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  #1   ^
Old Fri, May-12-17, 03:56
JEY100's Avatar
JEY100 JEY100 is online now
To Good Health!
Posts: 10,385
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default NSAIDs, more bad news.

From the People's Pharmacy:

Quote:
People who are hurting are caught between the proverbial rock and a hard place. Whether they’re suffering from a bad back or arthritis, there aren’t many medications that are effective.

Now more bad news about ibuprofen, naproxen, celecoxib (Celebrex), meloxicam and other NSAIDs has millions worried. That’s because a new study confirms an increased risk for heart attacks.

The evidence has been building for years that NSAIDs are bad for the cardiovascular system. Epidemiological studies have suggested that such drugs increase the risk for heart attacks, strokes, congestive heart failure and death. Here is a link to an article we wrote several years ago documenting these problems.

Despite prior research many health professionals and patients were reluctant to accept the bad news about ibuprofen, celecoxib, diclofenac, meloxicam, naproxen or other NSAIDs. There have been concerns about the quality of the studies. Some experts characterized the data as “imprecise” or “inconclusive.”

Now, Canadian and European researchers have just published an important article in the BMJ (May 9, 2017). The results reaffirm the risks of NSAIDs.

What They Did:
After reviewing 82 studies for inclusion in this meta-analysis they settled on eight that met their high standards. Over 400,000 subjects were part of this analysis. There were over 61,000 heart attacks in this group. Before we translate what they found we want you to read their words for yourself:

“Through its inclusion and exclusion criteria and the definition of exposures, this meta-analysis of individual patient data (IPD) aimed to emulate the design of a large, pragmatic randomised trial comparing the main non-steroidal anti-inflammatory drugs (NSAIDs) used in the general population. By studying 61,460 myocardial infarction [heart attack] events in real world use of NSAIDs, we found that current use of a NSAID is associated with a significantly increased risk of acute myocardial infarction. This was observed for all traditional NSAIDs, including naproxen.”
Interpreting the Bad News About Ibuprofen & Other NSAIDS:
So, how bad was it? The researchers noted that “NSAIDs exhibited a rapid onset of risk for myocardial infarction in the first week of use.”

That challenges the thinking of many people who assumed that it would take months of daily use to trigger this effect. Doses of ibuprofen greater than 1200 mg per day demonstrated the risk between eight and 30 days. That is higher than the standard daily dose recommended on the label of drugs like Advil or Motrin IB. The directions for Advil Tablets read:

“adults and children 12 years and over: take 1 tablet every 4 to 6 hours while symptoms persist
“If pain or fever does not respond to 1 tablet, 2 tablets may be used.
“Do not exceed 6 tablets [1200 mg] in 24 hours, unless directed by a doctor.”
If someone were to take the maximal OTC ibuprofen dose he would be approaching the “high dose” considered a risk by the researchers. Many doctors prescribe substantially higher doses for people who have suffered an injury or are complaining about chronic pain.

Bad News About Ibuprofen Not Isolated:

The authors note that NSAIDs as a class appear to have negative cardiovascular consequences. (The exception is aspirin, which may reduce the risk for heart attacks.) The higher the dose the greater the danger.

The Risk in Relative Terms:
Here is what was uncovered in terms of relative risk for people who took different NSAIDs for a week or less:

Ibuprofen: a 48% increased risk of heart attack
Diclofenac (Voltaren): a 50% increased risk of heart attack
Naproxen (Aleve, diclofenac): a 53% increased risk of heart attack
Celecoxib (Celebrex): 24%
Absolute Risk vs. Relative Risk:
In fairness, it is important to note that relative risk is almost always a scary number. A 50% increase in the risk of heart attack seems huge. And yet the absolute risk of suffering a heart attack is actually quite small. That’s because relatively few people will experience a heart attack in the first place.

We understand the the distinction between absolute risk or absolute benefit can be confusing. The pharmaceutical industry has learned how to take advantage of this complexity. For example, the maker of Lipitor (atorvastatin) used to state that this cholesterol-lowering drug was valuable:

“In patients with multiple risk factors for heart disease, LIPITOR REDUCES RISK OF HEART ATTACK BY 36%*…”
That seems like an impressive number. Some people might assume that more than a third of patients on Lipitor could avoid a heart attack. But the asterisk in the ads told something quite different:

“That means in a large clinical study, 3 percent of patients taking a sugar pill or placebo had a heart attack compared to 2 percent of patients taking Lipitor.”
So there was roughly one fewer heart attack out of 100 people taking Lipitor. And yes, that was a 36% relative risk reduction.

