Athletes, NSAIDs & Your Gut Health

Updated: 7 days ago

As an athlete or somebody who lives an active lifestyle we have elements in our lives on a daily basis that can affect our microbiome, hormones, organ system and other metabolic processes in a negative way.


Working out regularly comes along with some amazing benefits. We increase our cardiovascular health, add lean body mass (muscle), reduce body fat, have more energy and usually we look and feel better.


Along with those benefits come some downfalls such as sore muscles, injuries, soft issue damage and inflammation which can lead to a lot of over the counter or prescription medicine. Functional medicine addresses the root cause of these problems and in many cases that is simply the daily training, wear and tear on our bodies from being active. But we also have a way of addressing these problems that help avoid medication. The higher level the athlete the quicker NSAIDS are prescribed and in some situations Toradol is injected weekly before games. That is no joke, every injection has an effect on your kidneys and your gut. Studies show that Aleve and Toradol are more aggressive gastrointestinal effects than ibuprofen (Motrin/Advil) or celecoxib (Celebrex) and Meloxicam (1)

Aleve has been shown to significantly reduce choline absorption which is a nutrient needed by the brain. I supplement many of my athletes with choline in the form of acetyl-choline or phosphatidylcholine . The last thing I need if for them to be interfering with choline metabolism.

The same study shows that people who take PPIs (proton pump inhibitors) to help with the heart burn and reflux that they feel from taking NSAIDs have even more damage to their small intestine and microbiome. PPIs can also lead to more cases of SIBO (small intestinal bacteria overgrowth). To add to this, the FDA has a warning out on Toradol which states it can lead to intestinal bleeding and peptic ulcers. They also state " NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use."


Beyond your gut NSAIDs are work through your kidneys. There's cases of Acute Kidney Injury Due to Non-steroidal Anti-inflammatory Drugs. (2)


Some geeky science stuff- NSAID's action is cyclooxygenase (COX) enzyme inhibition, interfering on arachidonic acid conversion into E2 prostaglandins E2, prostacyclins and thromboxanes. These prostagladins are fatty acids that help form the mucosal lining of your gut. This is why we start to see a lot of GI issues. What this means is that NSAIDs stop the enzyme on the COX2 pathway which causes inflammation and pain. GOOD NEWS! We have something found in food which does the same exact thing! Have you heard of fish oils?


Yep! Fish oils work on the COX2 pathway by preventing inflammation. AA (arachidonic acid) is also something that is found in a lot of SAD (Standard American Diets). Not just that, in studies fish oils also have been shown to help with aerobic metabolism, lowering cholesterol and relieving DOMS (delayed onset muscle soreness) You can see my old post on Fish oils to find out more about how fish oils help with inflammation and brain health!


High doses of fish oil 2-4g daily over 30 days lowers pain and inflammation. The difference between taking NSAIDS and Fish oils is that fish oils won't work in 20mins. they have to be in your system for a few weeks. Fish oils are also neuro-protective which makes them ideal for contact sport athletes.


Recently studies show that Curcumin can actually help with pain relief and inflammation for athletes at the time of taking the supplement and could be the better choice for acute pain relief. 1ooomg per day has been shown to help with joint pain.

I could mention all of the pathways that curcumin acts upon to help with pain and inflammation but most of. my readers would be lost. Trust me when I say, if it's an inflammatory pathway, receptor, enzyme or protein- curcumin is coming in to help! It works as an antioxidant (because it comes from a Turmeric plant) and an anti-inflammatory. The downfall of curcumin is that it's not easy for your body to absorb (the bioavailability is low). Some companies have spent a lot of money making a curcumin product that has the highest level of bioavailability and they cost a bit more than the other products on the market. They are worth the price. You never want to waste your money on a cheaper product that your body can't even use. This is why it's important to buy your supplements from a licensed practitioner and not Amazon. Even if you see the same product on Amazon, you don't know the actual source, quality, how it was stored or shipped. You can purchase my favorite curcumin at this link https://us.fullscript.com/protocols/athleats-curcumin


One study suggests that 2 g of curcumin had a pain relieving effect in subjects with acute pain. At this dose, the activity was higher than that associated with 500 mg of acetaminophen. "The analgesic effect of the dose achieved significance only 2 h after administration, similar to that observed for acetaminophen. In contrast, the NSAID was more rapidly acting, with the strongest pain relief being reported one hour after administration but with significant gastrointestinal symptoms. This supports the use of 2 g (higher than needed for inflammation) curcumin for relief of pain as a potential alternative to NSAIDS." (4)


In layman's terms- take 500 mg of curcumin 3-4xs day to help with acute pain relief. Take it daily at 500mg to lower inflammation and pain over a longer period of time.

PROTIP: because curcumin has low bioavailability you can't just buy turmeric and add it to your foods and expect to work. If you do want to try to use shaved turmeric or turmeric powder add a black pepper to the mix to help activate the compounds and a fat. such as coconut milk or coconut oil to help the absorption of the mixture. If you want to try some whole foods over supplements see my recipe for Turmeric Protein Shake here and Coconut Curry Chicken with Zoodles here


IF I HAVE GI DISTRESS FROM NSAIDs WHAT CAN I DO ? If you are somebody who has taken a lot of NSAIDs over the course of your lifetime and already have stomach problems from them we can try to heal your gut lining with a change in your diet and nutraceuticals (natural supplements, herbs, food or parts of a food, that provide medical or health benefits, including the prevention and treatment of disease)

  1. Remove fried foods, eliminate processed foods and oils

  2. Remove inflammatory foods such as gluten, dairy and other foods that cause a reaction in your body

  3. Do a GI-MAP test which is a qPCR DNA stool test that shows us a comprehensive picture of your microbiome including opportunist bacteria, inflammation digestion, detoxification, hormones and more. (we can order, interpret and use these tests to treat you)

  4. Supplement protocol with botanicals


Some of. these supplements include: *every situation is different these are examples of supplements we may use



Over my years of working with active people and athlete other issues I have encountered frequently include :

  • Chronic Heart burn often times due to the timing of eating around training and workouts. And other cause could be low stomach acid. Yes, heartburn can be caused by low stomach acid rather than high and taking acid inhibitors doesn't relieve the problem it can also make it worse. In these cases we may use, DGL, Aloe Vera or a digestive enzyme with Betaine HCL

  • Bloating and gas -could be caused by food intolerances, allergies, low enzymes, stress, slow motility (movement of stomach muscles), SIBO

  • IBS- either as diarrhea, constipation or both. This can also be caused by food intolerance, stress, gluten, autoimmunity or more.

  • Leaky Gut- often caused from excess carbohydrate and sodium consumption with endurance athletes. This is a simple matter of balancing osmolality and can be fixed with a proper fueling and hydration program.

- for constipation be sure to have at least 25g fiber daily for women and 38g fiber for men, magnesium can help with constipation as well as muscle soreness, sleep and recovery.


If you made it this far you can tell that there's quite a few connections between having an active lifestyle and your gut health. At Athleats Nutrition we our speciality is getting to the root cause of you gut problems and helping you treat and heal them while maintaining your active life, playing your sport and reaching your body composition goals. If you would like to set up a discovery call with one of our practitioners who specializes in gut health please follow this link.



additional references:

PMID: 26482265

PMID: 27713300

PMID: 30281062

PMID: 21060672


#guthealth #nsaids #sportsnutrition #curcumin #fishoils #functionalmedicine #functionalmedicinenutrition #fixingleakygut

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