Ditch your NSAID meds
I am writing this post as we hurtle along I-680, the freeway bypass around San Francisco. We are on our way back home to Incline Village and it is simply amazing that the technology exists allowing me to do this. I’m using my laptop with Verizon Wireless National Broadband Service, which, although not as fast as my cable at home, still works plenty fast considering the circumstances. The other astounding thing about this experience is that I’m able to focus on what I’m doing with MD at the wheel in heavy traffic–it’s a real testament to my superhuman powers of concentration.
Today’s post is going to be a little bit soft on the science and long on the anecdotal, which is anathema to me, but since it’s my anecdote, I know it can be trusted. Plus, I have a bit of sort of soft science to back it up.
A few months ago I decided to quit taking Advil, my NSAID (non-steroidal anti-inflammatory drug) of choice, because of all the reports of that class of drug causing heart disease. I’m not a big advocate of any kind of medication use that can otherwise be avoided, so it was a good excuse for me to ditch my almost daily use of Advil. Since I’ve been hurtling pell mell toward my dotage I’ve noticed that I’ve begun to have a few aches and pains after a round of golf. A couple of years ago I started taking an 800 mg ibuprofen (the generic for Advil), which is a prescription dose and is comparable to four of the 200 mg non-prescription Advil, before every round I played, or if I forgot, I would take one immediately after. It seemed to do the trick as far as the aches and pains were concerned.
Once all the reports came out, however, I decided to seek an alternative. I began fooling around with various doses of fish oil and krill oil and came up with a combo that works very well for me. I take two ProOmega caps made by Nordic Naturals along with two krill oil caps (all krill oil originates in one place–Neptune Technologies–so they are all the same. Mine comes from Thorne.) along with a 500 mg curumin capsule (curcumin is a potent anti-inflammatory derived from turmeric). This combo I take the same way as I did the Advil: before if I remember; after if I forget. If anything it works better for me than the 800 mg ibuprofen without the potential for GI problems or heart attack. And not only does it not have the potential for causing these problems, it actually prevents these and many other disorders, so healthwise it’s really a win/win. I got such benefit from this regimen that I ran a medical search to see if anyone had tried it or anything resembling it on a research basis.
I found a recent paper in the neurosurgical journal Surgical Neurology entitled “Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.”
The authors began their paper with an overview of the prevalence of and problems caused by NSAID usage.
More than 70 million NSAID prescriptions are written each year, and 30 billion over-the-counter NSAID tablets are sold annually. It is estimated that 5% to 10% of the adult population and approximately 14% of the elderly routinely use NSAIDs for pain control.
This multibillion dollar industry, however, does not come without risk. NSAID-associated dyspepsia occurs in up to 50% of users. Almost all patients who take the long-term nonselective NSAIDS [Advil, for example] will demonstrate subepithelial gastric hemorrhage, and 8% to 20% more will have ulceration. In addition, 3% of patients will develop serious gastrointestinal side effects, which results in more than 100,000 hospitalizations, an estimated 16,500 deaths, and an annual cost to treat the complications that exceeds 1.5 billion dollars annually. Indeed, NSAIDS are the most common cause of drug-related morbidity and mortality reported to the FDA and other regulatory agencies around the world.
Recently it was found that the COX 2 inhibitors (Vioxx, Celebrex), designed to alleviate the gastric side effects of COX 1 NSAIDs, are not only associated with an increased incidence of MI and stroke but also have no significant improvement in the prevention of gastric ulcers.
As you can see, despite these drugs being available over the counter, they are not without the potential for serious side effects.
The authors of the study thought the same thing and decided, as I did myself, to look for a safer alternative. They decided to try fish oil and ended up using a Nordic Natural product that had a little different formulation than the one I used. They used ProEPA whereas I used ProOmega. I think they would have gotten a little better results had they used the ProOmega instead, but, hey, they’re neurosurgeons. What do they know about fish oil?
For the study the researchers selected 250 patients who had back pain that was due to degenerative arthritis and not reparable by surgery, all of whom were taking NSAIDS and about 75% of whom were on COX 2 inhibitors. These patients were instructed to start taking the fish oil (4 capsules per day) for 2 weeks then to reduce the dosage to 2 capsules per day. After the initial lead-in two weeks the patients were instructed to taper off their NSAIDs over the next one to two weeks. After one month the researchers sent a questionnaire to the patients inquiring as to the degree of subjective improvement they had experienced, any side effects they may have had, and to what extent they had been able to discontinue their NSAID dosage.
