August 7, 2018
It's now common knowledge—especially with the plethora of studies out there on the effects of painkillers on kidney toxicity and muscle damage—that ibuprofen, Advil and any other NSAIDs absolutely wreak havoc on your liver, gut, and kidneys.
This is especially true (and quite ironically considering when most exercise enthusiasts time the consumption of these anti-inflammatories) if you consume these before, during or after exercise.
Although studies published since 2005 have investigated the safety of NSAIDs before exercise, a 2012 study turned out to be particularly upsetting and was my first exposure to the idea that popping ibuprofen when my knee was hurting probably wasn't doing me any favors in the health department. In this study, nine healthy and trained men were studied on 4 different occasions:
- Taking a standard dose of 400 mg ibuprofen twice prior to a bike workout,
- Cycling without the ibuprofen,
- Taking 400 mg ibuprofen twice at rest, and finally,
- Resting without ibuprofen intake.
In each case, researchers measured small intestinal damage through monitoring plasma intestinal fatty acid-binding protein (I-FABP). They also measured urinary excretion of special sugar probes, which can determine the amount of gastrointestinal permeability – a sign that the gut is becoming “leaky” due to damage to the gut wall and increased permeability of the gut lining.
So what did the researchers find?
While both ibuprofen consumption and working out both resulted in increased I-FABP levels (reflecting small intestinal injury), levels were higher after cycling with ibuprofen than after cycling without ibuprofen. In addition, gut permeability (“leakiness”) also increased, especially after cycling with ibuprofen, which reflected a loss of gut barrier integrity. The amount of intestinal injury from ibuprofen and gut barrier dysfunction was extremely well correlated.
Based on this study, it can be concluded that exercise slightly aggravates your small intestine, and ibuprofen then turns this into a significantly more serious and risky issue. In fact, I can’t sum it up any better than the researchers, who concluded that “NSAID consumption by athletes is not harmless and should be discouraged.”
So what about the popular practice of taking NSAIDs before rather than during a long event like an Ironman or a marathon to “mask the pain?”
It turns out this has also been researched.
One study found that taking 400 mg ibuprofen four hours before exercise reduced the soreness, but didn’t actually prevent muscle cell injury. This is concerning because it means that the ibuprofen may mask pain, but at the same time can lead to increased risk of injury as you push through muscle damage.
Other studies have found that NSAID use during long events, such as a marathon or triathlon, actually decreases kidney function, which can lead to very dangerous issues during exercise, including a decreased ability to properly regulate your sodium and electrolyte status and your hydration levels. This becomes especially dangerous in the heat, in which there's already a great amount of stress on the kidneys and this extra stress may create a high risk of long-term kidney damage or kidney failure.
One of the most eye-opening studies on ibuprofen use during exercise occurred during the Western States trail running race, a popular and grueling 100-mile race. In this study, runners were split into three groups: a group with no ibuprofen intake, a group taking 600 mg of ibuprofen one day before and on race day, and a group taking 1200 mg of ibuprofen one day before and on race day. (Having a group that was actually taking more ibuprofen allows researchers to see if there is a “dose-response,” meaning whether a more pronounced effect is seen if more ibuprofen is given.)
This study found that both of the ibuprofen groups had significantly higher levels of markers for severe muscle damage, including C-reactive protein, plasma cytokine, and macrophage inflammatory protein, and this effect increased with higher amounts of ibuprofen intake.
Ironically, race time, post-workout soreness, and rating of perceived exertion were not affected by taking ibuprofen, which means that:
- Ibuprofen did not help at all, and…
- Ibuprofen caused significantly greater inflammation and muscle damage compared to not using it at all.
In one of the newer studies on NSAIDs, researchers asked 89 participants in several multiday ultramarathons around the world to consume either ibuprofen or a placebo every four hours during a 50-mile stage of their race. Afterward, they drew blood from the athletes and checked their levels of creatinine (a byproduct of the kidneys’ blood-filtering process and a sign of acute kidney stress). They found that a large percentage of all the participants, about 44%, had creatinine levels high enough to indicate acute kidney injury after running 50 miles.
