There has been a heated debate over many years within the bodybuilding community about whether anti-inflammatory medications like ibuprofen (Advil, Motrin) and naproxen sodium hinder muscle growth. These medications inhibit the synthesis of prostaglandins, which also play a role in muscle synthesis. All it took was one clinical study published in the Journal of Clinical Endocrinology and Metabolism to put bodybuilders into a panic about reduced protein synthesis, and it didn’t matter that such results were found in laboratory rats. While there is some evidence to suggest that the anabolic signal is shut off when anti-inflammatories circulate in the bloodstream, nothing is absolutely conclusive, and what might be seen in the rat model might not necessarily be the case for humans.
While I will never advocate chronic use of painkillers and anti-inflammatory agents, I think they definitely serve a purpose when acute injury is present. When I find myself in the middle of disputes with bodybuilders who INSIST that a few days on such medications will completely destroy all their efforts in the gym, I simply shake my head in frustration. If you are injured and your lifting is adversely affected by the injury, whether it be a muscle strain, a ligament tear, or a minor disc herniation, you need to be aware that training through that injury, especially when it deranges your form and causes other body parts to compensate for the injury, will end up really messing you up over time. I honestly think that a minimal decrease in muscle mass over the course of a few days is preferable to the imbalance and asymmetry which usually occur when a bodybuilder foolishly pushes through heavy workouts despite an injury which has a domino effect on the body.
Common sense, and medical expertise, dictate that the inflammation must be removed from the area, most commonly through short term administration of anti-inflammatory agents, ice, and rest. Trust me, if you follow a regimen like this, you won’t lose all the muscle you have built over the years. Be sure to take these medications with food, and if you have any history of gastric ulcers. bleeding disorders, or kidney dysfunction, avoid taking them. Remember that I am talking about DAYS, not weeks or months. This is one time when eating constantly has its benefits, since bodybuilders and fitness people can pretty easily fit in their medication administration with one of their meals. I know it’s difficult to back off from training, but if you truly want to HEAL, you must give the injured area time to repair itself. If you insist on continuing to train through the injury, especially, without any medications or other interventions on board, you can count on the injury either lingering or worsening over time.
Lately I have been in CONSTANT pain from inflammation in my neck, shoulders, elbows, wrists, hips and ankles which has me creaking like the Tin Man from the Wizard of Oz. I wouldn’t mind it so much if the pain patterns were completely predictable, but there have been days when the pain has shifted from one side to another. No amount of massage or adjustment seems to calm things down either. Granted, I have not been as diligent about taking my daily supplements due to almost two weeks of international travel which threw my daily routine off track in a big way. Now that I am back in the States for a while now, I plan to get back into my daily rhythm which will hopefully cause most of my aches to abate.
As a result of the pain I was enduring, I had a massage last week while in Bali. It was an amazing deal at 120,000 rupiah (about $10 U.S.) for a full hour of shiatsu massage, so I jumped on it. What I had forgotten was that shiatsu massage can hurt like a mother^%#@$* due to its focus on trigger points and deep pressure. I was writhing in pain for the entire hour, but figured I needed the torture. Usually if my patients experience deep massage, I will tell them to take arnica or ibuprofen for the next 24 hours to address inflammation, but since I am a doctor (and doctors really DO make the worst patients), and also since I had no access to anti-inflammatory agents, I tolerated the pummeling I got and simply hydrated as much as I could. The next morning, I was in so much pain that I could barely walk, and I couldn’t turn my head at all. Stretching was almost impossible because my range of motion was terrible. Thankfully, my range of motion increased gradually as the day progressed and my muscles warmed up.
After dealing with such intense discomfort for a while now, I think I will take my own advice and resume my daily intake of antioxidants, glucosamine, and turmeric. For those of you who may also be feeling like a poorly oiled tin man, you might want to follow suit.
Most people love nuts, especially those of us in the fitness industry who will actually fantasize about the calorie dense morsels. Since I usually take a stance from the fitness end, I want to explore one very popular nut as well as another which had until recently been considered more forbidden. Meet the peanut and the cashew.
