NSAIDs in Ultrarunning with Eve Pannone #220
Episode overview:
In this first of four episodes on drugs in ultramarathon running, Eve Pannone joins the podcast to discuss NSAIDs in endurance sport. The widespread use of NSAIDs like ibuprofen (Advil) and naproxen (Aleve) in ultramarathon running is alarming due to the health risks associated with kidney disease, electrolyte imbalance, and other factors. NSAIDs exacerbate some of the stresses of endurance sport to dangerous levels and have no proven performance benefit, yet changing public perception is a challenge. In this episode we break down why NSAIDs are harmful, what we can do as a community to protect athlete health, and viable alternatives to painkillers. If you enjoy this episode, be sure to check out the next three episodes in this mini-series.
Episode highlights:
(6:15) Defining NSAIDs: demystifying pain relievers, Non-Steroidal Anti-Inflammatory Drugs, pain relievers that work by reducing inflammation, ibuprofen (Advil), naproxen (Aleve), and others, controversy around Aspirin, Tylenol is not an NSAID
(10:28) Why NSAIDs are harmful: NSAIDs do not improve performance, risks and side effects, acute kidney injury, electrolyte imbalances, no positive and all negative effects
(40:48) Alternatives to NSAIDs: caffeine, paracetamol (Tylenol) is low risk but medical interventions to reduce pain are generally a bad idea, accept that ultrarunning is going to hurt
Our conversation:
(0:00) Introduction: the first of a series of four episodes on drugs in ultrarunning, outline of the mini-series, Eve’s recent open access review paper
(2:05) Eve’s background: setup, prevalence of NSAIDs in ultrarunning, Eve’s experience as a trail runner and medical student
(4:40) NSAID use in ultrarunning: prevalence, use in shorter events and during ultramarathons
(6:15) Defining NSAIDs: demystifying pain relievers, Non-Steroidal Anti-Inflammatory Drugs, pain relievers that work by reducing inflammation, ibuprofen (Advil), naproxen (Aleve), and others, controversy around Aspirin, Tylenol is not an NSAID
(9:46) Common NSAIDs: Advil, Ibuprofen, Naproxen, Aleve, Motrin, Diclofenac, Cataflam, Voltarol, Indomethacin, Indacin, and other less common products
(10:28) Why NSAIDs are harmful: NSAIDs do not improve performance, risks and side effects, acute kidney injury, electrolyte imbalances, no positive and all negative effects
(12:35) Prevalence of NSAID use: around 60% of ultramarathoners use NSAIDs, 87% in more casual races, women use more NSAIDs post-run, ultrarunners are more likely to take NSAIDs during competition
(15:04) Negative effects of NSAID use: disturbances in electrolyte balance, hyponatremia, acute kidney injury, NSAIDs inhibit kidney function, during an ultra your kidneys are already stressed, damaging the mucosal lining of the gut
(18:31) NSAIDs and muscle damage: oxidative stress, conflicting research as to whether NSAIDs reduce or increase muscle damage, other issues with NSAIDs
(19:51) NSAID dosage: is there a “safe” dose, dosage is highly variable and poorly reported, individual variation, most dosage comes in 200 mg increments from pills, one or two pills is enough to cause problems, dehydration and stress matter more than dosage
(23:20) NSAIDs as accelerants: NSAIDs exacerbate existing issues from ultramarathon-induced stress
(24:15) Forms of NSAIDs: pills versus topical treatment, topical NSAIDs are generally lower risk, potential differences in metabolism, little research has been done on topical NSAIDs
(28:32) Compare and contrast: cycling research on kidney injury from NSAIDs, most ultramarathon-specific research focuses on just one negative aspect of NSAIDs, more research is needed
(30:35) Confusion in endurance sports: endorsement deal between Iron Man and Aleve, UTMB had banned Ibuprofen, athletes get mixed messages, NSAIDs are common and acceptable outside of sport
(33:13) Policy on NSAIDs: athletes need to be aware of the risks, Ibuprofen should be banned, alternative medications, more research is needed for more concrete evidence
(36:16) Banning NSAIDs: necessary qualifications to be banned by WADA (anti-doping), do NSAIDs violate the “spirit of the sport”, WADA is unlikely to ban NSAIDs so prevention falls on leaders in ultrarunning
(38:40) Shifting public perception of NSAIDs: NSAIDs are perceived as harmless, “vitamin I”, Koop’s approach of throwing out NSAIDs
(40:48) Alternatives to NSAIDs: caffeine, paracetamol (Tylenol) is low risk but medical interventions to reduce pain are generally a bad idea, accept that ultrarunning is going to hurt
(44:14) Study on pain blockers: RPE is not affected by nerve blocking, the physical sensation of pain does not affect RPE
(46:14) Problems with masking pain: masking the pain does not fix your problem, if anything it can exacerbate the likelihood of injuries
(47:03) Wrap-up: more research is needed on NSAIDs, read Eve’s paper, additional resources, don’t use NSAIDs!
(48:47) Outro: giving thanks, recap of NSAIDs in sport, future episodes in this mini-series with Tammy Hanson from USADA, Corrine Malcolm on advocacy, Gabe Baida from USADA, thanks for listening
Additional resources:
Koop’s article on Ironman’s Partnership with Aleve
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