The Problems With Longterm NSAID Use


Ibuprofen, naproxen, aspirin, celecoxib, diclofenac… you’ve heard of at least one of these and you’ve probably taken some of these. I certainly have. Still, I seldom take NSAIDs (non-steroidal anti-inflammatory drugs). The truth is, these very commonly prescribed drugs can be heroic when I really need them, but I rarely need them because I do my best to take care of my body and prevent pain with nutrition and physical activity. That’s not exactly what this article is about though…

Why shouldn’t I take NSAIDs daily/longterm?

The reason lives within its mechanism of action. Basically, NSAIDs stop the function of inflammatory enzymes called prostaglandins, reducing pain, inflammation, and fever. Prostaglandins aren’t just involved in inflammation; they protect the stomach lining from its own digestive acid, which is why ulcers and gastrointestinal bleeds manifest with prolonged NSAID use. Prostaglandins help our tissues heal from injury and outside attack, are involved in blood clotting, and promote the aches and pains that force us to take it easy while we repair. When inflammation is constant and body-wide we see it as chronic illness.

Even though there is no evidence for longterm benefits for osteoarthritis (OA), NSAIDs are still widely prescribed as a first-line therapy. Not only are they ineffective, but they are damaging. NSAIDs inhibit cartilage formation and promote bone necrosis and joint degradation. This means that the bone-on-bone pain and immobility that OA sufferers experience gets WORSE with NSAID use. This could be partly because of the NSAIDs themselves, disrupting the healing functions of the body, and partly because the root cause of joint degeneration is not being dealt with (diet, lifestyle, genetics, stress, injuries, etc.). Additionally, OA patients’ cartilage actually uptakes more of the drug than healthy cartilage, which multiplies the effects of tissue breakdown. That’s clearly a huge problem.

Back in 1998, NSAIDs were responsible for more than 16,000 gastrohemorrhagic deaths and 100,000 hospitalizations each year. That means that these people had deadly and/or emergent bleeding of the stomach and esophagus.  In 2005, an estimated 139,000 Americans who took Vioxx suffered serious complications including stroke and heart attack; between 26,000 and 55,000 Americans died as a result of taking their Vioxx prescription.

Geez. So now what?

How about asking your doctor about some alternatives to drugs? Focused nutrition, exercise and stretching, water intake, stress-reduction, chiropractic or naturopathic manipulation, acupuncture, and so on, are items to take into consideration. I want to talk a little bit about nutrition, since it’s so powerful a tool. There are a lot of baby steps that one can take to improve their overall health and pain status, and nutrition is one that is completely within one’s own control.

Cutting out all processed foods (artificial, refined, in a box, bag, package, or altered from its natural state) is a fantastic start for many people. If we think logically about it, there aren’t really a lot of seriously ill, fat, fatigued wild animals because they are eating what they are programmed to eat in nature and they don’t add artificial ingredients to their food. We humans, and our pets in many instances, are ill, fat, and fatigued and just look how we eat! Agricultural and industrial foods take us far from our original design and diet. All we need to do is look around and see how many people are just absolutely, undeniably, visibly unhealthy.

If we examine the evidence, we can see that carbohydrate-rich foods common to agricultural societies aren’t easily found in nature and they are expanding the size of our population. But are all these people healthy? Carbohydrate reduction can reformat our bodies to reduce unnecessary inflammation and transform metabolism to be more efficient. Many people are finding that a well-formulated ketogenic nutritional approach is beneficial for chronic illness and pain. It isn’t just a fad; this way of eating has been around since the pre-agricultural beginning of time and it is a way to make the body burn fuel more efficiently and reduce/modify all of the markers of chronic disease. It isn’t for 100% of the population, but it really works well for most people, and it must be done properly. In my next blog post, I will nerd out and break down how this diet works with human digestion and biochemistry. I’ve been eating this way for most of the past 15 years, so I’ve got my own anecdotal evidence and I’ve seen the research, the pitfalls, and the victories. I want to stress that if you’re thinking of trying ANY dietary strategy, you must consult your doctor – please know that I’m not making any recommendations here. 

Some final thoughts: Longterm use of NSAIDs, whether over-the-counter or prescribed, appear to lead to joint destruction, chronic illness, gastric ulcers, and death in some cases. A whole-foods diet rich in natural fats, greens, above-ground veggies, and moderate in protein, game meat, wild fish, and offal, has shown to be excellent for pain reduction and longevity.

More to come on the ketogenic nutritional approach…


  2. Singh G. Recent considerations in nonsteroidal anti-inflammatory drug gastropathy. Am J Med. 1998;105(1B):31S-38S
  3. Brandt KD. Effects of nonsteroidal anti-inflammatory drugs on chondrocyte metabolism in vitro and in vivo. Am J Med. 1987 Nov 20; 83(5A): 29-34
  4. Prathapkumar KR, Smith I, Attara GA. Indomethacin induced avascular necrosis of head of femur. Postgrad Med J. 2000 Sep; 76(899): 574-5
  5. Newman et al. Acetabular bone destruction related to non-steroidal anti-inflammatory drugs. Lancet 1985;2:11-4
  6. In vitro studies on glucosamine and non steroidal antiinflammatory drugs. Pharmacol Res Commun. 1978 Jun;10:557-69
  7. David J. Graham, MD, MPH, (Associate Director for Science, Office of Drug Safety, USFDA) and 2006 Nov
  8. Paoli A, Rubini A, Volek J, Grimaldi K. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal Of Clinical Nutrition [serial online]. August 2013;67(8):789-796. Available from: MEDLINE Complete, Ipswich, MA.
  9. Moore J, Westman EC. Keto clarity: your definitive guide to the benefits of a low-Carb, high-Fat diet. Las Vegas: Victory Belt Publishing, Inc.; 2014.
  10. Cordain, L. (1999). Cereal Grains: Humanity’s Double-Edged Sword. Evolutionary Aspects of Nutrition and Health World Review of Nutrition and Dietetics,19-73. doi:10.1159/000059677

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s