The same thing is true about the absolute risk of experiencing a heart attack on ibuprofen or related NSAIDs. Even a 50% increased risk is still a relatively small absolute increased risk. Nevertheless, we do think this is a serious cardiovascular complication of NSAIDs.

Here is what the BMJ authors concluded:

“This patient level meta-analysis of acute myocardial infarction associated with NSAIDs involving 61 460 cases in 446 763 individuals is the largest investigation of its type, and its real world origin helps ensure that findings are broadly generalisable.

“In summary, compared with non-use of NSAIDs in the preceding year, we documented that current use of all studied NSAIDs, including naproxen, was associated with an increased risk of acute myocardial infarction…Given that the onset of risk of acute myocardial infarction occurred in the first week and appeared greatest in the first month of treatment with higher doses, prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses.”

Other NSAID Side Effects:
Digestive tract upset, stomach pain, nausea, bleeding ulcers, perforated ulcers
Heart attack, stroke, cardiac arrest
Irregular heart rhythms (A-fib)
Fluid retention, Heart failure
High blood pressure
Dizziness, unsteadiness, spaciness
Kidney damage, liver damage,
Skin rash and other dermatological reactions
Ringing in the ears
Asthma, breathing problems, allergic reactions
Changes in vision

People Love NSAIDs:
People in pain want relief, even if NSAIDs are not all that great at providing it. There just aren’t very many other options. More at: https://www.peoplespharmacy.com/201...nd-other-nsaids


CBS News: http://www.cbsnews.com/news/nsaid-n...rt-attack-risk/
Was also on ABC news.

Last edited by JEY100 : Fri, May-12-17 at 09:35.
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  #2   ^
Old Fri, May-12-17, 08:04
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Posts: 45,277
 
Plan: Paleo 99.5%
Stats: 210/170/160 Female 67.5"
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Progress: 80%
Location: San Diego, CA
Default

Probably a good thing cannabis is becoming legal in more states all the time. Opioids, nope. NSAIDs nope.

I haven't taken an NSAID for several years now, but I got a migraine and took one. Fortunately I barfed it up.
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  #3   ^
Old Fri, May-12-17, 09:46
JEY100's Avatar
JEY100 JEY100 is online now
To Good Health!
Posts: 10,385
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

Dr. Weil's new book Mind Over Meds summarizes all the concerns over pain relievers, but then I have found the alternatives he listed just don't work. The lifestyle changes (lose weight, eat anti-inflammatory diet) are OK, but arnica, capsaicin, turmeric, fish oil, ginger, tart cherry,... not so much. Acupuncture, massage...maybe but short-lived. So if bad, a regular aspirin...but then there's goes my stomach lining Nancy, your suggestion may be the best.
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  #4   ^
Old Fri, May-12-17, 14:45
Merpig's Avatar
Merpig Merpig is offline
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Posts: 6,163
 
Plan: IF/Fung IDM/Potato Hack?
Stats: 375/272.6/175 Female 66 inches
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Location: NE Florida
Default

Well Florida voters just elected to authorize medical marijuana - but if it's anything like previous referendums the people have voted on it will just be totally ignored by the legislature.

I try to limit myself to aspirin if I must take something, but I have to confess it doesn't work as well as ibuprofen. Sheesh, some 30+ years ago when I was suffering such severe nerve pain that I could not even hold a pain to write I was scarfing down 4 ibuprofen at a clip, 3-4 times a day (with my doctor's blessing). No internet to use back then! If the doctor said it was okay then you complied.
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  #5   ^
Old Sun, May-14-17, 10:22
chicachyna chicachyna is offline
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Plan: my own LC
Stats: 179/152/150 Female 66.5 inches
BF:28/28/24
Progress: 93%
Location: Tucson
Default

Relative risk, absolute risk. What a difference!
If one is taking a blood thinner, then aspirin is out too.
Perhaps mmj is the way to go!
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  #6   ^
Old Sun, May-14-17, 11:12
GRB5111's Avatar
GRB5111 GRB5111 is offline
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Plan: Ketogenic (LCHFKD)
Stats: 227/186/185 Male 6' 0"
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Location: Herndon, VA
Default

This confirms suspicions that many of us have held. I, too, no longer take any NSAIDs. An occasional aspirin, yes, but nothing else. medical marijuana? Yes, it should be available and considered as a normal treatment protocol; however, it should also be studied to better understand its overall impact to physical and mental health. It appears that there's too much money behind manufacturing NSAIDs to pull them from the market any time soon.
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  #7   ^
Old Fri, Nov-17-17, 03:56
JEY100's Avatar
JEY100 JEY100 is online now
To Good Health!
Posts: 10,385
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

Yesterday, the FDA increased the warnings on NSAIDs, Plan to extend them to OTC versions also.

https://www.fda.gov/Drugs/DrugSafety/ucm451800.htm

Quote:
Some of the most common painkillers available carry a warning: their use can increase the risk of heart attack and stroke.