125 patients returned the questionnaire after about 75 days on the fish oil regimen. (This is what I mean about soft science: this is hardly a double-blind, placebo-controlled study.) 78% of the respondents were taking the 2 capsule dose, 22% were taking the 4 capsule dose. 59% reported to have discontinued their NSAIDs entirely. 60% reported that their overall pain had improved. 80% stated that they were satisfied with their improvement and 88% said they would continue to take the fish oil. There were no side effects reported other than two patients who reported loose stools.
All in all a pretty positive experience, I would say. I can’t help but wonder at what happened to the other 125 patients who didn’t respond. My guess is that they probably didn’t seriously adopt the fish oil regimen and therefore didn’t respond to the questionnaire, but that’s only a guess.
One thing I did (that I always do anyway) that probably made my regimen work even better is that I avoided omega-6 fats as much as possible. Omega-6 fats are those found primarily in vegetable oils and are themselves inflammatory and act in opposing fashion to the omega-3s. They are best avoided whether you decide to adopt this regime or not.
If you are taking NSAIDs for any reason, I urge you to give this regimen a try. Use my specific formula or fiddle around with your own. Whatever you do, let me know how it works out.
She’s still driving; I’m still posting; ain’t technology grand?
http://www.tesco-shopping.com/terranovadrho.htm
Information on seal oil
I haven’t taken them, personally, but there is a bakery in town that has Omega-enriched bread, with seal oil in it.
I cannot taste it (I only taste full-flavoured bread). Others say they can.
Hi Constance–
Thanks for the info.
MRE
Whoah.. you’re on krill oil too! I’ve had a lot of good words to say on krill oil as well as on cod liver oil and fish oil.
We’re selling krill oil too. As well as Cox2Tame that indeed has.. turmeric as one of the ingredients. Helps me a lot when I have a case of instant itching (soy lecithin is a major culprit here).
Funny you mention GLA: tried it a while and joint problems that troubled me since age 15 (am now 43) reappeared. Was eating higher-carb too at the time and reintroducing some grains. Back to no grains, ditched the GLA and presto! No aching. Not even a bit of DOMS after lifting.
Bit of advice for you : try to find someone who does ART, a kind of painful massage therapy that works wonders. Doing rehab exercise wouldn’t hurt either.
Sir many thanks yr time. Sara seems to be in the hands of a fella who is a vegan to start, has never heard of Nicholas Gonzalez MD and just shuttles her from pill to pill.
As per Richard Burton once quipped…Actors are like Dr’s, one has a few that are wonderful and the rest are rubbish.
Which i’ll think is a power law ..thats me BTW, not the Skakespearean from the Valleys.Now thats Wales not LA !
Again thanks Sir
My pleasure–
MRE
Dr Eades “It’s been my experience that if one is on a low-carb diet the GLA is unnecessary and can even be counter productive. GLA converts on down the pathway to arachidonic acid, which then converts itself into some pretty nasty pro-inflammatory products. A number of years ago I read a bunch of blather about taking GLA and EPA, so I took a bunch to see what effect it had on some minor back pain that I was having.”
I took your advice and dropped GLA. As I remember, Gabriel didn’t advise oral application he advised topical application. But because I hurt everywhere I decided on a oral dose. Unfortunately, dropping GLA was followed by the return of the arthritis pain, much to my surprise. I had thought the effect was mostly the 10 grams of fish oil, not the one gel of GLA.
I came up with a reference that summarized “This study revealed that a GLA and EPA supplement combination may be utilized to reduce the synthesis of proinflammatory AA metabolites, and importantly, not induce potentially harmful increases in serum AA levels.”
I am hoping this reference is not the blather you mentioned, so I can thankfully forget my plan to drop GLA for one more cycle to firm up the GLA is bad for me hypothesis. (The return to normal took two weeks)
the link is
http://jn.nutrition.org/cgi/content/full/130/8/1925
Hi David–
No, the article you referenced is not the blather I was talking about. I’m sorry that your back pain got worse. Were I you, I would certainly go back to the added GLA. But, I do have a question…have you been on a low-carb diet while all this was happening? A rigid low-carb diet, not an I’m-kind-of-watching-my-carbs variety? It does make a difference.
