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Natural Pain Killers: NSAID Alternatives

Q:  Tracy, what do you recommend to your clients who need routine over-the-counter pain medication?  Are there natural alternatives that really work?  And what’s the difference between drugs like Tylenol and Advil and Aleve?  I have heard that these are actually much more dangerous than we think, but I am not sure I can explain well enough to my clients why that is.  Thanks!

A:   I am sure we are all going to encounter clients who have a need for daily help with managing pain (and inflammation) while we are helping them to get rid of the root cause.  Unfortunately, we have an unspoken cultural assumption that these over-the-counter medications are safe enough to take daily without pause.  It’s important to make our clients aware, however, that all these drugs are synthetic, foreign substances that the body must process and detoxify.  The entire class of NSAIDs (non-steroidal anti-inflammatory drugs) does some damage in exchange for short-term relief, whether it is in the gastrointestinal tract (as is the case with aspirin, ibuprofen (e.g. Advil), and naproxen (e.g. Aleve)) or in the liver (as is the case with acetominophen (e.g. Tylenol) – even at regular dosage levels for just 2 weeks, liver enzymes are elevated in over one-third of patients).   If you want a simple tool to explain the differences in ibuprofen and acetaminophen, this article is well-written and easy to follow, a good one to share with clients.

More importantly, however, I do think there are natural alternatives without all the side effects of NSAIDs.  In my practice, I frequently recommend curcumin (an excellent clinical overview here).  An ancient spice, turmeric is the bright gold ingredient found in many asian dishes, ubiquitous in curries. If you’ve cooked with it, you’ve experienced the permanent yellow stain it gives anything plastic or wooden.  Excessive intake of whole herb turmeric might increase the risk of kidney stones due to its high content of oxalates.  However, in pursuit of temporary pain relief, we can focus instead on curcumin, a polyphenol component of turmeric responsible for its rich color. It has been used in natural healing for millennia, especially in India and Ayurvedic medicine.  Curcumin has been studied extensively and found to be a powerful antioxidant, antimicrobial, brain protectant, detoxification agent, and anti-inflammatory.  It reduces pain in the body using a similar inflammatory molecule “quenching” that is found in NSAID medications – but without the potential gut-damaging risks.   My clients have used curcumin to reduce inflammation from arthritis, lower back pain, tennis elbow, joint replacement, cancer, infections, auto-immune diseases (e.g. multiple sclerosis), Crohns disease, Alzheimers, diabetes, and depression. Even if your clients  struggle with just occasional achiness after a rough week or an aggressive workout, curcumin can be quite helpful.

But there’s a catch. Not all herb products are the same. To be effective, extracts must be pure and potent. Curcumin is also notorious for being poorly absorbed in the blood stream, with 40-85% of dosage being passed through the GI tract unabsorbed. To ensure maximum efficacy, I recommend a specific formulation of curcumin that is a phytosome. That is, the curcumin is bound to a lipid (fat) molecule. This allows it to be absorbed into our lymph system for greater distribution to our body-wide blood supply. This phytosome is called Meriva, and research shows that the bio-availability of Meriva is about 10 times that of plain curcumin (e.g 500mg dose of Meriva can be as as effective as more than 4000mg of typical curcumin).  Note that Meriva is a trade name and not a brand name, so you find it sold under many brands.  The founding company is Thorne (which sells Meriva without any binders).

I recommend my clients start with a 500mg dose of Meriva twice a day for pain and inflammation, allowing it to build up in their body for 5 days before increasing if necessary to 1000mg twice a day.  The only negative reaction I have ever seen to Meriva is in one person who had an unknown (and unusual) food allergy to turmeric.  I would also be careful to research what detoxification pathways are used by your patient’s medications to ensure there is not an overlap/burden created by using high-dose curcumin that affects the activity of those pathways.  In this case, you would want to use other anti-inflammatory herb options from your toolbox such as bromelain or boswellia.

