Ibuprofen has been linked to an increased risk of heart attack, stroke and damage to the small intestine. Is it time to take paracetamol instead?
It is a mainstay of most medicine cabinets, the painkiller of choice for headaches, back pain and muscle soreness. Ibuprofen is more than 50 years old and one of the most popular non-steroidal anti-inflammatory drugs (NSAID). These drugs reduce inflammation by blocking the enzymes (COX-1 and COX-2) needed to make prostaglandins – chemicals released in response to injury or illness and which cause pain, swelling or fever. Unfortunately, prostaglandins also protect the stomach lining by reducing acid production and increasing mucus, so their blockage can cause stomach bleeding and ulcers, especially in older people.
This has been known for years, but more recently some NSAIDs have been linked to increases in the risk of heart attack (high doses leading to one fatal heart attack for every 1,000 people a year using the drugs), stroke and damage to the small intestine. According to Dr Alessio Fasano, director of the Centre for Coeliac Research at Massachusetts general hospital, they may, in genetically predisposed people, also increase the risk of coeliac disease. By making the small intestine leaky, these drugs allow gluten into the bloodstream and set up an autoimmune response. So is it time to turn to paracetamol instead?
All drugs have side-effects and many people can safely take ibuprofen. When NSAIDs work, they reduce pain by half. Paracetamol is not as effective and has its own risks, in that higher than recommended doses can cause liver damage. You should, however, always talk to a pharmacist or doctor before you start taking an NSAID: you should avoid them if you have asthma, have had a heart attack, stroke, stomach ulcer or kidney disease, or if you are taking certain drugs such as blood-thinning medicines.
Naproxen is an NSAID that has not been associated with an increased risk of heart attack or stroke and may be the safest option, especially if you may be taking it for some time. Some doctors will also prescribe a medicine to reduce stomach acid production if you are taking an NSAID long-term.
For sporty people who want to push themselves that bit harder by taking ibuprofen, it may not be worth the risk. A study of runners in the 100-mile Western States trail-running race found that those taking ibuprofen had higher levels of chemical markers for muscle damage, no reduction in muscle soreness after the event and did not run any faster. Another study found increases in the leakiness of the small intestine in cyclists who took NSAIDs before exercising. The authors conclude that it is not harmless for athletes to take NSAIDs.
So, if you need them for pain and have no medical reason not to take them, the benefits are likely to outweigh the risks. Just don't take them before a gym session.
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