Thanks for writing–
MRE
Dr. Eades,
I take cod liver oil caps by Nature Made with Vitamins A& D.
I take 2 a day. Is this the same as fish oil?
My husband and I are starting your way of eating, and hope to have magnificant results! I would like to get him off a lot of his meds, too many for my liking. I have a low thryoid and take .012 mgs. of Synthroid. How can we join your low carb challenge? I could not bring it on my browser, Safari. Are you still running it?
Thank you,
Doris
Hi Ms. De Jong–
I’m not familiar with Nature Made, but I can tell you that cod liver oil capsules are fish oil.
Unfortunately the company that was running the low-carb challenge in conjunction with our publisher was bought out by another company that decided not to continue the program, so it is no longer in existence. Sorry.
I wish you the best in your weight loss efforts.
MRE
No more than 100 carbs a day, most days 60 plus. It took me from 1999 to reach this point. Before I started training I had to stay very close to 30-50 carbs a day. I am training 2 to 3 times a week using Slow Burn. I feel great. Usually when I cheat on diet I feel flushed, weak, and hungry, but that is not happening now.
Soon, I will have my first A1ac reading. That will really tell how close to the diet I am. I will tell you that score along with the change in inflammation due to taking curcuminin.
I am not sure dropping GLA caused the pain to return because with Slow Burn I am making huge quick gains in strength and maybe my bones/ligaments/arthritis are not keeping up. I am using more than half to 2/3rd of each machine’s stack. Which for a 67 year old guy happened very quickly. Before Slow Burn I never got close to half of any machine’s stack. I need to do another trial to make sure that dropping GLA is the cause.
In the referenced GLA/Omega3 study, the 3 gram dose of omega 3′s was exactly the same as what I am taking. However my one a day capsule of GLA is 1/12 of the GLA in their study. Maybe a tiny amount of GLA to Omega3 is needed to get benefits on a low carb diet.
Thanks for responding, it was good to hear my referenced study was not the one you decided to ignore. I have gone back to 240 mg/day of GLA and my back & knees feel better. For now I am not reaching for failure on the third rep. I will consolidate before increasing the weight. Caution because while it is fun getting strong fast, I am not sure if it is safe for a 67 year old.
Cheers
David
Hi David–
Congrats on your success!
Be sure to let me know what your HgbA1c is when it comes back, Were you diabetic when you started all this?
Thanks for the update.
MRE
Got the results on curcumin. I took one 900 mg/day capsule from LEF.org. (best value I found for the dose-plus promises of better bioavailability)
Homocysteine dropped from 11.4 to 7.9. A 30% drop. The normal cutoff point moves around a lot for this test. Last year the cutoff was 11 something. Now for 59 plus males it is 15.3. And the lab is promising new cutoff values for September. But bottom line, I guess that I am near the median for 30-39 year olds. Pretty good I think.
CRP dropped 60% from 3.27 to 1.32. So it seems that curcumin is effective. YMMV.
My HgA1c is 5%. I was hoping for a lower number, but based on my glucose readings the 5% is reasonable. My fasting glucose is 106. I challenged my insulin with 44 grams of calories in ice cream. As I recall, blood glucose was back to normal in less than 2 hrs. However, 45 grams of whole grain bread took over 3 hours to get back to normal. The only time I got lower glucose readings than 106 was when my system overshot in response to carbs. Fasting glucose always tests around 106. Because 5% is less than half the way between 4.5 to 5.7, maybe that means I am doing better than half of the healthy population. That is not bad.
I have never been diagnosed as diabetic because my fasting blood sugar has never been higher than 110. But because my normal blood sugar is not under 100, I suspect that I am a little bit insulin resistant.
Thanks for your curiosity about my results. This bores friends and family to tears, so I never get a chance to talk about my hobby. I have 25 years of my medical tests in an access data base.
Cheers
David
Hi David–
Thanks for the update. The drop in CRP (C-reactive Protein) is pretty amazing. Is the addition of the curcumin the only difference between the two lab tests?
If you want to find out if you’re actually insulin resistant or not, see if you can find a physician who does the insulin challenge test that we wrote about in the Protein Power LifePlan.
