Wednesday, September 2, 2009

Vitamin I

This article from the New York Times is interesting to me. It should be to you also. In 2006 and 2007, I got Rhabdo during my Wasatch 100 race. Both years I was hospitalized for over a week. Eight people (reported), suffered from this condition after WS100 this year (2009). Erik Skaggs, winner of Wheres Waldo 100k, just got out of the hospital after finishing the race in record time. He has been acutely ill with Rhabdomyolysis suffering with acute renal failure. This is serious stuff, people. We can't live without our kidneys and living on dialysis is no walk in the park. As we say at the hospital regarding life on dialysis, "just shoot me". Seriously, I can't imagine living while on dialysis. That being said, I have totally switched to Tylenol during all my races if I need to take anything.

Phys Ed: Does Ibuprofen Help or Hurt During Exercise?

Dan Saelinger/Getty Images

Several years ago, David Nieman set out to study racers at the Western States Endurance Run, a 100-mile test of human stamina held annually in the Sierra Nevada Mountains of California. The race directors had asked Nieman, a well-regarded physiologist and director of the Human Performance Laboratory at the North Carolina Research Campus, to look at the stresses that the race places on the bodies of participants. Nieman and the race authorities had anticipated that the rigorous distance and altitude would affect runners’ immune systems and muscles, and they did. But one of Nieman’s other findings surprised everyone.

After looking at racers’ blood work, he determined that some of the ultramarathoners were supplying their own physiological stress, in tablet form. Those runners who’d popped over-the-counter ibuprofen pills before and during the race displayed significantly more inflammation and other markers of high immune system response afterward than the runners who hadn’t taken anti-inflammatories. The ibuprofen users also showed signs of mild kidney impairment and, both before and after the race, of low-level endotoxemia, a condition in which bacteria leak from the colon into the bloodstream.

These findings were “disturbing,” Nieman says, especially since “this wasn’t a minority of the racers.” Seven out of ten of the runners were using ibuprofen before and, in most cases, at regular intervals throughout the race, he says. “There was widespread use and very little understanding of the consequences.”

Athletes at all levels and in a wide variety of sports swear by their painkillers. A study published earlier this month on the website of the British Journal of Sports Medicine found that, at the 2008 Ironman Triathlon in Brazil, almost 60 percent of the racers reported using non-steroidal anti-inflammatory painkillers (or NSAIDs, which include ibuprofen) at some point in the three months before the event, with almost half downing pills during the race itself. In another study, about 13 percent of participants in a 2002 marathon in New Zealand had popped NSAIDs before the race. A study of professional Italian soccer players found that 86 percent used anti-inflammatories during the 2002-2003 season.

A wider-ranging look at all of the legal substances prescribed to players during the 2002 and 2006 Men’s World Cup tournaments worldwide found that more than half of these elite players were taking NSAIDS at least once during the tournament, with more than 10 percent using them before every match.

“For a lot of athletes, taking painkillers has become a ritual,” says Stuart Warden, an assistant professor and director of physical therapy research at Indiana University, who has extensively studied the physiological impacts of the drugs. “They put on their uniform” or pull on their running shoes and pop a few Advil. “It’s like candy” or Vitamin I, as some athletes refer to ibuprofen.

Why are so many active people swallowing so many painkillers?

One of the most common reasons cited by the triathletes in Brazil was “pain prevention.” Similarly, when the Western States runners were polled, most told the researchers that “they thought ibuprofen would get them through the pain and discomfort of the race,” Nieman says, “and would prevent soreness afterward.” But the latest research into the physiological effects of ibuprofen and other NSAIDs suggests that the drugs in fact, have the opposite effect. In a number of studies conducted both in the field and in human performance laboratories in recent years, NSAIDs did not lessen people’s perception of pain during activity or decrease muscle soreness later. “We had researchers at water stops” during the Western States event, Nieman says, asking the racers how the hours of exertion felt to them. “There was no difference between the runners using ibuprofen and those who weren’t. So the painkillers were not useful for reducing pain” during the long race, he says, and afterward, the runners using ibuprofen reported having legs that were just as sore as those who hadn’t used the drugs.

Moreover, Warden and other researchers have found that, in laboratory experiments on animal tissues, NSAIDs actually slowed the healing of injured muscles, tendons, ligament, and bones. “NSAIDs work by inhibiting the production of prostaglandins,”substances that are involved in pain and also in the creation of collagen, Warden says. Collagen is the building block of most tissues. So fewer prostaglandins mean less collagen, “which inhibits the healing of tissue and bone injuries,” Warden says, including the micro-tears and other trauma to muscles and tissues that can occur after any strenuous workout or race.