But the organ stress was particularly high among the runners who had taken ibuprofen, who were about 18% more likely to have an acute kidney injury compared to the racers who took a placebo. In addition, their injuries (based on creatinine levels) tended to be more severe. The researchers theorized that, by inhibiting prostaglandins, the NSAIDs prevent blood vessels from widening. Crimping blood flow to the kidneys might make it harder for those organs to filter the blood.
A second, more recent study backed this up and found that by reducing the production of prostaglandins, NSAIDs change how a body responds to muscular exertion. Researchers looked at muscle cells and tissue from mice that had experienced muscular injuries and compared the injuries to those that often develop during strenuous exercise. The tissue in the injured areas filled with a particular type of prostaglandin that plays an important role: stimulating stem cells within the muscles to begin multiplying to create new muscle cells that repair tissue damage. Afterward, tests in the mice showed that the healed muscle tissue was stronger than it had been before.
This process mimics exactly what should happen when you exercise strenuously—straining and then rebuilding muscle. But when the researchers used NSAIDs to block the production of prostaglandins, they found that fewer stem cells became active, fewer new cells were produced, and the muscle tissue (even after healing) was not as strong and supple. These findings imply that anti-inflammatory painkillers might impair your muscles’ ability to regenerate and strengthen after hard workouts.
Finally, the latest two studies that you can easily go read on your own speak for themselves; ibuprofen keeps you from gaining muscle and also increases your risk of a heart attack:
- Use of anti-inflammatory drugs like ibuprofen inhibit muscle growth by 2-fold in young, healthy individuals.
- Taking common non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for only a week may increase heart attack risk by as much as 50%.
So as you can see, the use of NSAIDs isn’t really a case of “jury’s out.” Just don’t use these things, period. With so many other natural methods out there to control pain or quell chronic inflammation, this seems to be a no-brainer. So in this article, I'll fill you in on the potent alternatives I use to avoid dumping NSAIDs into my body, and how to enhance muscle repair and recovery with natural ibuprofen alternatives.
#1 Natural Ibuprofen Alternative: Fasting
The majority of post-workout sports nutrition recommendations will tell you to shove carbohydrates and protein down your gullet as soon as possible after you finish a workout.
While this has merit in some cases, there is actually quite a bit of evidence that fasting can also have a recovery effect.
In a study on cyclists, three weeks of overnight-fasted workouts increased post-workout recovery capability, while maintaining lean muscle mass, lower body fat, and maintaining performance. Another study on endurance athletes suggested that fasted training may more quickly activate muscle protein translation, especially compared to athletes who had eaten carbohydrates before training.
There are also benefits to fasting for weight training. One study found that subjects who lifted weights in a fasted state had a greater anabolic response to a post-workout meal. In this case, levels of p70s6 kinase, a muscle protein synthesis signaling mechanism that acts as an indicator of muscle growth, doubled in the fasted vs. the fed group. Martin Berkhan, a big proponent of fasting and author at LeanGains.com, has a good take on the possible mechanism behind fasted training adaptations:
“Another way to think of it is that by providing nutrients to the body, exercise is experienced by the body as less of a stressor compared to fasted-state training. No need to adapt or compensate when all is provided for you. A similar phenomenon can be seen with antioxidant intake, where recent studies show that ingesting antioxidants from supplements weakens the body's own response to deal with free radicals created by training. We are making it easy for the body and that may be a suboptimal way to train.”
I personally use fasting in two ways:
- Intermittent daily overnight fast of 12 to 16 hours, leaving me with an 8- to 12-hour daily compressed “feeding window”.
- Weekly or bi-monthly 24-hour fast from dinnertime to dinnertime. To maintain the adequate availability of recovery nutrients during these fasts, I’ll cheat with occasional low-calorie recovery or energy-enhancing nutrients such as essential amino acids, exogenous ketones, minerals, a multi-vitamin and bone broth.
A word of warning: I've found from my experience in nutrition consulting that for extremely lean individuals with low essential body fat stores, people prone to eating disorders, and women who deal with adrenal fatigue or hormonal imbalances, the risks and stresses of fasting outweigh any benefits. Learn more about how to safely fast by getting Kion's free fasting guide, Fasting Decoded, here.