That warning was strengthened by the FDA on Thursday, after more evidence connected those risks to a category of medication known as non-aspirin nonsteroidal anti-inflammatory drugs, also known as NSAIDs.

The over-the-counter and prescription versions of the medications relieves the symptoms of fever, headaches, colds and cramping. Ibuprofen (Advil or Motrin) and naproxone (Aleve) are the most common forms of NSAIDs.

"Based on our comprehensive review of new safety information, we are requiring updates to the drug labels of all prescription NSAIDs," the FDA said on its website.

Here's what to know:

People with heart disease have a greater chance of having a heart attack or stroke after using NSAIDs.
There's also an increased risk of heart failure associated with NSAID use.
The risk of heart attack and stroke associated with NSAID medications has been known since 2005, so this is an update to those warnings.
This change is specific to prescription NSAIDs, though the FDA did say it plans to request changes to the over-the-counter labels as well.
The risk of heart attack and stroke is greater when people use higher doses, and can increase the longer the drugs are used.
Some NSAIDs likely increase the risk of heart attack and stroke more than others, though the FDA couldn't definitively say which ones are higher-risk.
The warning does not apply to aspirin, which is actually often recommended for people with a high risk of heart attack.
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  #8   ^
Old Fri, Nov-17-17, 11:48
Meme#1's Avatar
Meme#1 Meme#1 is offline
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Plan: Atkins DANDR
Stats: 210/183/160 Female 5'4"
BF:
Progress: 54%
Location: Texas
Default

The marketing of these drugs was tremendous...They knocked aspirin right out of the market. To round it out they made sure that no child took aspirin again with a scare of Ryes Syndrome. Remember before that St. Joseph aspirin was the go to for all children with fever.

Well my mother was right again. She wouldn't touch any of these "new" drugs, only aspirin. One doctor gave her Celebrex and after taking it a couple of times, she said it made her feel weird and stopped.

When my DD2 was in high school she kept getting strep throat so she was put on Zithromax Z-pac. It put her in acute renal failure... (could have been the strep but I think it was the Zithro) Many of the children on this floor, the kidney failure floor of the children's hospital were there due to these kidney damaging drugs.

We've been sold another bill of goods by the drug companies...
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  #9   ^
Old Fri, Nov-17-17, 12:00
cotonpal's Avatar
cotonpal cotonpal is online now
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Plan: very low carb real food
Stats: 245/128/135 Female 62
BF:
Progress: 106%
Location: Vermont
Default

When nsaids came on the market, first prescription only, the one thing they did that no other drug had ever done, was relieve severe menstrual cramping. They made a huge difference in my life. Luckily this is a condition that only required the pills to be used for a few days every month. Now I read that a lchf diet can really help with cramps. I am too old to know whether or not that is true. I haven't taken nsaids in well over a decade but for me I suspect they would still be worth the risks associated with them if lchf didn't work. Before nsaids I took codeine, or darvon or tramadol. My father was a doctor so he would give me whatever high level pain killer he had around. Nsaids changed all that for me.

Jean
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  #10   ^
Old Fri, Nov-17-17, 12:12
Meme#1's Avatar
Meme#1 Meme#1 is offline
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Plan: Atkins DANDR
Stats: 210/183/160 Female 5'4"
BF:
Progress: 54%
Location: Texas
Default

Naproxen started out prescription only with huge warnings about drinking a lot of water with each dose. It knocks out back pain like nothing else.
Once it became available over the counter under the name Aleve.... most people didn't realize how powerful the drug is, in it's ability to damage the kidneys. Most people think it's as safe as aspirin because they don't know.
After all, all of those happy commercials with people laughing and enjoying life! Surely they wouldn't sell something to us that could permanently damage us for life! sarc
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  #11   ^
Old Fri, Nov-17-17, 13:14
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khrussva khrussva is online now
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Plan: My own - < 30 net carbs
Stats: 440/205/210 Male 5' 11"
BF:Energy Unleashed
Progress: 102%
Location: Central Virginia - USA
Default

Aleve was my go-to for back pain. I only took it when really needed it, though. Thankfully, the back issues are gone. I have not taken an NSAID in 3 years. With my CVD risk factors the timing couldn't be better.