Best–
MRE
I have Ankylosing Spondylitis and Sjorgren’s Syndrome. I am gluten intolerant and have been off gluten and dairy of for 3 years. My AS is severe so I was tested for Klebsiella, but all the tests for stool and blood were negative. I take high EPA fish oil at 4 per day and other supplements. My acupuncturist suggested the Specific Carbohydrate diet. My questions are can/how can I make a difference with Omega 3′s—is a low carb diet similar to SC diet and have you heard of Celadrin making a difference?
Thanks
JP
Hi JP–
A Specific Carbohydrate diet can be a low-carbohydrate diet but doesn’t have to be. AS and Sjogren’s syndrome are both inflammatory diseases. Omega-3 fats help them in the same way they help all inflammatory problems–by changing the ratio of pro-inflammatory/anti-inflammatory products. You might want to consider adding some krill oil to your regimen because of its greater absorbability and extra anti-inflammatory properties.
I have no experience with Celadrin, so I can’t really comment on its effectiveness or lack thereof.
Best–
MRE
Yes, the CRP drop was surprising. I can’t think of any thing besides the curcumin that caused it. It is only one data point – so I have to give a YMMV warning.
The only change in supplements was a minor one with my B vitamins. About 8 months ago, I was taking a tablet for most of the B vitamins. In an attempt to reduce the number of tablets I substituted Costco’s Kirkland B50 formula. It was the strongest B combination I could find. I soon decided to add a folate tablet, and am considering adding a biotin tablet and a B12 tablet.
Everything else, as far as supplements go, was the stuff I have been taking for about 3 years. Diet is the same, maybe more protein. Exercise is more intense, using Slow Burn. The hormones released by Slow Burn are profoundly stronger than my prior exercise.
I have gotten better at getting the “growth hormone” night time pulse. Very low carb intake during and after supper. I don’t “feel” the growth hormone pulse, but I awaken with a little tent. I am assuming the growth hormone pulse is a precursor to that event. If I am not very careful about my late carbs this event does not occur.
It doesn’t seem to me that these changes explain the drop in CRP. I do remember thinking that CRP would probably change more than homocysteine, so maybe we have two data points. One data point being the change in homocysteine, and the other data point being the larger change in CRP.
Yours in Protein Power,
David
Hi David–
Thanks for the info. I have a question about your comment. You wrote “I don’t “feel” the growth hormone pulse, but I awaken with a little tent.” Is the ‘little tent’ a typo or is it some term I’m totally unaware of?
Best–
MRE
Dear Dr. Eades,
Had to come back here and let you know how well this fish oil/krill oil/curcumin regimen is working for my husband, who has osteoarthritis and suffers nasty flareups.
He’s been trying this for about a month or so, and has said the magic words, “It seems to be working.”
That is, in itself, a miracle. He’s tried just about every supplement on the market in an effort to reduce the arthritis flare ups and deal with the pain. He was also prescribed Naproxen 500mg twice daily.
We’ve been married for two and a half years, and this is the *first* time I’ve ever heard him say, “It seems to be working” about any supplement he’s tried. Normally it’s, “No, I don’t notice much difference, I guess it doesn’t work” in regard to the various supplements tried (everything from borage oil to something called ASU).
Within about two weeks of adding krill and curcumin (he was already taking fish oil), my husband was able to start skipping doses of the naproxen. It was only about a week ago that I noticed he was limping around a bit, and in quite a bit of pain…
Turns out he ran out of his curcumin and krill oil, and had been having to take more of the Naproxen again. While he has been prescribed a regimen of naproxen 500mg twice daily, he prefers to only take it unless he really needs too (because of the known negative side effects).
To make a long story short, I made sure we got some more krill and curcumin, and today my husband doesn’t need any naproxen.
The krill oil isn’t all that expensive (compared to things like OsteoBi-Flex), and the curcumin is darned cheap.
Anyway – thank you so much for sharing this information about the krill and curcumin. It really does work.
For anyone else trying it – it’ll take a couple of weeks before you start noticing a major improvement, at which point you might be able to “ditch” your NSAIDS. And it’ll take about a week if you happen to run out of krill/curcumin to start noticing that the joints are hurting again.
Hi Sara–
Thanks for the inspiring story of your husband’s success. I’m sure his GI tract appreciates the break from the constant bombardment by naproxyn.
You make a point worth repeating. With natural substances such as the krill oil/fish oil/circumin regimen it takes a while to see results. Natural substances have to build up in the tissues, a situation that doesn’t occur overnight.
