Ibuprofen: Benefits and Risks

Discussion in 'Health & Fitness' started by Ramon, Nov 14, 2012.

  1. Ramon

    Ramon Hall of Fame

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    I read an interesting article from a tennis newsletter on Ibuprofen:

    http://www.active.com/nutrition/Articles/Hope-or-Hype-Ibuprofen-A-K-A-Vitamin-I.htm

    It basically explains that the mechanism that results in an anti-inflammatory effect also inhibits enzymes that promote repair and muscle building. The author recommends taking Ibuprofen for acute pain but not as a regular supplement to avoid soreness after exercise. I recently had an acute shoulder injury, and I found Ibuprofen to be helpful to get me through competitive matches, but I don't plan to take it regularly once it starts to feel better.

    Any thoughts?
     
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  2. ollinger

    ollinger Legend

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    Do a search and you'll find many reasons to use as little of it as possible. It clearly inhibits healing, might increase the risk of injury such as tendon rupture, tends to increase blood pressure (which goes up in any event during exercise, so further increase can be harmful), and so on. About the only benefit I'm aware of other than reducing pain (which can be done much more safely with moderate doses of Tylenol) is that ibuprofen used daily may reduce the risk of Alzheimer's dementia (which is now felt to have an inflammatory component associated with the amyloid deposition in the brain).
     
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  3. charliefedererer

    charliefedererer Legend

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    Use as little ibuprofen as possible!


    Ibuprofen masks pain, allowing players to continue to abuse their bodies.



    There once was a theory that ibuprofen could prevent joint damage by decreasing inflammation. No evidence for that theory has been produced.

    Instead, many more suffer worse muscle/tendon/ligament/joint injuries because ibuprofen masks the pain that should have warned players to stop playing.
     
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  4. Itagaki

    Itagaki Semi-Pro

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    Part of the problem is the usual recommended dosage for ibuprofen is completely analgesic, wont do **** for inflammation.

    According to a dentist friend, anything less than 2400mg/day is going to do squat for inflammation. This is about the prescription level of ibuprofen (800mg 3x daily). I've seen some recommendations of taking 3200mg/day for 5 days straight, then going off it completely to actually affect the inflammation. This is of course accompanied by rest
     
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  5. rufus_smith

    rufus_smith Professional

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    I'm in the health professions and the article is a little misleading when it seems to support "inflammation" as a healing mechanism that should not be thwarted by ibuprofen. I can guarantee you too much inflammation is a bad thing for your joints and tendons. Any a high pain or swelling needs to be reduced as soon as possible to prevent tissue damage. Ice packs are a safe way to reduce it but are not practical for long periods of time. Ibuprofen will can be quite helpful when used properly.
     
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  6. charliefedererer

    charliefedererer Legend

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    Can you cite any study that proves your theory?
     
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  7. charliefedererer

    charliefedererer Legend

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    Can you cite any study that proves your theory?
     
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  8. Itagaki

    Itagaki Semi-Pro

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    Well it's certainly not my theory

    But unfortunately no, i've only taken the statements at face value from those that had experience dealing with it. Never cared to do the research myself.

    However, I'm fairly confident that prescription strength ibuprofen tablets are 800mg and usually prescribed to be taken 3-4 times daily
     
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  9. charliefedererer

    charliefedererer Legend

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    The reason I asked is that I have done literature searches multiple times to try and find one human study that shows taking high dose ibuprofen has had a demonstrable effect on ANY disease or injury.

    I have not found any.

    I have asked the question many times here, and no one has provided such a study.




    There is a move afoot in medicine termed "evidence based medicine".

    It is aimed to try and separate out theoretical benefits of treatments [even if having some degreee of sound scientific basis] from those that have actually been "proven" in a reasonable study.


    So far, I believe that the widespread belief that high dose ibuprofen has beneficial effects for inflammatory processes has yet to be proven.

    Indeed, the studies done so far, even in inflammatory diseases such as arthritis, have not shown a change in the underlying disease process.



    Could it possibly be that there are so many inflammatory pathways involving so many different types of mediators and cytokines, that interruption of just one of these pathways [cyclooxygenase] by ibuprofen does not have a clinical effect?