The painkillers also blunt the body’s response to exercise at a deeper level. Normally, the stresses of exercise activate a particular molecular pathway that increases collagen, and leads, eventually, to creating denser bones and stronger tissues. If “you’re taking ibuprofen before every workout, you lessen this training response,” Warden says. Your bones don’t thicken and your tissues don’t strengthen as they should. They may be less able to withstand the next workout. In essence, the pills athletes take to reduce the chances that they’ll feel sore may increase the odds that they’ll wind up injured — and sore.

All of which has researchers concerned. Warden wrote in an editorial this year on the website of the British Journal of Sports Medicine that “there is no indication or rationale for the current prophylactic use of NSAIDs by athletes, and such ritual use represents misuse.”

When, then, are ibuprofen and other anti-inflammatory painkillers justified? “When you have inflammation and pain from an acute injury,” Warden says. “In that situation, NSAIDs are very effective.” But to take them “before every workout or match is a mistake.”


Slomohusky said...

Wow! Thanks for sharing this one as well. I actually do not take anything before/during any training or workout. If I have noticeable pain afterwards thru the day I might take one Aleve. This is good FYI. Reminds me of Kenny Easley. He was a standout Safety for the Seattle Seahawks in the early 80's. Great player whose career was cut far too short due to Kidney problems. He had to go on dialysis. It was determined the cause abuse of Advil dosages. I believe he passed away a few years back as well.

robert.blair said...

From Wikipedia:

Easley was drafted as the fourth overall pick in the first round of the 1981 NFL Draft by the Seahawks where he started in safety as a rookie. He earned AFC Defensive Rookie of the Year honors that season when he recorded three interceptions for 155 yards and one touchdown.[3] In 1983, Easley was selected as AFC Defensive Player of the Year and recorded seven interceptions.[6] In 1984, Easley led the National Football League in interceptions with ten, returning two of them for touchdowns and was named as NFL Defensive Player of the Year. Afterwards he signed a five-year contract with the Seahawks which made him one of the highest paid defensive players in the league.[7] He missed part of the 1986 season for ankle surgery.[8]

Prior to the 1988 season, the Seahawks traded Easley to the Phoenix Cardinals for quarterback Kelly Stouffer.[9] There he was diagnosed with a kidney disease and failed the physical. The trade was soon canceled and Easley announced his retirement a few months later. He filed a lawsuit against the Seahawks, the team trainer, and the team doctors saying that an overdose of Advil for the ankle injury a few years earlier caused his kidney to fail, it was later settled out of court.[10] He received a new kidney two years later. [11

kelly said...

Hey you guys, thanks for the comments. It's good to be an informed runner. It's nice to try and prevent any problems from happening. That's too bad about k.Easley. What a bummer that would be. Tylenol it is, then!

Slomohusky said...

Aren't there some possible liver issues with Tylenol we need to be concerned with as well? Interesting the article pointed out the pain between those taking and those not was the same regardless during/after the run. Maybe that is the answer to it all? Still, I am very sorry you had this Kidney issue after the Wasatch Race. I heard about Erik Skaggs as well. Glad he has been released from the Hospital.

I am enjoying your blog, thanks for sharing!

Thanks robert.blair for all the Kenny Easley info. He was a good one.


Excellent research and information. I am a physio and I really appreciate the work you put into this blog. I'm so glad I don't take vitamin 'I' . I will certainly follow up with your great blog in the future. From wayy up here in Canada.

Team Gangels Runs said...

Tylenol is way more dangerous than Advil.

From Wiki.

While generally safe for human use at recommended doses, acute overdoses (above 1000 mg per single dose and above 4000 mg per day for adults, above 2000 mg per day if drinking alcohol[2]) of paracetamol can cause potentially fatal liver damage and, in rare individuals, a normal dose can do the same; the risk is heightened by alcohol consumption. Paracetamol toxicity is the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia and New Zealand.[3][4][5][6]

kelly said...

Hi Heather, thanks for stopping by my blog. I checked yours out and I love it as well. Maybe Tylenol is not much better. Read Team Gangels Runs blog. (see comments)

kelly said...

Hey Team Gangels, thanks for the information, but what do you recommend using during competition? There have been a few races where I just suck it up and take nothing. What do you take? Thanks.