Best–
MRE
Heya MRE
Last poster was most likely using the term ‘little tent’ as a euphenism for getting an erection or “morning wood”. Maybe your knew that and were just teasing? Heh.
Anyways, very interesting about the curcumin reducing CRP. You take the curcumin and fish/krill oil alone? Or with or around a meal? Any problems with stomach upset? I wonder because I ocassionally took a supplement with curcumin and boswellin (boswellic acid) by itself to help with aches. Never made it a regular part of my regimen because I would sometimes burb up the stuff.
Hi Rich–
I shoulda figured out the ‘little tent.’ Thanks for the heads up.
I take my fish oil/krill oil/circumin all at once and I’ve never had a problem. Of course, as my wife is quick to point out, I have a stomach of iron.
Best–
MRE
Dr. Eades,
I just started your krill oil (1000mg) and curcumin (500mg) regimen today. I’ve been taking fish oil for several months already, totalling 3g EPA and 2g DHA daily. This is the dose recommended to me by my rheumatologist for RA. I don’t know if it helps or not, to be honest.
My question is by adding the krill oil am I now getting too much Omega 3? Should I cut back on the fish oil?
Thanks so much for providing this means of communication. It’s tremendously helpful.
Christy
Hi Christy–
The krill oil is a fairly small dose, but it’s potent because of its phospholipid structure. I wouldn’t think you would have a problem, but since you’re not my patient and I don’t have an exam, labwork, etc. to go on, I would recommend that you check with your doctor who put you on the fish oil.
Best–
MRE
I began a journey of GI discovery last winter and it just keeps getting … more interesting. I am very intrigued by this article and plan to ask my doctor about fish oil as an ibuprofen replacement next time I see him. Thank you!
Hi NM–
Don’t forget the krill oil and the circumin. Both are a part of the regimen I found so successful.
Best–
MRE
I haven’t had the chance to read all the comments yet, but if it hasn’t been pointed out yet- not all krill oil is the same or comes from the same company.
There’s at least one other company that “makes” krill oil..one place selling it is Vitacost.com. Notice there is no mention of phospholipids..and the amounts for the other things aren’t the same.
Interesting website you have here
Hi Only Natural–
Thanks for the heads up. I’ll check this out next week and report back.
Cheers–
MRE
Hey there MRE,
I just wanted to thank you for the curcumin suggestion. I have been taking fish oil for years and then read something on cod liver oil so about 4 or 5 months ago I switched to it instead and I got some additional relief from the pain in my hip joints. I then read this article and started taking curcumin and within a week felt a great improvement from hip pain. Prior to this I would take NSAIDs in hope of getting relief but it never helped much. I was amazed at how much relief I have gotten from this. Also, my NSAID usage is almost completely non existent except for occasional headache.
I keep trying to convince others (family/friends) but no go as yet. HA! Their loss.
Thanks a million, and love your blog!!
Hi Licia–
I’m glad the circumin helped. Since I’ve been on it daily along with krill oil and fish oil, I have not taken another NSAID. It just took me a couple of weeks to get to that point, which is typical with natural products.
Cheers–
MRE
Dr. Eades,
Is the curcumin supp you take 500mg of 100% curcumin, or is it 500mg of curcuminoids (complex)? And would you recommend/not reccomend/be agnostic on the idea of messing with BioPerine as a booster/availability enhancer? Thanks.
Hi Michael–
The supplement I now take is 800 mg curcumin, which is actually about 750 mg of curcuminoids, along with 5 mg of BioPerine.
Cheers–
MRE
Quick question. Is it best to take it all (the 2 capsules of ProOmega and 2 capsules of Krill oil) in the morning? Or split it up and take one of each AM and PM? (Still looking for the curcumin … but that would be taken in the AM, right?)
DH suffers from psoriatic arthritis (when the psoriasis on his hands flare up, so does the arthritis in his knuckles). Of couse, he doesn’t eat low carb; can’t get him to give up his potatoes, bread, and cookies.
He’s waiting for me to try this regimen first. If I have luck, he says he’ll try it too.
THANKS for such great info!
Hi Kathy–
I don’t know that it makes a difference. I take my regimen whenever I think of it. Usually it’s early in the day, but if I forget, I take it at bedtime. It doesn’t seem to make much difference to me. Once you get blood levels where they need to be, a daily infusion just keeps them there, and it probably doesn’t matter much when it is as long as it is.
Cheers–
MRE