    [​IMG]

    Ibuprofen does NOT interrupt the inflammatory cycle at multiple points like steroids do.

    [​IMG]






    Now I won't dispute that ibuprofen is a powerful medication with morbidity and mortality associated with it's cardiac, renal and hepatic side effects.

    But is precisely because the multiple severe side effects are so well documented that the burden of proof ought to show that ibuprofen is effective in treating the underlying process enough to demonstrate a documented change in the condition that is supposedly treating.
     
    Last edited: Nov 14, 2012
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  10. Itagaki

    Itagaki Semi-Pro

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    Hmm, that's actually very interesting to me. Is there any anti-inflammatory medicine that has been proven effective? Especially OTC drugs I.e. Naproxen, aspirin etc
     
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  11. charliefedererer

    charliefedererer Legend

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    No.

    I edited my above post to show some of the other multiple inflammatory pathways.

    Cyclo-oxygenase inhibitors like ibuprofen and naproxen only inhibit the following pathway:

    [​IMG]


    Although that is not to say that the cyclo-oxygenase pathway does not potentially have demonstrated physiologic functions in multiple organs.

    [​IMG]
     
    Last edited: Nov 14, 2012
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  12. coolblue123

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    #12
  13. charliefedererer

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    ^^^ Glad to hear you got some help from this forum.

    Hope that ankle is healed. It sounds like a nasty injury.
     
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  14. cluckcluck

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    My wife and I talked about this just the other day. She said during exercise is bad to take Ibuprofen because it can easily damage the liver. I don't recall exactly what she said but now I only take it after a hard match/practice if I need it.
     
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  15. ollinger

    ollinger Legend

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    ^ Not sure what your wife is referring to, the more important effects are on the kidney, thus the problem with blood pressure.
     
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  16. rufus_smith

    rufus_smith Professional

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    #16
  17. Chotobaka

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    Correct. Ibuprofen, when used at high doses or for extended periods of time, can effect the kidneys. Acetaminophen may effect the liver when used in the same fashion.
     
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  18. Ramon

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    Wow! I didn't know Ibuprofen had those kind of risks. It also seems that every other pain killer has risks too.

    Any opinions on which pain killers have the least amount of risks and side effects?
     
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  19. Bowtiesarecool

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    Mari juwana?
     
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  20. charliefedererer

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    The first "study" had only 9 patients! 9 people is a starting team in baseball, but it is not a real study.
    Still, it is interesting that there was no improvement in joint stiffness, or grip strength with ibuprofen - only with the steroid prednisolone.
    [By the way using a steroid in the study was a bad idea - the effects of the steroid can last for several weeks after a course, thus it is hard to make conclusions about the patients that received steroids before getting the ibuprofen, aspirin or lactose.]
    Yes, ibuprofen did relieve some pain compared to placebo - but no more than aspirin (no Tylenol was used in the study.)
    My point above is that ibuprofen has not been shown to objectively change signs of inflammation, like joint stiffness or or grip strength.
    It is a fairly good pain reliever - but many patients are told that ibuprofen is effectively decreasing the inflammation and therefore lessening the damage caused by the underlying disease.
    This tiny "study" does not show that.


    The second paper you cite is a review with no data being provided.

    I was really hoping you had something to back up your post:
    "I'm in the health professions and the article is a little misleading when it seems to support "inflammation" as a healing mechanism that should not be thwarted by ibuprofen. I can guarantee you too much inflammation is a bad thing for your joints and tendons. Any a high pain or swelling needs to be reduced as soon as possible to prevent tissue damage. Ice packs are a safe way to reduce it but are not practical for long periods of time. Ibuprofen will can be quite helpful when used properly."

    That is, that you have some information that shows that ibuprofen is effective in decreasing inflammation in joints and tendons.

    (I have never doubted ibuprofen is a pretty good pain reliever.
    But as this is a tennis health and fitness forum, the widespread belief that ibuprofen can decrease the inflammation in joints and tendons after injuries I still believe has never been proven.)
     
