What Are NSAIDs? A Quick Guide to Common Pain Relievers Like Ibuprofen
Should I Take an NSAID for my pain?
An NSAID is a non-steroidal anti-inflammatory drug. There are a few that usually come to mind, such as ibuprofen, naproxen, and Motrin, among others. There are quite a few. Some are more powerful or detrimental than others. And what is their mechanism of action? They reduce inflammation and, therefore, take pain out of your life. Often touted as the number one over-the-counter (OTC) drug out there. Many people use them daily, at higher than recommended doses, because they’re “safe”. So what, doc said to take them. Oh, in that case, it’s definitely not doing any harm to me. If you look into the actual side effects and understand how they work in the body, then we actually find a concert large list of side effects. Such as infertility in men and women, stomach ulcers, and doubling the likelihood of Acute kidney injury. Not something to just overlook.
How NSAIDs Work: The COX Enzyme Connection
Let’s start with how it works in the body. NSAIDs inhibit an enzyme called cyclooxygenase, also known as COX. Some of these drugs work on specific ones, called “selective COX inhibitors”. Either way, the downregulation of COX 1 and COX 2 reduces inflammation in the body, and then takes pressure off your nociceptors (pain receptors and nerves), therefore bringing relief. Sounds good in theory, but not so much. Over the years, there have been different strengths and types of NSAIDs, trying to either sledgehammer all inflammation or be selective to certain receptors. So what is the difference between COX 1 and 2?
The COX-1 vs. COX-2 Dilemma: Selective Inhibitors Aren’t Always Safer
Cyclooxygenase enzymes are producers of prostaglandins, chemical messengers that call out to recruit growth factors for healing, vascular dilation (for increased blood flow) and overall keep things running smoothly in tissue. COX 1 is typically working daily, the quiet professional, just showing up, doing work and “keeping it real”. Big things to consider are its role in the mucosal lining of the stomach.
COX-1’s Role in Stomach Protection and The Cause of Ulcers.
They upkeep the “raincoat” of your stomach, protecting it from acid erosion of your stomach tissue. If you powerhouse every day with these drugs, they never have a chance to rebuild the lining, leading to severe stomach discomfort, erosion, ulcers, and even bleeding. This is even a higher risk for those who drink alcohol and her the age of 65. Oh, so I will just take the selective ones that only block COX 2 and let COX 1 do its thing. Well, that’s a great theory, but a big concern is that selective NSAIDs, blocking only COX-2, lead to uncontrolled platelet aggregation (clotting) from COX-1.
COX-2 Blockers Doubled Clotting Risks Pulled a Drug from the Market
Simply put, you let the clotting factors run unchecked. There was a drug that was pulled off the market in the early 2000s that did just this. The reason it was EVENTUALLY pulled was that the risk for stroke and heart attacks doubled, and years before, when it was approved, these risks were downplayed or ignored by the company running the trials. This company was also the maker of the drug. Quite interesting. In any case, that is a wild number to increase risk. There are still drugs coming on the market that follow a similar mechanism of action, so it is important to do your research on all drugs.
NSAIDs and Male Fertility: The 2018 Study on Testosterone Drop
The next big thing is testosterone. The hot topic on everyone’s feed these days. There was a study in 2018 showing how NSAIDs can affect infertility in men. Check it out here. The study looked at the effects of ibuprofen in healthy men (18–35 years, BMI <30, no chronic conditions). They received 1,200 mg/day (two 600 mg doses) or placebo for 6 weeks.
Compensated Hypogonadism Explained
The Ibuprofen group showed a significant drop in testosterone / Luteinizing Hormone (LH) ratio, indicating reduced testicular sensitivity and Sertoli cell function, down 23%. Sertoli cells are responsible for spermatogenesis (creation of sperm). LH and FSH rose, but total testosterone stayed normal. With LH rising and testosterone staying the same or lowering, this means the body was compensating by telling the pituitary to raise LH, but the Leydig cells were desensitised to LH, therefore lacking the ability to produce testosterone in the testicles. This is similar to what we see in andropause (age-related testosterone decline).
