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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