Go Easy on the Advil, Motrin, Ibuprofen etc.

Another study has added to the evidence we already have that suggests that nonsteroidal antinflamatories, the "non-aspirin pain killers" you buy over the counter at the pharmacy are bad for you.

The latest study, published in the journal Neurology was hoping to prove that taking these drugs would lower the incidence of dementia. Instead it found the opposite.

Here's the study: Risk of dementia and AD with prior exposure to NSAIDs in an elderly community-based cohort. J. C.S. Breitner et al. Neurology 2009, doi:10.1212/WNL.0b013e3181a18691)

The researchers "followed 2,736 dementia-free enrollees with extensive prior pharmacy data, following them biennially for up to 12 years to identify dementia and AD."

What they found was:

Contrary to the hypothesis that NSAIDs protect against AD, pharmacy-defined heavy NSAID users showed increased incidence of dementia and AD, with adjusted hazard ratios of 1.66 (95% confidence interval, 1.24–2.24) and 1.57 (95% confidence interval, 1.10–2.23)

This did not surprise me at all, for reasons that were not cited in any discussions of this study.

Many people do not realize heavy use of NSAIDs has been linked to high blood pressure and that there appears to be a lifetime dose that dramatically raises the risk of developing end stage kidney disease. I have written about this with appropriate journal citations HERE.

One of the studies cited on that page, published in Archives of Internal Medicine , concluded:

[Men] who took acetaminophen six or seven days a week had a 34% higher risk of hypertension. Those who took NSAIDs six or seven days a week had a 38% higher risk and those who took aspirin six or seven days a week had a 26% higher risk.

High blood pressure is a known cause of vascular dementia, and the older and more fragile people are, the more likely high blood pressure is to damage tiny capillaries in their brains.

An earlier study published in the New England Journal of Medicine in 1994 looked at the connection between painkiller use and the development of End Stage Renal Disease [ESRD], i.e. kidney failure. It concluded:

A cumulative dose of 5000 or more pills containing NSAIDs was also associated with an increased odds of ESRD (odds ratio, 8.8)

I am pretty certain this study was done before the advent on the market of the extremely high dose OTC forms of NSAID so it is likely one "pill" was less than the "extra strength" pills many people take today.

This should be a wake up call for people with diabetes given that people with diabetes are very likely to already have kidney damage thanks to years of undetected high blood sugars before diagnosis and to doctors describing dangerously high post-meal blood sugars as "safe" when we know kidney disease is associated with blood sugar spikes in the range between 135 mg/dl and 270 mg/dl. (Research HERE and discussion HERE)

A lifetime dose of 5,000 pills means 3 pills a day for five years. Given that many people take double or triple dose pills up to six times a day, the limit described on the label, it would be possible to hit this dangerous lifetime dose within a year.

It's not clear if the damage is being done to the kidney, which causes high blood pressure, or the other way around--that the drug is causing high blood pressure through some other means which then damages the kidney.

Whatever the explanation, we know high blood pressure is a major cause of vascular dementia, which is the kind of dementia that afflicts many of the elderly--and that vascular dementia is the form most prevalent among people with diabetes, as discussed in this earlier Blog Post.

The reason chronic use of NSAIDs is such a concern is that doctors tell people to take them for the chronic pain caused by arthritis, a condition extremely common in older people for which there is no truly effective pharmaceutical treatment.

So it looks like it's time to start rethinking your use of these NSAIDs. There isn't really much in the way of alternatives. Tylenol is worse, and has a lower lifetime dose associated with kidney failure, so that isn't a solution either.

Aspirin has recently been linked to a higher risk of brain microbleeds. The study is HERE and you can read a discussion HERE. Prophylactic use of Aspirin has been debunked as a way of preventing heart attack in people with diabetes, which is discussed HERE.

So what can you do if you have both pain and diabetes? Obviously, you can avoid taking painkillers for transient problems like sore muscles which heal themselves.

If you have chronic arthritis, the situation is tougher. The field of alternative arthritis treatments is rife with fraud and ripoff supplements, so if you decide to look for alternative treatments read what you find in a spirit of rampant disbelief. Some treatments that may be worth trying are Glucosamine and large doses of Omega 3 oils (fish oil).

But since pain can really take the fun out of being alive, there are times when a painkiller is necessary. If you do decide to take an NSAID look for the lowest dose that will work. Often you may find through experimentation that the effective dose is much smaller than the dose the label suggests.

For example, I find little difference between the effect on nerve pain from my ruined discs of 1/2 of a 325 mg Tylenol pill, the very smallest sold, and the full pill. When my kids were in elementary school, I used to give them the toddler dose when they were sick with fevers and it always lowered the fever even though the label prescribed a dose 4 times as high for their weight.

Take as few pills as you can and take each pill with an awareness that it is adding to your lifetime dose.

If you have arthritis, keep moving and explore options like warm water swimming to help with joint pain.

If you haven't yet developed arthritis be very careful to avoid the kinds of overly aggressive exercise that stresses on joints and is likely to cause arthritic changes as you age.

Running is a good example of a popular form of exercise that tears up knee joints. Weight lifting can also do enormous damage over time to joints when people train too aggressively.

Walking is a much safer form of exercise for people who plan to keep their bodies going into their 80s or 90s and hope to keep their brains functional through the life of that body.