#2 Natural Ibuprofen Alternative: Anything Collagen-Related
Every time my wife makes bone broth from a whole chicken, which she does about once a week (her recipes are all inside her Healthy Home Workshop package, by the way), I have her leave the bones in a whole extra day. I then take the bones, put them in a cast-iron skillet, dose them in extra virgin olive oil and a dollop of gelatin skimmed from the top of the bone broth, sprinkle in a little sea salt, black pepper, and turmeric then finally add some Vitamin C from the squeeze of an entire fresh lemon.
I then eat my way through the entire pile of bones, usually dipping them in a good stone mustard, chewing the knuckles off, sucking the marrow out, and foraging the entire giant steaming hot pile of savory goodness like some kind of an ancient Viking.
Why? Simple: with this tactic, I get enormous doses of collagen, glycine, and gelatin.
Studies have verified in both human and rodent models for pain, repair and absorption that a dose of collagen, at as little as 1-2g a day can produce a significant improvement in joint comfort, and that subjects with the greatest joint deterioration -and with least intake of meat protein in their habitual diets -benefited the most. (Read that sentence again my plant-based diet friends!) On a related note, a systematic review concluded that hydrolyzed collagen has a host of positive therapeutic effects on osteoporosis and osteoarthritis, is protective of cartilage, and decreases pain.
Then there's glycine. Glycine is a major component of collagen and is linked to collagen synthesis and growth. Us mere humans can only synthesize 3g of glycine a day, but yet up to 12g is required to be able to satisfy all the body’s needs for collagen synthesis. Listen to this podcast by my friend Chris Masterjohn to learn why humans have this seemingly disabling deficit.
Finally, when it comes to the combination of the gelatin from the bone broth and Vitamin C from the lemon, one recent study showed a 100% increase in exercise-induced collagen synthesis with this combo. Another paper showed that Vitamin C is an essential part of skin health too, acting as both a small molecular weight antioxidant and as a critical factor for collagen synthesis.
#3 Natural Ibuprofen Alternative: Magnesium Lotion
In the article “Why I Slather My Body With Magnesium Oil After Every Hard Workout,” I delve into the science behind transdermal magnesium therapy, and the notoriously poor absorbability of magnesium powders and capsules compared to a topical application (here's the latest study that shows the superiority of topical vs. oral magnesium).
Problem is, magnesium oil makes the sheets “sticky” when you sleep, and it stings quite a bit if it touches any open wounds or cuts—and I'm certainly often covered with both due to obstacle course racing, hiking, and hunting.
Enter magnesium lotion.
The stuff I use is made by “Ancient Minerals.” It is formulated for even the most sensitive of skin and designed to deliver magnesium through the dermis, directly to the cells, where it can relax muscles and combat calcium build-up from muscle micro-tearing. Contaminants in seawater make finding a pure magnesium source tough, so the source used in this lotion is from something called “Zechstein Minerals,” which sounds like some kind of Nazi military food but is apparently a very pure source of magnesium.
In addition to 185 mg of elemental magnesium in each teaspoon, it also contains organic plant moisturizers like coconut oil and shea butter, which soothe and hydrate without leaving your skin feeling waxy or greasy. It is fragrance-free and does not contain any formaldehyde-releasing preservatives.
After a tough training session or race, I simply put about a quarter size dab into my hand and put that amount on one leg, then do the same thing for the other leg, both arms, and my low back. It goes right through the skin and directly into the muscles. Not only does this approach seem to help folks who tend to get non-exercise related nighttime leg cramps, but anyone who has raced an Ironman, a Hurricane Heat, a century cycling race, or any other long event knows that one thing that keeps you awake at night afterward are your legs, abs and/or arms twitching and cramping, and this also keeps that from happening.
Finally, if you really want to take your magnesium application to the next level, you can also try the following 1-2-3 combo to drive the lotion even more deeply into the tissue. I learned this trick from former podcast guest and Tour de France recovery specialist Jeff Spencer. See the video below, in which I'm using ice, a MarcPro and magnesium lotion.
