I’ve been keeping tabs on running and the use of ibuprofen since hearing a rumor years ago that downing the popular painkiller before a run was hard on the kidneys. Gretchen Reynolds reported in a New York Times column, “Phys Ed: Does Ibuprofen Help or Hurt During Exercise?” (September 1, 2009) (http://well.blogs.nytimes.com/2009/09/01/phys-ed-does-ibuprofen-help-or-hurt-during-exercise/) that athletes who used ibuprofen shortly before or during strenuous running (the study was done during the Western States Endurance 100 Miler) showed signs of mild kidney impairment and endotoxemia, a condition in which bacteria leak from the colon into the bloodstream. That development sounded particularly bad, and I largely abstained from ingesting ibuprofen before running.
I imagine that for many runners, the context of the study gave them some necessary leeway to continue taking ibuprofen. These were ultramarathoners, after all; who knows how many ibuprofen they were taking during a 100-mile race? When you’re running 100 miles in one go there are probably a whole lot of bodily issues – to put it mildly – that might contribute to endotoxemia and kidney impairment. Ominously, however, Reynolds pointed out in 2009 that enthusiastic ibuprofen use was not limited to ultramarathoners and that it appeared athletes were increasingly using it as a prophylactic. According to the researchers that Reynolds cited, ibuprofen was not shown to reduce soreness in runners who took it ahead of time and it did nothing to lessen the perception of pain during competition. Additionally, ibuprofen works by inhibiting the production of prostaglandins, which are crucial in creating collagen, the building block of most tissues. So, those who take ibuprofen before and during a run are actually reducing the training stimulus by undermining the body’s creation of the collagen necessary to repair tissues and strengthen bones. Remember, that the stress of the training stimulus creates microtears in muscles that when they repair after rest, come back stronger. It is clear that ibuprofen undermines the relationship between stress, damage, repair, and strengthening. There are, of course, other training problems that undermine the repair phase of training – namely overtraining and lack of rest (oh, snap).
Is the idea that runners are popping ibuprofen before runs with as little forethought as they might use to lace up their shoes, or that the pills are thought of as candy or “Vitamin I,” an accurate assessment of what is going on in the running world? I have been at several races where I have witnessed runners passing out numerous ibuprofen pills and joking with each other about how many they needed to consume that morning. I have a feeling that ibuprofen abuse might be widespread among runners and that we need to start heeding the warnings.
Why am I blogging about this now? Well, in this morning’s New York Times, Gretchen Reynolds reported on a follow-up study in “For Athletes, Risks From Ibuprofen Use” (http://well.blogs.nytimes.com/2012/12/05/for-athletes-risks-from-ibuprofen-use/?smid=fb-share) that provides good evidence that endotoxemia is not limited to ultramarathoners popping ibuprofen like candy and that seventy percent of endurance athletes use ibuprofen in the mistaken belief that it will help them train harder and recover faster – it won’t. The recent examination of ibuprofen’s effects on endurance athletes used male athletes riding stationary bikes. Test subjects took 400 milligrams of ibuprofen the night before, as well as the morning of, a one-hour stationary bike ride. On other days, the same test subjects didn’t take ibuprofen, or they scrapped the bike ride. When researchers assessed the results, it was clear that when the men rode and ingested ibuprofen, there were much greater signs of intestinal leakage than when they biked without ibuprofen or had ibuprofen without exercising. Researchers’ concluded that a year of regular ibuprofen use in conjunction with exercise could result in compromised intestinal integrity, and that there were no legitimate reasons to use it before exercise and that there were several good reasons to avoid it. I really don’t like the sound of endotoxemia.
Keeping an eye on this issue for the last several years, as well as some anecdotal evidence gleaned at various races, convinces me that all runners, not merely masters runners, need to be much more thoughtful when reaching for the painkillers, particularly when using them as a prophylactic. There’s good evidence that they are doing almost the opposite of what they think they are doing. I would further argue that soreness is a necessary part of the training stimulus and that ordinary soreness is part of being a runner and that it might actually indicate that your body is rebuilding collagen and is strengthening itself. If you take away the soreness, you are, ultimately, undermining the benefits of the training stimulus. That’s my take on the issue. What do you think?