23% Drop in Testicular Function After Just 2 Weeks
These effects took place only after 14 days and continued to get worse as the study went on for six weeks. In the end, the consensus was one of concern and that if continued long-term, it would most likely cause lasting effects. In any case, this is good information to tell someone who takes this stuff like a daily tic tac and thinks nothing of it. But what about women? Does it affect them the same?
NSAIDs and Female Fertility: Ovulation Disruption and Cysts
The concern with steroid hormones in women is definitely still there. But the real eyebrow-raising research was on how it affected fertility, and specifically ovulation. Quick breakdown on ovulation. The follicles in the ovaries are stimulated with a spike of estrogen, then Follicle Stimulating Hormone starts telling the follicles in the ovaries to grow. One of the follicles becomes dominant and inside it holds an oocyte (egg). Once the follicle gets to a certain point, it bursts, releasing the egg down the fallopian tubes to be fertilised. Or not if you’re mad at your husband.
How Prostaglandin Blockade Halts Egg Release
So what happened with drug use? The NSAIDs inhibited prostaglandins and therefore did not allow the “bursting” of the follicle process to happen. This left 1/3 of patients with functional cysts in the ovum. There have been a few studies to show this, but the conclusion from this one was particularly concerning.
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- “Conclusions – The findings may serve as an alarm of the harmful effects of these drugs on female fertility and be taken into consideration in females planning to have a child.” – https://ard.bmj.com/content/74/Suppl_2/117.3.citation-tool
After Only 10 days of NSAID use in women!
When we hear that the fertility rate is declining in the world today, this is not something to look over. NSAIDs are widely used around the world and an easy, over-the-counter drugs that many people don’t even think twice about. If fertility and hypogonadism aren’t interesting to you, perhaps consider the effects on the stomach.
NSAID Risks: Kidney Injury, Delayed Healing, and More
The inhibitions of COX enzymes have a direct effect on the mucous lining of the stomach. If these enzymes are stopped and they don’t have the ability to rebuild the lining. It then leads to stomach upset, ulcers, and bleeding, literally from the stomach acid itself breaking its own walls down. We are now unravelling the importance that the stomach has in more than just storing food in our bodies. With autoimmune disease, GI distress, and IBS on the rise, to say that NSAIDs don’t play a role in this is an “eyes wide shut” approach.
There are several other things that send up red flags with chronic, daily NSAID use, and some literature actually shows it inhibiting the healing process with injury, and potentially causing more harm, leading to worse damage. It directly affects the needed inflammation cascade required in the injury response and repair phases of healing. Check out the blog on inflammation for more insight. Don’t be so quick to pop a pill right off the bat.
Alarming Study Showing How NSAIDs Harm Your Child’s Kidneys
Ibuprofen and other NSAIDs are common go-to meds for kids’ fevers or aches, but a 2014 study of 15 young patients shows they can seriously harm kidneys by cutting off blood flow, leading to acute kidney injury (AKI) that’s often overlooked. This risk spikes in dehydrated children, like those with stomach bugs (vomiting/diarrhea), causing kidney function to drop sharply (creatinine levels over four times normal) and recovery to take weeks, even if it reverses. The “safe” label on over-the-counter versions hides these issues, with little monitoring. We need large trials comparing NSAIDs to options like acetaminophen to figure out exactly how common this is in children. Read the full study here.
The “Triple Whammy” Trap: NSAIDs and Blood Pressure Meds Double Kidney Failure Odds
Know someone on Blood pressure medication? Well the danger doubles for them. Adding NSAIDs to ACE inhibitors, Angiotensin II Receptor Blockers (ARBs), or diuretics creates a “triple whammy” that further restricts kidney blood supply, raising AKI risk by up to 108% according to studies, especially in older adults or those with diabetes. Doctors should check creatinine levels in everyone on BP meds and in young kids before using NSAIDs for fever. Above all, warn parents about over-the-counter risks, and promote awareness to prevent these kidney problems. Here is the literature on the BP med/NSAID combo.
You are Responsible for Your Body’s Well Being, Not the Pill Bottle.
This is not medical advice, and I am not a doctor. The article’s purpose is to give you information and have an informed conversation with your medical provider about medications and ultimately how to heal your body and live a vital life. Take the information and create the perspective that suits you. And leave out the rest. You are the expert on your body. Or at least should strive to be. You only get one.
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