Slomohusky said...

Maybe I am going out on a limb since I have only done a Full Marathon years ago. I also have never run beyond that mileage. However, the only time I ever had the need to deal with medicating pain issues was post training runs. Which only amounted to one or two Advil or now Aleve (one in one day and rarely at that)in my current training. I have never taken anything while running. Never even thought of it. I think I would throw it up if I did? I guess if I needed - maybe that is a sign I am running too far or hard for my body at any given time. Hence, my body telling me to stop running.

However, I certainly am NO expert. I have run only one Marathon. I certainly respect the ultra distance runners, especially trail ones. In fact, I am in awe with all you doing these distances. However, if you need to take meds like this while running - it seems like you are competing against your own body and yourself in a possible negative way. In a competition that might in the end seriously damage your competitor (your body). However, again I am certainly no expert beyond my own experiences.

Curious - have there been any other recent studies on the overall short and long term health of runners doing distances of 100 miles? If so, what journals, publications, websites have addressed this?

Keep up the great efforts. As I mentioned in awe of anyone doing these distances running. My highest respect and keep kickin!

robert.blair said...

Hi Kelly,

I really hope you read this, and have not already moved on from this post.

Try Traumeel. I get it at Whole Foods Market. Not sure where else it is, or if there is a Whole Food market near you.

Traumeel comes in tablet, gel or cream form.

I first heard about it by reading a post on Will Cooper's website.

(Go to middle right of the website has a link to other ultra runners' blogs, then choose Will Cooper's name from the list. Search on the right of his website to find his Traumeel post).

This has been my experience with Traumeel in training. It does take the edge off the joint or leg pain that sometimes happens to me starting about 3.5-4 hours into a race or long training run.

It does not "take it away" quite as fast or as completely as I think Motrin does, but, as Will Cooper states in his blog, it is much safer than Motrin.

You put a tablet under your tongue and let it dissolve so it goes directly into your bloodstream, rather than what Motrin does, go into your stomach and possibly create problems later with the kidneys, etc.).

I used the cream at about mile 48 of a 62 miler and must say I did not think it was very effective using it that way.

Maybe it was because it had been sitting in a drop bag under the hot sun and became more liquid like, and I was in a hurry to get out of the aid station and did not rub it into my muscles real well. I do not know.

I used the cream again the next morning on very stiff legs, and let me say at that time it REALLY took the edge off. I would use the cream in that instance again.

I have never tried the gel.

In each form it is about $20, but you get like 100 tableta for the $20, so I think it is economical.

I think I read on its packaging a warning to only take at most 3 tablets a day, so its use may be limited. I do not recall how long it lasts when I have used it.

I have continued to use Motrin on occasion during a race or a training run over 40 miles, but since learning of its dangers I do use it much less frequently.

More tips about using Motrin:

If you use it at all, a pharmacist told me to take a Rolaids 5 minutes before you pop the Motrin so that your stomach is prepared for it.

Scott Mills told me when you take the Motrin be sure you drink plenty of water afterwards and eat as well.

When I take the Motrin I only take one capsule at a time, and have never taken more than 3-4 during one day. Some people pop two at a time and maybe that is what gets some folks in trouble.

I would be very interested in learning just how much Motrin Erik Skaggs took, and at what hours during the race. Plus, did he hydrate adequately when he was taking the Motrin? From his story it seems that it was a COMBINATION of taking the ibuprofen AND insufficient hydration.

I am not saying that taking ibuprofen as long as you hydrate well is healthy. I am just saying it may decrease the severity of the risk. I am no doctor, so I have no idea.

I hope this information has been helpful.

Good luck out there, and good luck in all of your races. Take care,

Robert Blair

Team Gangels Runs said...

Hey Kelly,

I take Ibuprofen during 100 mile races. I am not prophylacticly taking it before or thoughout. I have usually taken it around mile 80 when I am really hurting and never more than 400mg every 6 hours.

I think as Robert eluded to, more than likely taking the recommended dose will most likely cause no harm. All of the kidney failure race reports I have read/seen have been a result of large doses (ie. >2400mg in a race). I would also be interested in knowing how much and when Skaggs was taking.

kelly said...

Hey Robert, thanks for the info on Traumeel. I have seen it at Whole Foods, but have never tried it. I will get some next time I am there. Thanks for your input, I do appreciate hearing what others do during racing. I hope you enjoyed the holiday weekend.