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Non Steroidal Anti Inflammatories (NSAID’s) and Natural Alternatives

What are they?

Aspirin, Advil (ibuprofen), Motrin (Ibuprofin), Nuprin (Ibuprofen), Ibuprofen, Naprosyn, Feldene, Butazolidin, Indocin, Clinoril, Ansaid, Indomethacin are just some of the most common medications in the treatment of pain, the next most common being acetaminophen ( Tylenol).

How do they work?
They inhibit an enzyme called cyclooxygenase which converts cell membrane – bound arachidonic acid into prostaglandins,(PGE1, PGE2, PGE3), throboxanes and prostacyclin ( collectively known as prostanoids ). NSAID’s inhibit all of these. PGE 2 has the ability to sensitize nociceptors ( pain receptors ), and ultimately result in the experience of pain.

The PGE inhibition occurs at the site of inflammation. An anti aggregation effect on platelets occurs due to inhibition of thromboxane synthesis. Aspirin inhibits granulocyte adherence to damage vasculature, stabilizes lysosomes and inhibits macrophage migration into the site of inflammation.

Side effects

Unfortunately the ‘good’ prostaglandins are also inhibited. The therapeutic dose varies among individuals, but is generally 2,600 – 4,000mg/d for aspirin, 800-3200mg/d for ibuprofen, 550 -1650mg for Naprosyn. These doses are also associated with well researched side effects:

  • 10,000 – 20,000 deaths a year occur in the US alone from NSAID ulcer complications. The risk of serious upper gastro-intestinal bleeding with using NSAID’s is between 200 – 500% greater compared to non users. According to a 1999 study in The New England Journal of Medicine, if these figures were tabulated singularly, they would represent the 15th most common cause of death in the USA. These statistics do not include the use of over the counter NSAIDS. Research doctors call this the ‘silent epidemic’ with many doctors and patients unaware of the problem.
  • Acceleration of bone destruction in hips ( osteoarthritis of the hip), that’s right, NSAIDS accelerate degeneration.
  • Interference in the metabolism of articular cartilage and repair of bone.
  • PGE’S also include Omega -3 fatty acids which are anti inflammatory, these ‘good fats therefore get inhibited; thereby increasing inflammatory conditions by altering ratios of omega 3’s to omega 6 (bad) fats.
  • The increase of a myocardial infarction ( heart attack ) with NSAID use was between 35-50%, (averaged 40%), in a 2006 Finnish national study, the largest population –based observational study so far on cardio risks of NSAIDs. The risk of increased heart attack came on after just one day of use. They concluded that the risk to the population was serious because they are primarily taken for NON – life threatening  reasons.

Common questions

    • What about Acetaminophin ( Tylenol )?

This product is also anti pyretic ( decreases temperature), inhibits prostaglandins, and is anti inflammatory. The most common side effect is Liver damage, increase in liver enzymes, as it reduces glutathione, one of the bodies most important free radical scavengers, and its most powerful anti-oxidant. Kidney damage can also occur with long time usage. Therapeutic doses are 325 -500mg 4x/d.


Chiropractic care

The State of Oregon Evidenced based Guidelines for low back pain recommend spinal manipulation as safer and more effective than the above drugs.

Doctors studying the effect of spinal manipulation, medication and acupuncture for pain lasting greater than 3 months, sometimes averaging pain over 8 years old, ( chronic pain), found that 27% had symptoms completely resolve following 9 weeks of chiropractic treatment. 47% reported improvement in health and no side effects. This was far superior to both acupuncture and medication. Spine Journal, 2003.

The AHCPR ( American Health care Policy and Research Center) in 1997 produced guidelines for all general practitioners in North America stating that spinal manipulation was the most effective form of intervention for back pain. It not only saved money on less drugs and surgeries, but provided faster relief and cut down hospital stays and ER admissions.

Recently, in 2017, both the CDC, ( Center for Disease Control ), and The American Academy of Physicians, have endorsed Chiropractic care, along with exercise, cognitive therapy and acupuncture (biopuncture), as the first line of treatment for neuro-musculo-skeletal ( nerve-muscle-joint) problems in the wake of the opioid drug epidemic in the U.S. ( See our facebook page for more information on that), stating that they have a better track record of arresting these problems instead of just prescribing drugs.

