Drug Runners

By Dr. Aaron Case BSc, DC (July 2008)

This article is about some of the most common questions that runners ask me about taking anti-inflammatory drugs during their training:

  1. Are anti-inflammatory drugs helpful?
  2. What are the advantages and disadvantages of anti-inflammatory drugs?
  3. If I decide not to take anti-inflammatory drugs as a runner, what options do I have?
  4. As a runner, if I decide to take anti-inflammatory drugs how/when should I take them?
  5. Before we begin the question and answer portion of the article, I first want to define anti-inflammatory drugs.

Non-steriodal anti-inflammatory drugs (NSAIDs) are used to treat arthritis and other conditions and to relieve pain and inflammation.  Popular NSAIDs are aspirin (e.g. Bayer) and Ibuprofen (e.g. Advil and Motrin).  These drugs dramatically reduce production of prostaglandins resulting in less pain and inflammation.  Unfortunately, prostaglandins also protect the stomach lining among other important functions.  Therefore, improper or prolonged use can result in an ulcer or kidney damage as well as other side effects.

To further understand what anti-inflammatory drugs are, it is important to also know what drugs are NOT classified as being anti-inflammatory. Another type of drug used to relieve pain and fever but NOT to reduce inflammation is acetaminophen (e.g. Excedrin and Tylenol). This drug tends to be less toxic and is typically recommended for pain relief, especially for injuries that are not inflammatory.

QUESTION 1: Are anti-inflammatory drugs helpful to runners?

Many athletes do take anti-inflammatory drugs for pain relief and to help with an injury.  However, based on the pros and cons below, it is good to be aware of the risks and options. I have developed the habit of not taking anti-inflammatory drugs because I prefer to go with healthy food options (see below), apply ice, and identify the underlying cause of my injury/pain (i.e. training errors, footwear, biomechanics, nutrition, etc.). That being said, I have taken anti-inflammatory drugs the night of a marathon when my legs are too achy to sleep and I have decided (for obvious reasons) not to take an ice bath after the race.

QUESTION  2: What are the advantages and disadvantages of anti-inflammatory drugs?

Advantages:

  • Pain relief within an hour that lasts for about 7 hours
  • Relieves inflammation in the long term

Disadvantages:

  • Recent research shows that many (especially chronic) running injuries have no inflammatory cells present and therefore you will only feel better because the pain is temporarily reduced.
  • The anti-inflammatory effect can take several days to a week or more to have an appreciable effect.  Therefore, dosage for one or two days only has minor anti-inflammatory effects whereas the effect from ice is immediate.
  • Possible side effects include muscle cramps, stomach irritation, stomach ulcers, gastrointestinal bleeding, heart palpitation, rectal bleeding to mention a few (there are about two dozen more that I do not have space to include in this one article).
  • There may be an increased risk of infection since the intestines are less effective in preventing bacteria entering other parts of the body.
  • NSAIDs can cause more toxic damage when combined with other medications and alcohol (ice does not).
QUESTION  3: If I decide NOT to take anti-inflammatory drugs as a runner, what alternative options do I have?

You can ice, avoid pro-inflammatory foods and eat anti-inflammatory foods.

Ice

  • A 10 minutes on/10 minutes off cycle before and after your run.

Avoid Pro-inflammatory Foods
Pro-inflammatory foods will increase inflammation, increase your pain from the inflammation, increase recovery time between runs and they may also raise your risk for chronic disease.

  • Examples of Pro-inflammatory Food: Junk foods, high-fat meats, processed meats (lunch meats, hot dogs and sausages), sugar, trans fat and saturated fats in excess.
  • Eat Anti-inflammatory Foods
  • Adding foods that reduce inflammation will not only decrease injury and increase run recovery, but improve how you feel and help to decrease your risk for chronic diseases. Here are some suggestions:
  • Fats and Oils: The right types of fats in your diet will impact pain and inflammation in a positive way. Omega-3 essential fatty acids are very powerful anti-inflammatory agents. They are found in cold water oily fish, walnuts, flax seeds, canola oil and pumpkin seeds. Adding omega-3 fatty acid supplements from flax oil or fish oil may also help reduce inflammation.  Olive oil is another type of oil that will reduce inflammation. In fact, olive oil has been shown to reduce pain and the risk of cardiovascular disease.
  • Carbohydrates and Fiber: The bread, cereal and pasta in your diet should mostly be 100% whole grain products. Whole grains are excellent sources of fiber, and a high fiber diet will reduce your inflammation. Berries are also a great food choice, especially blueberries and strawberries which are packed with anti-inflammatory phytochemicals and anti-oxidants. The pigments in brightly colored fruits, vegetables and berries contain many phytochemicals that have anti-inflammatory properties. Examples: quercetin (found in apples and red onion skins), cumin and turmeric (found in curry powder), bromelain (found in pineapples) and ginger.
  • Other Anti-inflammatory Food Tips: Overall, when you are choosing anti-inflammatory foods to help reduce your inflammation and pain, choose fresh foods instead of heavily processed foods. Here are some tips:

o Be sure to choose low fat milk and cheese and lean cuts of meat which will not promote inflammation.
o Breakfast could be oatmeal served with fresh berries and walnuts, with a cup of soy milk.
o Snack on whole fruits, nuts, seeds, and fresh vegetables throughout the day.
o Eat more fish and less fatty red meat.
o Stay away from deep fried foods and bake or stir fry your meals instead.
o Choose green, orange, and yellow vegetables for your side dishes.

o Drink plenty of water, fresh 100% fruit and vegetable juices, herbal teas and green tea.

QUESTION 4: As a runner, if I decide to take anti-inflammatory drugs, how/when should I take them?

Try not to take anti-inflammatory drugs less than 24 hours before longer races, as you may experience bleeding during and after the race in your stomach and urine (may occur and go unnoticed).

NSAIDs mask pain and therefore could make your injury worse, so you are better off taking them after your run so that you are aware if your injury is worsening during the run.

Of course, always consult with your Medical Doctor on the proper use of any medication or supplements.