4 Surprising Facts About Anti-Inflammatory Medications & Your Gut
You may not be familiar with the terms “NSAIDs” but I can bet money that you have heard of Aspirin, Ibuprofen (Advil or Motrin), and/or Naproxen (Aleve). These medications fall under the drug classification of NSAIDs which stands for non-steroidal anti-inflammatory drugs. Put simply, NSAIDs act as pain relievers by reducing inflammatory pathways in the body.
NSAIDs such as aspirin, ibuprofen, and naproxen are some of the most used over-the-counter pain relief medications. People take them for a variety of complaints ranging from headaches, joint pain, muscle aches and sprains, and menstrual cramps.
In the final post of my 3-part series on medications that affect your microbiome, we take a closer look at how these common pain relievers could contribute to poor gut health.
(If you missed part 1 or 2, you can click the links to check them out. I covered “10 Way to Protect Your Gut If You Need To Take Antibiotics”, and “4 Ways The Birth Control Pill Affects Your Gut”.)
What do NSAIDs have to do with chronic gut issues? To understand that, you first need to understand a few things about your gut…
In order to achieve optimal digestive functioning (aka. no bloating, regular bowel movements, minimal food sensitivities, etc.), you need to take care of both your microbiome and your gut-barrier.
The microbiome is the community of microorganisms that lives in your gut. There are more than 1,000 bacterial species that make up this community – and a healthy gut is one that is rich in a variety of beneficial bacterial species. More diversity and abundance equate to better health outcomes. An unhealthy gut is one that lacks abundance and diversity.
The microbiome serves multiple functions:
It digests food parts that our body is unable to handle on its own, such as tough plant fibers and resistant starches.
It regulates metabolism and plays a role in hormonal regulation.
It synthesizes amino acids and vitamins.
It trains and regulates the immune system to protect us against invading pathogens.
The gut-barrier is made up of your gut lining, immune cells, and a protective layer of mucus. This is also where most of your microbiota live. The gut-barrier functions to allow for absorption of important nutrients while keeping harmful substances and pathogens from entering your body’s circulation.
If the microbiome is out of balance, or any part of the gut-barrier is compromised, this creates an environment for increased intestinal permeability (aka. leaky gut) and inflammation. Either of these factors can leave you susceptible to a host of gut issues including symptoms of abdominal pain, cramping, gas, bloating, constipation, and diarrhea; and dysbiosis, infection, and/or autoimmune conditions, in more severe cases.
This is where NSAIDs come into the conversation.
If you read the warning label on any of these medications, you’ll see that one of the listed side effects is stomach bleeding; and if you take too much, it can cause damage to the stomach or intestines.
This is just the tip of the iceberg.
Here is what isn’t on the label but is important to know about NSAIDs when it comes to your gut health:
1. They increase intestinal permeability causing leaky gut.
Intestinal permeability is present in 50–70% of long-term NSAID users, while inflammation is present in 60–70% of them. A leaky gut makes you more susceptible to dysbiosis, bloating, food sensitivities, and inflammation.
2. They damage the blood vessels and increase bleeding time affecting the gut.
Mucosal damage is present in approximately 30–40% of NSAID users.
NSAID administration can increase intestinal permeability within 12–24 hours after drug intake and cause inflammation in the small intestine within 10 days, while ulcer formation can take up to 2 weeks.
3. They inhibit repair mechanisms that allow the gut lining to regenerate and effectively slow healing time.
Chronic exposure to NSAIDs can cause swelling in the mucosal lining of your intestines, tissue damage and bleeding in the mucosa, anemia, scar tissue formation, and ulcerations.
4. They inhibit immune defenses against viruses.
If your body can’t respond appropriately to potentially threatening viruses, this could leave you vulnerable to infection which may have negative consequences for your gut health and overall well-being.
Furthermore, while the impact of NSAIDs on the human intestinal microbiota is not well studied due to difficulties associated with this type of investigation, animal studies tell a disheartening tale.
Short-term oral treatment with naproxen shifts the small intestine microbiota composition in rats and causes intestinal ulceration and inflammation.
All this to be said, taking medication is a personal choice. If you need to use NSAIDs to manage pain or a specific medical condition, here are a few tips:
Take your medication as prescribed. The risk for side effects increases with increased use.
Only take NSAIDs when necessary. Consider alternative modalities for pain management such as hot or cold application, Epsom salt baths, stretching, acupuncture, chiropractic treatment, herbal medicine, and mindfulness-based treatments such as meditation, yoga, or tai chi.
Supplement with probiotics. The jury is still out on this one, but current evidence suggests supplementation with probiotics in chronic users of NSAIDs may help to restore an altered microbiome.
Take additional measures to support gut health through diet, hydration, supplementation, adequate sleep, stress management, and daily movement. (You can follow me on Instagram @coralieempowerednutrition where I’m always posting content on digestion and gut health.)
As an aside, if you are thinking, “Okay, I’ll just take some Tylenol instead,” you should know that it isn’t any better. Tylenol (generic name: acetaminophen) has also demonstrated negative effects on the gut-barrier and microbiota composition.
Are there any alternatives?
Absolutely! Curcumin, a bioactive substance found in turmeric, is well-studied, and has been shown to have beneficial effects when it comes to reducing pain and inflammation.
A systemic review and metanalysis looked at the effectiveness of high- and low-dose curcumin for treatment of pain in knee osteoarthritis. It was found that curcuminoids have similar pain relief effects to NSAIDs and fewer reported adverse events.
If you are using curcumin to reduce pain or inflammation, be sure to use a product that combines with bioperine, black sesame oil, or another lipid matrix to aid with absorption. The recommended dose for reduction of pain and inflammation is between 2 to 4 grams per day (8 tsp of turmeric powder = 4g curcumin).
Always consult your trusted healthcare professional before starting any new supplements or stopping medication.
In case you missed it, don’t forget to check out part-1 “10 Ways to Protect Your Gut If You Need To Take Antibiotics”, and part-2 “4 Ways The Birth Control Pill Affects Your Gut”.