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  21. Topaz

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    I'm currently in nursing school, and have started to avoid ibuprofen because of all the side effects I keep reading about ...especially with kidneys.

    If you do take it, drink lots of water with it.
     
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  22. charliefedererer

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    Tylenol (acetaminophen) is generally regarded as the pain reliever with the least risk, as long as dosing is strictly adhered to.


    Here is what the review article on ibuprofen that rufus_smith says:

    "Adverse Reactions

    NSAIDs are widely used, frequently taken inappropriately and
    potentially dangerously.64 Nevertheless, ibuprofen exhibits few
    adverse effects.65
    The major adverse reactions include the affects
    on the gastrointestinal tract (GIT), the kidney and the coagulation
    system.66
    Based on clinical trial data, serious GIT reactions
    prompting withdrawal of treatment because of hematemesis,
    peptic ulcer,67 and severe gastric pain or vomiting showed an
    incidence of 1.5% with ibuprofen compared to 1% with placebo
    and 12.5 % with aspirin.68 Ibuprofen was a potential cause of GI
    bleeding,69,70 increasing the risk of gastric ulcers and damage, renal
    failure, epistaxis,71-74 apoptosis,75 heart failure, hyperkalaemia,
    76 confusion and bronchospasm.77
    It has been estimated that 1 in 5 chronic users (lasting over a long period of time) of NSAIDs will develop gastric damage which can be silent.
    78
    Other adverse effects of ibuprofen have been reported less
    frequently. They include thrombocytopenia, rashes, headache,
    dizziness, blurred vision and in few cases toxic amblyopia, fluid
    retention and edema. Patients who develop ocular disturbances
    should discontinue the use of ibuprofen.34
    Effects on kidney (asvwith all NSAIDs) include acute renal failure, interstitial nephritis, and nephritic syndrome, but these very rarely occur. 27"
    - http://www.omjournal.org/ReviewArticle/PDF/201007/RA_AnOverviewofClinical.pdf

    The above review also goes through a long list of medications that ibuprofen had interactions with.



    Still to be fair, for someone relatively young and healthy, ibuprofen may be a reasonable medication to take for pain relief.

    Severe side effects are much more common in those taking fairly high doses for an extended period of time.

    I have to admit that many years ago I was much more likely to take a couple of ibuprofen if I felt sore from tennis or a work out.

    I don't think I have taken ibuprofen or any pain medication for at least 5 years. I probably am lucky, but I just don't get that sore, or have much pain.

    (1 hour hitting session Firiday; 2 hour hitting session Saturday followed by two sets of doubles; 2 hour hitting session Sunday followed by 4 sets of singles; 3 hour hitting session Monday; squats, deadlifts, bench press yesterday; 1 hour hitting session today + serve practice followed by Thrower's Ten and accessory exercises like bent over rows and lat pull downs.)



    I am also willing to bet that for those suffering from acute bouts of pain, or long term painful conditions, that many consider ibuprofen a godsend.
     
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  23. Cindysphinx

    Cindysphinx G.O.A.T.

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    If Ibuprofen is only a pain reliever and does not decrease the inflammation in joints after injury, could someone explain why my joints feel better *for days* after I ingest 3 tablets of ibuprofen? I do not get this sort of relief from regular painkillers like Tylenol.

    I dunno. When I was struggling to regain knee strength many months after meniscus surgery, my OS sent me back to PT but this time put me on an anti-inflammatory also. The anti-inflammatory seemed to control the inflammation just enough for me to get through the exercises without a flare-up. Once I had regained enough strength, the muscles supported the joint better and I didn't need the anti-inflammatory. Today, my knee is 100%.

    Just sayin' . . .
     
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  24. Cindysphinx

    Cindysphinx G.O.A.T.

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    Oh, wow. I think Tylenol is more dangerous than ibuprofen. My husband does pharma work, and he is of the opinion that Tylenol probably couldn't even get approved today because of liver toxicity. Once your liver is fried, you are fried.
     
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  25. FastFreddy

    FastFreddy Semi-Pro

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    When I jacked up my neck my Doc told me to take 1200mg every 4 hrs for 5 days.
     
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  26. Topaz

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    And once your kidneys are done...you're done as well.