#4 Natural Ibuprofen Alternative: Cryotherapy
Cryotherapy is the treatment of injuries or inflammation via exposure to cold temperatures. While cryotherapy can get extreme (whole-body cryotherapy chambers can plummet to -200˚F!), there are much simpler and less expensive ways to engage in cold exposure.
I personally favor cold water immersion since it is easier to do and also triggers the mammalian dive reflex, provides hydrostatic pressure from the water and ultimately beats out cryotherapy chambers (although, admittedly, any form of cold-water therapy does require one to get wet and re-do hair and makeup).
I use some form of cryotherapy nearly every day, particularly in the form of a morning and an evening cold shower, a daily dip in the cold pool behind my house and a long history of many swims in frigid lakes, rivers and seas, which I consider to be a muscular and nervous system “reboot.” The benefits of cryotherapy include an enhanced immune system, increased cell longevity, reduced levels of inflammatory molecules and, of course, an incredible tolerance for running outdoors in the cold and performing snow angels in your underwear.
Cryotherapy stimulates the sympathetic branch of the autonomic nervous system by inducing a hormetic stress response. A hormetic stressor is any light or mild stressor (like exercise) that stimulates a beneficial adaptive response, so you come out stronger than you were before. When you experience cold, the sympathetic nervous system (your “fight-or-flight” nervous system) kicks into gear to preserve your core body temperature. Blood vessels in your extremities constrict, restricting blood flow so that the temperature of your internal organs doesn’t drop. As a result, your heart rate increases to pump blood where it needs to go, and your lungs breathe powerfully and deeply. The result is a boost to your sympathetically controlled cardiovascular system and an overall improved recovery process.
There are many ways to get the benefits of cryotherapy. One way to maximize the effects of cold exposure and heat exposure is to use hot-cold contrast therapy. Hot-cold contrast therapy is alternating exposure to hot and cold water or temperatures. Once a week, regardless of my training load or recovery status, I personally do a hot-cold contrast session in which I swim, tread or move in my AquaFitness pool, which I keep at 55 – 60˚F, for 8 minutes, soak in my hot tub, which I keep at 104˚F, for 2 minutes, then repeat this cycle for a total of 30 minutes.
You can simulate this session by taking a 5-minute shower and alternating between 20 seconds of cold water and 10 seconds of hot water 10 times through, sitting in a sauna for 5 to 10 minutes then jumping into a cold shower for 2 minutes and repeating for 20 to 30 minutes, or taking a 20-minute hot magnesium salt bath followed by a 5-minute ice-cold shower. The simplest solution? Just take a quick 1- to 2-minute cold shower at the beginning and end of each day.
If you don't have a cold pool or cold tub setup, I tell you how to set up for yourself in nitty-gritty detail here.
#5 Natural Ibuprofen Alternative: Sulfur-Rich Foods
Ever smell a rotten egg? That's a sulfur-rich food. It is one of the most abundant mineral elements in the human body, coming in at around 140 grams for the average person. Sulfur is involved in hundreds of physiological processes, including the formation of the disulfide bonds that give strength and resiliency to hair and skin; taurine synthesis for proper functioning of the cardiovascular system, muscles, and the central nervous system; and perhaps most importantly for recovery, the synthesis of glutathione, one of the body's premier endogenous antioxidants.
But you don't need to eat rotten eggs to get sulfur.
Sulfur is found in methionine, an essential amino acid found in meat, eggs, and cheese. It's also found in cysteine, an amino acid found in pork, poultry, eggs, and milk. But when I'm recovering from a hard workout or race, my body simply doesn't seem to function as well when being forced to digest complex, protein-rich foods, so I'll often instead opt for oodles and oodles of sulfur-rich vegetables (which don't just contain the sulfur that animal meats do, but also more potent groups called “organosulfur compounds“).
What qualifies as a sulfur-rich vegetable?
Any and all fibrous non-leafy green vegetables that steam well and emit that distinctive, rotten-egg-ish odor usually contain decent amounts of sulfur, including brassicas like cabbage, broccoli, cauliflower, Brussels sprouts, bok choy, and related vegetables, and alliums like onions, shallots, garlic, and leeks.