Natural Supplements

Boswellia extract from Boswellia Serrata tree. A quality extract ( such as MediHerb’s liquid Boswellia or tablet of Boswellia Complex ) will inhibit Leukotrienes, ( pro-inflammatory molecules similar to PGE 2 ‘s ). The Boswellia Complex contains Tumeric, which is a natural PGE 2 inhibitor, WITHOUT side effects. ( See also our blog post on bioavailable Tumeric ). Below is a table of results over 7 months of patients taking a Boswellia Serrata extract and a potent prescription NSAID Cox 2 inhibitor Valecoxib ( Bextra ): Note, that after 5 months of use, Boswellia ALONE outperformed the prescription Cox 2 inhibitor.

At 6 months both were discontinued for 1 month. Interestingly, the Boswellia patients still had decreased pain and stiffness levels, while the COX 2 INHIBITORS PAIN THRESHOLD STARTED TO INCREASE. THATS RIGHT NSAID’s WILL MASK THE PAIN from inflammation in some cases. Boswellia significantly reduces pain and stiffness at 2-3 months, in my own clinical experience.

Boswellia’s action is increased by a factor of 5 when ingested with fats. Fish oils, advocado’s, eggs, etc., will all increase the therapeutic effect of Boswellia. Concurrent intake of fats will also improve Tumeric absorption, on average, by around 30%.

Boswellia Complex also contains Celery seed. This supports the body in fighting inflammation, and in particular, in helping to decrease uric acid levels. Ginger is also included for its anti inflammatory benefits. While we have several Boswellia products, The combination of the 4 ingredients in the Boswellia Complex, listed above, create a powerful synergistic effect on supporting the body to reduce inflammation. We also have Boswellia preparations with White Willow Bark and Devils Claw, and also with Glucosamine Sulphate. The doctor will determine which is the best/most appropriate for your own personal circumstance, which will differ from one person to the next, based on your own unique clinical needs, even if you have an ‘ identical Diagnosis ‘.


Fish oils are another natural anti inflammatory. More precisely, omega 3 fats. We can measure these as part of lab panels that we do on patients. There are specific ratio’s that will reflect our w-3 ( good fats) ratio to our w-6 ( inflammatory fats )…..Have you ever wanted to know what yours is? There are numerous studies on these; most notably, the work of Jeffrey Maroon, M.D. with the Pittsburg Stealers NFL Football team…He was able to show a significant relationship with decreased inflammation and injuries in the playing staff, using high doses of fish oils, while significantly reducing their reliance on NSAID’S, so furthering their sporting performances. We have several types of Fish oil; supplements, in both capsule and liquid forms, which do not contain mercury and do not have a fishy taste!

Some people, if they are inflamed enough, cannot immediately handle fats, due to poor gallbladder and liver health. In these cases, we work to support these organs to work at a higher level, so that essential fatty acids can be introduced into the body. ( they are called essential fatty acids because our body does not make them, thus, we need to eat them.).


An anti -inflammatory diet is one that steers away from pro-inflammatory foods and involves large amounts of phytonutrients from many vegetable sources. Increasing vegetable fiber for just 7-9 servings a day drastically decreases inflammatory processes in the body. We provide coaching in these, should you wish to use one. We also have purification programs which are focused on significantly decreasing stress on the body, while feeding large amounts of phytonutrients in, to facilitate body system cleansing, and promote restorative function.

A good rule of thumb is to decrease your sugar consumption, that of processed foods, junk beverages and high levels of caffeine ( coffee/energy drinks). Some people are sensitive/ allergic to milk, wheat, soy, eggs, etc. These sensitivities and/or allergies will drive up inflammation in the body and act as a handbrake to proper healing. We can identify these sensitivities/ allergies, and provide guidance in replacing them in the diet, without it being overwhelming; oftentimes, we are able to re-introduce them when inflammation levels have decreased, after a period of time.

Try to eat a raw vegetable with each meal. Use any excuse to get vegetable fiber into the body….try to get different colors in, as far as fruit and vegetables are concerned.