    Liver tissue actually can regenerate to a degree. Not so for your kidneys.
     
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  27. Nostradamus

    Nostradamus G.O.A.T.

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    Studies show that motrin taken for competitive or otherwise exercise reasons for just 3 times a week can have harmful effects. Hypertension and other cardiac issues. Kidney damage is mostly on older people with already existing kidney problems.
    Stomach ulcers can happen to anyone who uses it regularly even if it is just once or twice a week. also motrin inhibits healing mechanism after exercise damage.
    so no motrin for the purposes of preventing or treating some minor aches and pains after a tough tennis match. Ice pack or 1 hour long Message is better way to go.
     
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  28. Mick3391

    Mick3391 Professional

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    Do something I don't do, REST. If it's "Acute", sanity would say rest, but you like me probably won't, if so just take the Ibuprophen, take Tylenol also, you'll survive.
     
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  29. Cindysphinx

    Cindysphinx G.O.A.T.

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    I suppose if you decide to take something, you have to pick your poison. Part of the trouble with Tylenol is that it is easy to overdose, and it is easy to forget that you cannot drink alcohol.

    ***************************

    FDA continues to receive reports of severe liver injury associated with the use of products that contain acetaminophen.

    Sandra Kweder, M.D., deputy director of FDA's Office of New Drugs, says the agency's most recent action is aimed at making pain medications containing acetaminophen safer for patients to use.

    “Overdoses from prescription products containing acetaminophen account for nearly half of all cases of acetaminophen-related liver failure in the U.S., many of which result in liver transplant or death," says Kweder.

    Most of the cases of severe liver injury occurred in patients who

    took more than the prescribed dose of an acetaminophen-containing product in a 24-hour period
    took more than one acetaminophen-containing product at the same time
    drank alcohol while taking the drug
    “There is no immediate danger to patients who take these combination pain medications and they should continue to take them as directed by their health care provider,” says Kweder. "The risk of liver injury primarily occurs when patients take multiple products containing acetaminophen at one time and exceed the current maximum dose of 4,000 milligrams within a 24-hour period.”

    **********************

    http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm239747.htm

    So if you have a beer after your match and then take a couple of Tylenol when you get home, you could have a problem.

    I personally consider ibuprofen safer. YMMV.
     
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  30. coolblue123

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    Thanks for the wishes. Just got healed. Took 9 monthes and killed my tennis season this year. It sucked goat ashes. But could be worst. Was on a boot for 4 months. I think if I didn't take Ibuprofen and just took fish oil only it may of healed faster.
     
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  31. TCF

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    =================================
     
    Last edited: Dec 11, 2012
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  32. El Diablo

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    liver damage occurs sometimes when people take enormous overdoses of tylenol. I routinely see people in the hospital who don't get liver damage after taking an entire bottle of 60 pills, so it is not inevitable even in the most extreme circumstances. The medical community generally considers tylenol safer than ibuprofen if both are used sensibly.
     
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  33. LuckyR

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    Ibuprofen, though Over The Counter, has risks as many have posted and should NOT be taken chronically or as many used to do, prophylactically. On the other hand it is not poison and it is perfectly reasonable to take on occasion for moderate aches, often associated with activities like tennis.
     
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  34. Cindysphinx

    Cindysphinx G.O.A.T.

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    Well, OK. I'm not a medical professional. But I have heard the opposite. I actually know someone who tried to kill herself by taking a bottle of Tylenol. Didn't work. And her liver is fine.

    But there are also reports of people developing liver problems off of unremarkable doses. It's a Russian Roulette thing to some extent. You can't know if you are susceptible to liver damage from Tylenol until it is too late.

    Maybe there are idiosyncratic reactions to Ibuprofen also, I don't know but would assume so.
     
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  35. Topaz

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    Ibuprofen toxicity to kidneys is well documented.

    And anyone with any kind of gastric disease or complication is immediately contraindicated for ibuprofen (and NSAIDs in general).

    We had a patient who took 25 Unisom. She lived. Doesn't mean its a good idea!!!