For example, a variety of garlic sulfides have been shown to protect your body from peroxidative damage and increase glutathione activity in the liver. Sulforaphane, an organosulfur compound found in broccoli, cabbage, Brussels sprouts, and cauliflower, inhibits mitochondrial permeability and reduces oxidative stress by increasing glutathione activity.
A sulfur-rich salad from a salad bar like this might contain:
- Roasted cauliflower
- Roasted broccoli
- Red onions
- Roasted garlic
- Steamed cabbage
- Roasted brussels sprouts
- Avocado chunks
- Black rice noodles
- Olive oil
- Chopped walnuts
- Good salt
- Black pepper
Sulfur is also important for modulating the Nrf2 pathway. One of the most important anti-aging pathways in the body is that of the Nrf2 transcription factor. Nrf2 is responsible for unzipping and exposing genes that encode for the expression of antioxidant proteins that protect against oxidative damage. Activating Nrf2 switches on a host of antioxidant pathways, increases glutathione production and can even trigger the expression of an anti-aging phenotype. A phenotype is an observable characteristic that results from the interaction of the surrounding environment (including food) with an organism’s genes. So the stimulation of an anti-aging phenotype results in an increase in expression of genetic factors in a living organism that help to combat the effects of aging, such as enhanced detoxification pathways.
As you now know, glutathione acts as a powerful antioxidant within the mitochondrial matrix, and the other antioxidants that result from Nrf2-induced transcription also benefit the mitochondria in a similar manner.
If you are familiar with sulfur (hydrogen sulfide or HS2), you may know it only as a poisonous gas that smells all too much of rotten eggs and flatulence. But HS2 is also a signaling molecule. Brace yourself: we’re about to wade through some thick scientific terminology. HS2 causes the formation of a disulfide bond between two cysteine residues: cys-226 and cys-613. The resulting compound deactivates what are called keap1 ubiquitin ligase substrate adaptors. When these adaptors are activated, they cause a chain of events that suppresses Nrf2. So by deactivating these adaptors, HS2 creates an environment in which Nrf2 can act freely and allow the transcription of powerful antioxidant genes.
One of the best ways to increase the activation of Nrf2 factors is to – you guessed it – consume a lot of sulfur. So fill your diet with plenty of sulfur-containing foods from the Brassica family, which includes bok choy, broccoli, cabbage, cauliflower, horseradish, kale, kohlrabi, mustard leaves, radishes, turnips, and watercress. Each of these is also high in isothiocyanates, a potent cancer-fighting agent. These, along with sulfurous and stinky eggs, onions and garlic, contain sulforaphane, an HS2-containing compound. Another Nrf2-activator is curcumin, found in turmeric, the primary spice in Indian curries. Broccoli sprouts, which can be purchased, kept in your freezer, and added to smoothies, are a quite potent sulforaphane-containing superfood. According to my friend Dr. Rhonda Patrick, freezing and blending broccoli sprouts appears to be an excellent way to increase sulforaphane availability, and can give a 3.5x yield!
#6 Natural Ibuprofen Alternative: Ground & Walk
Even if I'm blistering, hobbling, limping and teeth-grittingly sore after a hard squat and deadlifting day or a race like a triathlon or a Spartan, I still go out of my way to walk (often thousands and thousands of steps) the day after a hard, muscle-damaging event.
Sure, the first few steps usually suck, bigtime, but then after that, things get easier. Blood begins to flow. Lymph fluid begins to circulate. The heart begins to pump.
One study found that grounding yourself to the earth, or “Earthing,” might help relieve delayed onset muscle soreness (DOMS). When walking barefoot on beach sand, close to or in the water and on dewy grass, free electrons in the ground that are called “negative ions” transfer into your body through the soles of your feet. These free electrons are some of the most potent antioxidants known to man, and experiments such as those discussed in the documentary and book that my friend Dr. Mercola talks about here have shown exposure to negative ions from the ground and earth can decrease pain and inflammation, improve sleep and make your blood less viscous – all good news if you're worried about clotting and soreness after a tough event.
