(Second of Two Parts)
The over-the-counter (OTC) painkiller ibuprofen seems to be safe for short-term use in the recommended doses, judging from trials conducted up to 2013.
But as I noted in the last issue, alarming headlines appeared in the media in 2017 that left me in some doubt. When it comes to heart health, maybe ibuprofen is not so safe after all.
And another part of the body – not the heart – may be at even greater risk. . .
Researchers from McGill University, Montreal, Canada, wanted to determine the risk of a heart attack for people taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
So they looked at data from eight existing studies, which involved a total of 446,763 people. The researchers found people who took ibuprofen had an increased risk of 48%.1
This figure was found among people taking any dose at all – high or low — for one to seven days. But that means the group would include people taking amounts well above the OTC maximum of 1,200 mg per day.
When the researchers looked only at those taking less than 1,200 mg of ibuprofen for eight to 30 days, the increased risk of heart attack was only four percent.
The packaging instructs OTC users to take no more than two 200 mg pills at a time, doses should be six hours apart, and no more than three doses a day total. That’s where the 1200 mg maximum daily dose comes from.
I don’t condemn the OTC use of the drug based on this study. Unfortunately, it’s not the last word. . .
Danish Study Sees 31% Increased Risk
Another study, also published in 2017, found that ibuprofen increased the risk of out-of-hospital cardiac arrest by 31% in a Danish population.2
One of the authors of the study, a cardiology professor named Gunnar Gislason, said that selling NSAIDs in convenience stores sends the wrong message. He thinks they should only be available at pharmacies where advice is available on how to safely take them.
He also thinks people with existing cardiovascular disease, or who have many risk factors for heart disease, should probably avoid them.3
Risk of Not Dealing with Pain
This study obtained its data from doctor prescriptions, which tend to be for more serious problems, at higher doses, and for longer periods than you’d expect to find among people buying ibuprofen off the shelf.
Christopher O’Connor, MD, former Chief of Cardiology at Duke University, Durham, North Carolina, felt it wasn’t necessary to limit ibuprofen’s availability. He observed that most cases of cardiac arrest in the study were elderly people with existing risk factors.
He observed, “I don’t want my 20-year-old son who twists his ankle playing soccer to walk around in pain because he’s scared to take ibuprofen.”
He also points out that not doing anything to resolve pain involves risk, too. Pain can constrict blood vessels and be detrimental to cardiovascular health.
Not All Consumers Stick to Guidelines
Dr. David Kaufman is a Professor of Epidemiology at the Boston University School of Public Health. He conducted a study to find out whether consumers buying retail stick to the dosage guidelines.
He found that out of 1,326 people taking ibuprofen over seven days, 11% exceeded the daily limit.4
The risks of taking NSAIDs have been made very clear by the FDA. The agency has issued several warnings about them. Labeling information clearly states they can cause severe allergic reaction, severe stomach bleeding, and, apart from aspirin, increase the risk of heart attack, heart failure and stroke. They should be taken for no more than ten days.
Sharon Hertz, Deputy Director of FDA’s Division of Anesthesia, Analgesia, and Rheumatology Products, describes the difficulties involved in assessing safety.
“Available scientific data don’t suggest an increased risk of serious cardiovascular events for short-term, low-dose use of OTC NSAIDs, but it is not known if that is because there is no risk or because there are many challenges when trying to study the use of OTC NSAIDs.”5
An Even Bigger Threat?
In recent years damage to the lower gastrointestinal tract has emerged as an issue.
Researchers from Spain found “Increased gut permeability can be seen as soon as 12 hours after the ingestion of single doses of most NSAIDs.”6
Increased intestinal permeability or “leaky gut” has been linked to a wide range of health disorders.
Using capsule endoscopy — a tiny camera that takes pictures inside the body — an international research group writing in Mayo Clinic Proceedings explained that “even low-dose NSAIDs are responsible for gut mucosal injury and numerous clinical adverse effects, for example, bleeding and anemia, that might be difficult to diagnose.”
In their opinion, “even minor and subclinical injury to the intestinal mucosa can result in significant, though delayed, metabolic consequences, which may seriously affect the health of an individual.”7
Even after decades of use, we’re still discovering adverse consequences from using NSAIDs. As Dr. Hertz admitted, there’s no guarantee that even short-term, low-dose use involves no risk to the cardiovascular system. It seems an even bigger threat could lie within the digestive system.
If you suffer with migraine or cluster headache and want to avoid drugs, a non-invasive hand-held device might be just what you need. We’ll take a look at this soon.
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