Peanuts have become popularized by baseball stands, candies which feature them, and clever labeling on peanut butter jars which, through their colorful and whimsical labels, have won great favor by children and adults alike. The problem with consumption of large amounts of peanuts and peanut products is that androgen dominance develops, which is closely tied to inflammation and insulin resistance. Individuals who are more sensitive may find that they have more acne breakouts when they consume peanuts, peanut oil, or peanut butter. So in a sense, peanuts can wreak some hormonal havoc on the body.
In contrast, cashews may be considered a hormonal ally. Cashews contain compounds referred to as anacardic acid which has a demonstrated anti-estrogen effect in which it blocks the activation of estrogen receptors once they have attached to estradiol. Anacardic acid also kills hormone sensitive breast cancer cells in vitro and may have a beneficial effect in human subjects. If you consume one half cup of cashews, you will ingest approximately 20 milligrams of anacardic acid. The jury is still out on how much of an impact the anti-estrogen effect has, but it certainly won’t hurt either.
By no means am I suggesting that you eliminate peanuts or peanut products from your diet (provided you aren’t allergic to them). But if you consume excessive amounts of peanuts and are noticing that you are suffering from acne breakouts, the peanuts may be the culprit. You might want to stop eating peanuts for a couple of weeks to see if your skin clears up. If you simply cannot live without a nut butter, you can consume almond butter or cashew butter as an alternative. If you have any interest in blocking estrogen through consumption of key foods, adding cashews to your meal plan may be just the boost you need to balance estrogen levels.
Over the years, numerous medical studies have explored the idea that ibuprofen interferes with muscle growth, with conflicting conclusions. I know that there are some weightlifters who will take ibuprofen on a daily basis to combat numerous pain issues so that they can lift more comfortably, but this is something I would NEVER recommend. As a physician I am well aware of ibuprofen’s remarkable ability to shut down acute inflammation, but I am also aware of the risks of taking high dose ibuprofen over an extended period of time. I think it is also important to bear in mind that 1) there are different types of inflammation found in the body, and 2) some inflammation is actually necessary for optimal muscle growth.
The reason why I broach this subject is that I also know people who lift who stubbornly refuse to take ibuprofen under ANY circumstances, stating that it isn’t worth the impaired muscle growth. These people could be in agony from a muscle strain, bursitis, arthritis flare-up, tennis elbow or any number of conditions which arise from localized inflammation, yet will refuse to take anything. I will see them at the gym, struggling to move the weight that they are accustomed to lifting, only to cut their lifting regimen short or sharply reduce the weight lifted. Some of these people are so intent on pushing through the pain that they often make things WORSE and have to stop training completely until their injuries subside. Now that is just stupid. It makes far more sense to tackle the acute inflammation systemically with ibuprofen and rest the area for a few days so that one can return to full capacity, rather than risk even greater injury which essentially forces one to stop training.
I recently dealt with a bone spur which asserted itself with such exquisite pain that I was unable to bear weight fully on my left foot for 4 days. Instead of being stubborn and refusing to take anything, I took 800 milligrams of ibuprofen twice a day with food for a week. I also refrained from doing any high impact moves which would aggravate my foot and wore flat shoes for a week. Within the first 2 hours of taking the first dose of ibuprofen, I went from feeling like I was stepping on a knife to walking with only a slight limp. Was I concerned about adversely affecting my body’s ability to build muscle? Certainly not. Healing was my primary concern. Besides, there would have been no way that I could have trained the way I normally do while dealing with such outright pain, so it made sense to shut down the inflammatory process which was causing all the discomfort in the first place by taking the dreaded ibuprofen. I was smart about how I took it, and I did not take it for an extended period of time. Thankfully, it was a successful therapeutic treatment and I am glad I did it.
With all this said, I am still very cautious about prescribing high dose ibuprofen. The effects on the gastrointestinal tract are significant, so it is imperative to eat when taking this medication. I also caution people against taking too many doses throughout the day. A very real example occurred with a friend who was apparently taking high doses of ibuprofen (600-800 mg 4 times per day) without food for severe daily headaches. This practice resulted in a peptic ulcer which bled enough to cause her to pass out twice, landing her in the emergency room.
For those of you who have a habit of taking ibuprofen chronically, even if you are only taking 200 or 400 mg at a time, I highly recommend that you discontinue such chronic use. It is best to reserve ibuprofen for acute flare-ups.