
Most supplement forms of turmeric cannot be adequately absorbed, and therefore you are getting little if any effect, even if taking massive doses.
How do you increase the bioavailability of many curcumin extracts?
- Combine with other ingredients. Black pepper contains piperine (about 5% as well be weight), a potent inhibitor of drug metabolism. When your liver breaks down curcumin, it will attempt to make it water-like to be excreted by the kidneys. A tiny bit of black pepper can inhibit that process and increase the absorption of curcumin.
- Using whole form turmeric (easy to find in stores) in your cooking also increases absorption because of the natural oils.
- Combining with healthy fats also will work, as water and oil (or fat) do not mix well, making it harder for your liver to quickly eliminate it, and negate the effect.
The number one way to increase the bioavailability of curcumin in the body to quickly achieve the clinical effect we are after (less inflammation, less pain, less joint stiffness) is to take a potent bioavailable curcumin supplement.
I have researched curcumin products extensively over the past two years, and have found what I believe to be the best form on the market.
In a double-blind crossover study of this high potency curcumin supplement against standard supplement curcumin extracts, one containing natural turmeric oils, and the other containing fats to increase absorption, this form showed 30 times the bioavailability in rats and humans. 4
Safer than NSAIDS, and with added side benefits rather than side effects, a highly bioavailable curcumin product should be a no-brainer for the symptoms of joint pain and inflammation.
- Bidaut-Russell M, Gabriel SE. Adverse gastrointestinal effects of NSAIDs: consequences and costs. Best Pract Res Clin Gastroenterol. 2001;15(5):739-753.
- Sunagawa Y, et al. Colloidal Submicron Particle Curcumin Exhibits High Absorption Efficiency – A double-blind three way crossover study. J Nutri Sci Vitaminol. 67, 37-34. 2015
* These statements have not been evaluated by the Food and Drug Administration (FDA). This information or product is not intended to diagnose, treat, cure, or prevent any disease. You should always consult with your health care provider before taking any new supplement.