NSAIDs Are Harmful for Athletes and the Rest of Us

Slowly people are letting go of their love of NSAIDs (ibuprofen, ADVIL, Naproxen, NAPROSYN, etc). They are far from benign painkillers. Many people mistakenly view “inflammation” as an enemy. With that mistaken understanding, they love the idea that Non-Steroidal-Anti-Inflammatory Drugs (NSAIDs) block inflammation. As I’ve been writing and telling patients for years, “inflammation” is also known as the physiological recovery process. Sure, too much of anything, including inflammation is bad, but too little is also not healthy. NSAIDs start damaging your kidneys and raising your risk of a fatal heart attack from the very first pill. NSAIDS have now been shown to block the muscle developing impact of exercise. Another article published in the August 21, 2017 issue of Acta Physiologica (a prominent physiology journal, nearly 130 years old) included: “young individuals using resistance training to maximise muscle growth or strength should avoid excessive intake of anti-inflammatory drugs”. I would add that the impacts are even worse for older individuals. One reason I enjoyed working the medical tent at major US marathons (Boston Marathon, USA Olympic Trials, Houston Marathon, Marin Corps Marathon) was that it was the only place my colleagues shared my concerns about NSAIDs. Those not-so-benign over the counter pills are a major risk factor for serious and even fatal problems for endurance athletes. When I was Medical Director of the Santa Rosa Marathon, I banned NSAIDs from the medical tent. Runners often think they should take ibuprofen or some other NSAID before a race and they would come to the medical tent asking for some. When I refused them,the runners were annoyed, but I explained that I didn’t want to see them later that day for a heart attack or hyponatremia (the most common cause of marathon deaths). The adverse effects of NSAIDs are less immediately evident outside of endurance events, but the impacts are no less severe. Remember that popping NSAIDs is just not good for you. Use them rarely and be aware that there are many better options....

Doctors, Drugs and Conflicts of Interest

Following up on last month’s controversial statin-boosting recommendations, three weeks ago the Journal of the American Medical Association published an editorial claiming that statins are good at preventing heart attacks in people who haven’t had one. To say that I was skeptical would downplay my reaction. I looked over the article carefully. The author based her opinions largely upon a recent reanalysis of several studies. Her claim was that meta-analysis was very positive, both on the consideration of effectiveness as well as on the matter of adverse effects. In other words, the bottom line was that the positives were substantial, with little risk of problems. Thats not what I’ve read. So, I dug deeper. The article she refers to (Cochrane Collaboration Statin Review 2013) reads a bit differently. The following is from the “plain language summary” section of that article: Of 1000 people treated with a statin for five years, 18 would avoid a major CVD event That is good news to those 18 (ie 1.8%). The big “howevers”, pertain to the adverse effects. Statin studies funded by manufacturers lead us to believe that adverse effects are rare. Partly how they create such low apparent rates of adverse effects is they begin with a “trial period” and then drop anyone who has a problem from the full study. The people who complete the study, and whose experiences are reflected in the relevant study’s conclusions, are then much less likely to report a problem. Independent studies show huge adverse effect rates (over 50% by some conventional academic estimates). No one doubts that statins very commonly cause diabetes. That is very well known. Muscle problems are very common or very rare, depending on what study you read. Other effects, like mental impairment for example, are even less consistently evident in the research. Unfortunately the Cochrane review skimmed over contentions about statin side effects Then I looked into the fine print “conflicts of interest” section. It turns out that the author of the piece is a PAID consultant for three drug companies, and receives research funding from TWELVE! The manufacturers of some of the most popular statin drugs “contribute” to her work. There is a website that tracks MD funding from drug companies (propublica.org) but this only had data on two of those contracts. That “tip of the iceberg” totals nearly $90,000. Why is such ethically tainted commentary accepted in medicine and why is it published in such a prestigious medical journal? Why are docs so easily mislead by drug company...