    If you want to avoid Tylenol because you are concerned about what it does to your liver, fine. (do you also not drink alcohol?) But don't embrace ibuprofen thinking it is so much safer than Tylenol. Not quite so.

    Ironic that nursing school has made me not want to every take any medications. Ever again!
     
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  36. Ramon

    Ramon Hall of Fame

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    Ibuprofen's side-effects sound similar to Aspirin. I don't see as much Aspirin on the drug store shelves as I used to see. Is Aspirin worse?
     
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  37. 5263

    5263 G.O.A.T.

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    Not really, as Vitalzym is a blend of enzymes (enzymes mentions in OP)
    that reduces inflammation in a healthy natural way. I've shared it with several
    Players TE and it has always helped with 2-3 days.

    Anyone have comments for plain ole asprin?
     
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  38. ollinger

    ollinger Legend

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    ^^ Ummm, you may have heard that enzymes are polypeptides (proteins), so that if you swallow them they are simply digested in your stomach into individual amino acids and are not distributed in your body as intact enzymes. Thus a swallowed enzyme cannot possibly have effects elsewhere in your body, such as on muscles or tendons.
     
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  39. ollinger

    ollinger Legend

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    (p.s. -- this is at least the third thread -- healing injuries thread, ibuprofen thread, BP thread -- where you mention this Vitalzym garbage. It is nonsense. If peptides could be swallowed and remain intact, diabetics could merely swallow their insulin instead of having to inject it. I suspect snake oil would be more useful than what you're hawking here.
     
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  40. Cindysphinx

    Cindysphinx G.O.A.T.

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    Heck, yeah I drink alcohol!! If Tylenol were as delicious and mood-altering as alcohol, I would drink that too!

    That said, I eschew medications of all kinds. By the time you get to be 50, people have pushed all kinds of drugs on you "for your own good." We are no longer using drugs to treat disease. No, now we take all sorts of pills to deal with "risk factors."

    Me, I'm not having it.
     
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  41. Avles

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    Ollinger,

    These appear to be some peer-reviewed studies on oral enzyme supplementation:

    http://www.clinexprheumatol.org/article.asp?a=2784
    http://www.springerlink.com/content/eyfkrjvwy720ca45/
    http://www.hindawi.com/journals/ecam/2008/970128/abs/

    I'm not qualified to judge the studies on their merits, and perhaps the supplements in these studies are totally different from the product 5263 is mentioning.

    But it seems strange to me that this sort of research would even exist if oral enzyme supplementation were as blatantly and inherently useless as you appear to be claiming.

    If basic biology tells us that oral enzyme supplementation can have no effects elsewhere the body, why are scientists studying its effects?
     
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  42. Fee

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    Ibuprofen for menstrual cramps (400 mg at a time, usually only one dose necessary) and Tylenol/Caffeine/Aspirin for my migraines once or twice a month. Hot showers for sore muscles and if it's really bad, a trip to the Foot Massage place nearby for a $35 massage (fingers crossed I get someone good).

    I have also become very pill adverse. My mother had something like ten prescriptions before she died (horrible diet that she refused to change and never exercised at all), and my father has five or so now, but he's 82 so he gets a bit of a pass. I hate taking pills, even my chewable multivitamin.
     
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  43. ollinger

    ollinger Legend

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    1) you cite two human studies and a rodent study. Neither human study has a placebo group. This is generally considered unacceptable in studies of pain control because both "active " medications may have placebo effects that can be considerable in subjective scale studies like these. We can't tell from these studies whether a placebo would have caused the same degree of symptom relief.
    2) both studies are sponsored by drug companies; in fact, in one of them the authors thank the drug company rep for design and data analysis of the study!! What you need to know about drug companies is that they reserve the right to publish or not publish a study they pay for. So they may have commissioned 20 identical studies done by different groups, with 19 of them being unpublished and showing no benefit and this published one showing possible benefit.
    3) in the rutin study the authors point out that the enzyme is quickly metabolized to homovanillic acid (a dopamine metabolite) and other products. They profess they have no idea why an enzyme would work. Why are such studies done, you asked? Because the companies that make the product pay people to do them.
    4) the rodent study is irrelevant as rodents have very different GI tracts than we, and may for example absorb some peptides directly from the roof of the mouth, for example.
     