In addition to the ground itself, a couple of other potent sources of negative ions include the air you breathe when you are walking next to moving water such as waterfalls or the ocean and the gases released by plants and trees and sunlight (even through the clouds)—so a walk outdoors on the beach or in a forest is actually a perfect recovery tactic.
There are even special sandals I wear called “EarthRunners,” which are equipped with carbon lacing and carbon plugs built into the bottom of the sandal. Unlike rubber-soled shoes or sandals, this type of grounding footwear conducts negative ions from surfaces like sand, concrete, grass, roads, blacktop, etc. and straight up into your feet, while still allowing you to walk around shod (e.g. not looking like a hippie barefoot caveman).
For more about grounding, you should listen to the Clint Ober podcast, here.
#7 Natural Ibuprofen Alternative: Deep Tissue Work
No matter where I am at in the world, whether the coffeemaker is in the hotel room or the lobby, whether I have to be on stage speaking in an hour or my flight arrived at 3 am the evening prior, or it’s snowing, sleeting or sunny outside, I always set the chronograph on my stopwatch to 15 minutes and spend at least 15 minutes “making my body better.”
This usually involves using the same tried-and-true stretching or deep tissue mobilizing routines I do at home.
As a matter of fact, I have a few such routines in my back pocket that I can do anytime, anywhere in the world, including:
- 15 minutes yoga warriors and sun salutations.
- 15 minutes of ELDOA stretches.
- 15 minutes foam rolling and deep tissue work.
- 15 minutes arm swings, leg swings and calisthenics.
- 15 minutes walk with deep nasal breathing and box breathing.
In addition to these 10-15 minutes of body care that always include some component of fascial “mashing” and mobility work, when I'm at home, at least once per week, I complete an entire metabolic mobility routine for 45-60 minutes, usually on a Wednesday morning, and often for a bonus weekend session. The video here shows exactly what I do.
I also try to get a massage like this once every one to two weeks. It sucks and it hurts but it works wonders for keeping my body aligned and moving well (and I recently came across the app “Soothe,” which easily allows me to hunt down a massage therapy just about anywhere in the US and get them to come to my condo, hotel or anywhere else).
Why do I do all this seemingly masochistic bodywork?
You can read my entire brain-dump on the importance of maintaining supple connective tissue and fascia here, along with the extreme importance of deep tissue work to help one recover from tough workouts or races.
But when I'm traveling or stuck in a hotel room during a conference or after a race, and since I pack light, I often don't have access to the entire suite of medieval torture devices that I do at home.
So what do I do instead?
I get creative.
- The corners of dumbbells or kettlebells at the average hotel gym can easily be used to dig into the sides of your hips or sore shoulders…
- A water bottle like a Nalgene can be wrapped in a sock or item of clothing and used as a roller for the calves, forearms, sides of hips, low back, hamstrings, hip flexors, IT band, quadriceps, etc…
- Tennis balls, softballs, and lacrosse balls can be used to dig into your neck, the back of your shoulders, your hips, etc. and golf balls are perfect for the feet…
- Rocks, the corners of park benches, flagpoles, etc. at an outdoor park setting can also be used on hips, backs, the undersides of knees and more…
So get creative. Remember Baloo the Bear from the Jungle Book cartoon, who rubbed his back incessantly on a tree? Be like that. You don't necessarily need to pack a massage therapist and a giant foam roller in your suitcase.
- Anything Collagen Related
- Magnesium Lotion
- Sweat & Shiver
- Sulfur-Rich Foods
- Ground & Walk
- Deep Tissue Work
When you implement these methods—and especially if you combine them all into one mighty routine—you'll bounce back much, much faster and feel much, much more happy and pain-free after a tough workout, an injury, surgery, or difficult crucibles like a Spartan race, Ironman, bike race, marathon, Crossfit WOD or anything else that seems to absolutely crush you.
This translates into extra days available for training, playing sans soreness with family, knowing you're not going to get a blood-clot flying or driving long distances after a hard training block or race, and beating back the chronic repetitive motion and inflammation-related injuries that often rear their ugly heads after your body has been through the grinder.
Do you have questions, comments or feedback about anything in this article, or your own recovery tips or natural alternatives to NSAIDs? Leave your thoughts below and I promise to reply!