A Burning Question - Harmful GERD Treatment

Sorry to do another “I told you so” (OK I really am not sorry) but a big study came out showing that taking acid lowering drugs, some of the most widely used drugs in America, HUGELY increases the rate of B12 deficiency. Like 65% hugely. Basic physiology - the stomach produces serious acid (like concrete-melting acidity) and it needs to. Why? To protect us from nasty stuff in our food like bacteria AND to digest food. You can’t absorb B12 if you don’t have enough acid. It is not “rocket science” then to figure out that lowering stomach acid will also destroy your ability to absorb B12. To me the story of this study is that it reveals how unthinking we can be. Heartburn is uncomfortable because the acid is in THE WRONG PLACE not because there is too much acid. That is nothing new at all. I learned that 30 years ago in medical school. Complicating the problem is that most docs don’t know how to test you for B12 deficiency. The B12 blood test misses the great majority of people with B12 deficiency. AGAIN, this is not new. I learned that in medical school. In recent years better tests have become available but too few of us know about them. If a doctor remembers that B12 deficiency throws off your ability to feel vibration and your balance, very, very few know how to discover that on physical examination unless it is so bad that you stumble down the hallway in the medical office. Is missing B12 deficiency a big deal? When conventional estimates of the number of people over age 60 who are B12 deficient run as high as 30% and the consequences (dementia, depression, fatigue, neurologic disease) are so high, it is a very big deal. One powerful example of the consequences of B12 deficiency is strongly common but way under appreciated. Did you know that an American over age 60 is three times more likely to die from a fall as she/he is to die from a car accident? That’s right. Over 15,000 die each year from falls and around 5,000 from car accidents. Why do so many elderly Americans stumble to their deaths? One reason is that B12 deficiency makes you unsteady on your feet. Whereas prescribing a drug that often makes a patient quickly feel better is easy, sorting out and helping the patient cure the cause, is much more difficult. GERD is a symptom, not a specific diagnosis. There are many causes...

Heart Disease Myths

Everybody knows how to prevent heart disease. Not really. Everybody just thinks they know. In truth, just about everybody is pretty much wrong. OK, admittedly the parts about exercising, shunning cigarettes and not getting too stressed are clear to us all. Those of you with sharp eyes have noticed that I did not mention diet or medication. Eating well is crucial but “eating well” is probably different from what you think it is. As far as medication, most everyone thinks that lowering your cholesterol with medication, probably a statin drug like LIPITOR, is effective and necessary for many of us, including those don’t like taking medications. Some TO-BE-DETERMINED statin drug was one element of the “polypill”, an almost magical drug mix formulated to prevent most of our major long-term health risks. Many in medicine advocated the polypill. Some were skeptical of such an aggressive medicinal approach to health care. We’ve seen this before. More should have been skeptical, and not just about the medications. Conventional dietary recommendations are almost as suspect. Lets back up and examine our assumptions about heart disease. Eating Well First, let’s look at that “eating well” piece of the puzzle. The official “healthy heart” diet is pretty straight forward? Limit your fats. They are bad for you, especially saturated fat. Fats make you fat and that’s not good. Margarine is better than butter because it doesn’t have all that saturated fat. Eat more breads, especially whole grains. I am not going to comment on the avoid salt and eggs recommendations right now, other than to say they are also wrong. Eating fatty food is supposed to be bad because it bumps up your cholesterol. “Cholesterol is bad if not downright evil. Your cholesterol is high, you are going to die of a heart attack or stroke. We have to get it down, right NOW.” This advice about diet, cholesterol, eating more grains and medicating away heart disease is wrong. Worse still is that this misguided advice led us astray for decades, wasting an awful lot of well-intentioned effort on the part of patients, and inevitably costing lives. How could this have come to pass? The core, the heart of our mistaken approach, is pretty simple to identify. Some authorities made bad assumptions and, as often happens, most of us trusted the experts and fell neatly into line behind them. Instead of marching off into a golden sunset, it was over the cliff. When we actually got round to asking the right questions carefully and conducting...