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  44. ollinger

    ollinger Legend

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    5) we haven't even touched on the appropriateness of the statistical data analysis. Several studies of large swaths of the medical literature indicate that somewhere between 50 and 85 percent of PUBLISHED medical studies lack adequate statistical power analysis to definitively prove that there is a difference between the study groups. I don't have the expertise to do this, but I didn't see mention of statistical power analysis in the citations.
     
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  45. Avles

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    Ollinger,

    As I said, I wasn't trying to defend these studies' results -- only asking why scientists would be conducting studies that seemed to fly in the face of basic biological principles as articulated in your post.

    Your answer to this question seems to be that drug companies will pay people to study any implausible thing if they think it will help their bottom line, that medical researchers will gladly take their money and study the implausible things, that the drug companies can (and do) essentially tamper with their results by only permitting helpful studies to be published, and that "peer-reviewed" journals will obligingly publish these bought-and-paid-for study results.

    That's a pretty distressing thought!
     
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  46. ollinger

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    ^^ Absolutely. When I ran the clinical psych research ward at Mt. Sinai (NYC) many years ago we took on a few relatively minor drug company studies that we weren't very interested in. (The vast majority of our research was federally funded by NIH and the VA). We, and pretty much everyone else, would do this because the money allowed us to hire extra research assistants who would spend some of their time on the drug company stuff but could also be used some of the time for the real research we were interested in. So it was a way to fund more of the research you really wanted to do.
    Not everything in peer reviewed journals is any good. Read the financial disclosure sections in major journals and your head will spin. And read "The Truth About the Drug Companies" by Marcia Angell (former editor-in-chief of The New England Journal of Medicine). Among other shocking disclosures, she describes published drug company studies that were entirely fabricated, made up from thin air.
     
    Last edited: Nov 17, 2012
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  47. Avles

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    Fair enough--

    I guess the appropriate response to this state of affairs is to rely on the most reputable journals, and to focus on meta-analyses to avoid being led astray by marginal results.

    Seems to me that the situation as you characterize it calls for some pretty significant self-policing (or additional government regulation) in the medical research community...
     
    #47
  48. ollinger

    ollinger Legend

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    I tend to rely on certain major landmark studies, usually collaborations between many institutions and usually NIH funded, such as the STAR-D study of antidepressants and the CATIE study of antipsychotics. I think those are pretty dependable.

    The government has not been entirely passive about all this. Recent regulations require drug companies to "publish" all studies they fund regardless of outcome, but not in journals -- they have to set up a website where all results can be archved. So the data presumably can be found, but one has to go searching for it.
     
    #48
  49. 5263

    5263 G.O.A.T.

    Joined:
    Mar 31, 2008
    Messages:
    10,396
    you are right...sort of, but shows how a little understanding misleads.
    First, they are coated to allow for body's functions. One coating is taken on
    an empty stomach, followed by a 8oz of water to dilute and wash on thru to
    deeper into the system. Another coating makes the empty stomach not as important.

    All the theory in the world is fine, but when it comes to real world application,
    I've had amazing results with many inflammation injuries like TE. At least 10
    players helped within days and none not helped, along with several other of
    these type injuries. One player kept complaining about his TE for months and
    went to the doc as well...no help. I told him not to complain to me anymore
    because I had told him how to fix it. He relented, gave in, and tried it. He was
    better in 2 days and well in 4; totally amazed after months of pain.
    I am sure nothing is Fail Proof, but results with this have always impressed me.
    Just sharing a good product. I don't sell or have any stock/interest other
    than giving the best tip I have found.
     
    Last edited: Nov 18, 2012
    #49
  50. ollinger

    ollinger Legend

    Joined:
    Nov 24, 2004
    Messages:
    5,907
    It sounds sillier to me each time you try to explain it. The smallest known enzyme has 62 amino acids. The GI tract has mechanisms for absorbing chains of generally 2 or 3 amino acids. None of these facts is altered by coating anything or flushing it with water (the latter usually DECREASING absorption of most things).
     
    #50

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