Another excellent anti-inflammatory food extract is bromelain, found in pineapple stems.  Technically an enzyme, bromelain is well-absorbed in the GI tract and reduces inflammation by reducing the production of bradykinin, an inflammatory mediator that reduces our pain perception threshold.  It has been shown to be particularly useful for joint pain.  It also helps to increase absorption of other herbal remedies (such as quercetin, a natural antihistamine for allergy or asthma relief) and is thus often paired with them in herbal blends.  I recommend my clients start with 250-500mg of Bromelain taken twice a day.  Use the lower end of this spectrum with your clients who have hypertension (Bromelain is also an effective “fibrinolytic agent” meaning it can break down fibrin or other clots in the blood and effectively thins blood).  Also, I recommend you not use it with clients who are taking prescription blood-thinning medications (e.g. Coumadin) without direct doctor supervision.  Again, I know of no common, negative side effects barring outright allergy to the extract itself (or the food it came from – in this case, pineapple).

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56 Questions for “Natural Pain Killers: NSAID Alternatives”

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  1. 24
    Feres says:


    I’m wondering if the curcumin of Designs for Health Curcum-Evail is as effective as the Meriva? It’s also bound to a fat, sunflower lecithin.

  2. 23
    Annie says:

    Would you recommend taking Meriva and Bromelain together? Could you get either of these on prescription?
    Thank you

    • 23.1
      SAFM Team says:

      I am not aware of either of these inflammatory agents being available in a prescription formula of sufficient dosage to be effective. Certainly they *can* be taken together, and their effects can be synergistic. However, the combination is often not necessary with one agent being sufficient on its own. This is another great example of bio-individuality and the need for individuals to experiment to find what works best for them.

  3. 22
    Joan says:

    Hi. You have been so helpful with these others questions. I am 52. I have been on Naproxen for 20 years for Osteodegenerative Arthritis of the hips. My back also “went out” as I call it 5 years ago. No more cartilage as it were left on C4-5. I was a jogger for 30 years and ran it away as it were. Found out after 2 MRIs I have severe scoliosis on my left side also, which was part of it. Never knew I had that. I suffer from Interstitial Cystitis and Vulvadynia.
    I eat very healthy and watch everything I eat to control the IC pain; no citrus, nitrates, soy, etc. I take tons of homeopathic supplements to control the IC pain such as Marshmallow pills, Bromelain, pure Aloe Vera pills, etc. I also take Virgin Salmon oil for my hips, back, etc. I have started on the Tumeric last year. I want to get off the Naproxen, as it was suggested to me to do so for my liver and to take 2 Extra-Strength Tylenols. Not good either. And didn’t work. After a week I could barely walk. The Tumeric I take I gather isn’t strong enough to conquer what the Naproxen does for me. So am wondering if the Meriva and anything else can help with my hip and severe back pain, and won’t trigger any IC pain? And is there anything else that can help? I thank you for your help.

    • 22.1
      SAFM Team says:

      Alas, you have a fairly complex mix off dynamics at play in your body, and this format doesn’t allow us to give professional, case-specific input. The combination of IC and vulvodynia often involves a build-up of oxalates in the body. I recommend you seek out the support of a functional medicine practitioner who can help you to assess your unique needs and, more importantly, help you get to the root cause of them. I wish you the very best of wellness!

  4. 21
    Holly Williams says:

    I have advanced osteoarthritis in my knees and other areas. I have been relying on high doses of Curcumin BCM95 for pain management and have recently started a Systemic Enzyme therapy and overhaul of diet to address possible food allergies. The Curcumin has done pretty well with pain but I have recently read where it could cause anemia in low iron individuals. This has been an issue for me in the past with heavy periods but I am in menopause now and no longer have them. I don’t know if I am currently anemic but have been having some symptoms of it again. I am looking for a suitable alternative to Curcumin that would do as well with the pain without the risk of iron loss.

    • 21.1
      SAFM Team says:

      First of all, I would think of curcumin as possibly exacerbating anemia, but not causing it. If you have a tendency toward anemia, you will want to address that separately as a key focus, separate from curcumin concerns or not. Ferritin is the best marker of iron sufficiency (want at least 50 ng/ml). I would also check serum B12 (ideally at least 650 pg/ml). Suboptimal levels of both of these may have much more to do with suboptimal stomach acid or digestion overall rather than iron-specific issues. There are many substances which can chelate iron in the body, and indeed curcumin can do this as well. In my experience, this is not a big deal except in cases of high dosing. If you are concerned, however, you might consider using boswellia as an alternative to curcumin. Our bodies respond uniquely to various herbs, so you will need to explore this to see if it’s equal/adequate in relief relative to curcumin. I wish you the best of wellness!

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