Just like they do with salt, caffeine, red meat the media regularly splashes troubling results of various OTC medication studies on the evening news. These reports, accurate or not, made me wary about taking any medications unless I had a really good reason to. When I get a cold virus related headache Tylenol is the pain reliever that works best for me. I used to think it was totally safe if taken as directed. But I've seen reports that even if taken as directed liver damage can occur. So I'm downright paranoid of everything these days. I'm just getting over the first serious chest cold that I've had in several years. I had a nasty headache for several days. I took a chance and used Tylenol a couple of times a day for a week. It worked. But I still didn't like taking it.
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  #12   ^
Old Fri, Nov-17-17, 13:47
Meme#1's Avatar
Meme#1 Meme#1 is offline
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Plan: Atkins DANDR
Stats: 210/183/160 Female 5'4"
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Location: Texas
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Glad you're getting better Ken.
The flu is making it's rounds this year. One of my GSs was sick with fever for one solid week+ and had the "flu" as confirmed at the doctor on a second visit because he wasn't getting any better and kept fever even with meds.
I saw on the news that one a kid was hospitalized and almost died from it.
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  #13   ^
Old Sat, Nov-18-17, 20:49
Merpig's Avatar
Merpig Merpig is offline
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Plan: IF/Fung IDM/Potato Hack?
Stats: 375/272.6/175 Female 66 inches
BF:
Progress: 51%
Location: NE Florida
Default

<sigh>, what to do? What to do? I still get lots of pain. LCHF does a lot of good things but pain relief is not one of them. I try to limit myself to a couple aspirin if I must but that doesn’t do much to help. I avoid Tynenol like the plague as I don’t need liver failure. A “normal” dose of Tylenol does about as much for pain as a couple M&Ms would do. An amount sufficient to help with pain would probably kill me from liver failure.

The one that always worked for me is ibuprofen. It was always my “go to” but not at the suggested dose. The dose used to be two tablets and that did nothing for me. Now the suggested dose is ONE tablet! But anything less than three tablets is not eve worth taking. I really need four for pain relief, but three will take the edge off. I hate to take them but sometimes I need to sleep.

I spent the day today at my sewing machine making doll clothes for my granddaughter for Christmas. So tonight I have sciatica, a headache, aching shoulders....

Anyway I did take three ibuprofen just a bit ago. They are kicking in! But I’ll only do it once a day and try not to every day. But damn, there must be something!

Haha. My surgeon gave me a prescription for about 60 opioid painkillers when I had my wrist surgery in August 2016. I still have about 50 left. Sometimes I take one of those when I want to avoid ibuprofen!
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  #14   ^
Old Sun, Nov-19-17, 03:54
cotonpal's Avatar
cotonpal cotonpal is online now
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Posts: 4,140
 
Plan: very low carb real food
Stats: 245/128/135 Female 62
BF:
Progress: 106%
Location: Vermont
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When I took ibuprofen for menstrual cramps I had to take 6 to get any relief. I am so glad those days are over with. I know I would still opt for the ibuprofen over the pain. Luckily I don't have to choose.Opioids may actually be the safer option for those of us who are not in danger of becoming addicted. I used to have a lot of leftover oxycontin just hanging around because I no longer needed it. There needs to be a way to treat people with legitimate pain issues.

Jean
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  #15   ^
Old Sat, Nov-25-17, 07:35
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WereBear WereBear is offline
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Plan: Epi-Paleo/IF
Stats: 220/161/150 Female 67
BF:
Progress: 84%
Location: USA
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Tylenol has never worked for me, and now I consciously avoid it because it is so easy to have an overdose and damage the liver. They put it in everything OTC and what used to be a harmless practice to get through a bout of flu can now endanger your life.

I was in despair over my painfully arthritic hands which would make me up in the middle of the night. And I was already eating low carb!

Gluten free and MSM have done absolute wonders. And if I need painkillers, I take white willow and devil's claw; together they need a lower dose.

Pharma tweaks the molecules to get them patented, so often the natural alternative (white willow was the first aspirin) will dodge the side effects.

I am fortunate I found things that worked; and they were outnumbered by what I tried that didn't work.

Last edited by WereBear : Sat, Nov-25-17 at 08:06.
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