NSAID what?

NSAIDs - can’t live with ‘em, can’t live without ‘em. Basically says every performance athlete ever.

Well… what are they? NSAIDs are non-steroidal anti-inflammatory drugs. Some familiar names you might see on drugstore shelves are Advil + Motrin (ibuprofen), Bayer (aspirin), and Aleve (naproxen), among others. So, what do they do? Well, you may reach for them if you’re experiencing any swelling or inflammation, have a headache, or looking to relieve some pain to get through regular, daily activities. I know I have in the past. I used to swear by taking two every other hour to reduce the pending inflammation I was bound to experience after class, rehearsals, or a long day at the theater. NSAIDs may be helpful for short-term relief, but what happens when you begin to rely on these over-the-counter drugs for longer than the short term? And what is short-term?

What is inflammation? Inflammation is one of the body’s protective responses to physical trauma or infection.1(5.1) Not only that, it’s a mechanism through which the body begins to repair itself, giving itself space and the necessary materials (nutrients, signaling enzymes, and more) to heal. The cascade of acute inflammation is the body recognizing infection or damage, recruiting cells/materials to the site, eliminating bacteria, and resolving inflammation.1(5.2)

How do NSAIDs work, and what do they do within our bodies? In short, NSAIDs work to stop or inhibit the initiation of the inflammation cascade noted above - from recognition to resolution. What I find fascinating is that the medication doesn’t discriminate between the inflammatory and anti-inflammatory enzymatic activity; both are shut down. Ideally, there would be a balance here so the body can differentiate and initiate the necessary process: inflammation for protection and repair or anti-inflammation to aid in natural swelling reduction.

So… what happens over time? Over time, continued and prolonged use of NSAID medications can throw the body out of whack, potentially unable to think for itself whether it should trigger the cascade of inflammation. That certainly doesn’t seem super helpful. The body could feasibly heal itself if given the appropriate nutrients and the ability for enzymes to signal and activate properly. The natural inflammatory response helps make this happen.

What can you do? If these meds happen to be part of your recovery or physical therapy program to help reduce inflammation along with ice, please don’t stop and continue following the advice of your specialist. If you’re not in a PT recovery program, notice the frequency you’re reaching for this medication. Is it every morning? Before every class, rehearsal, practice, or performance? More often than that?

Then take note of your dietary consumption. Is your diet prolonging inflammation, instigating it, or supporting the reduction of inflammation? Foods to consider that may be contributing to inflammation include, and are not limited to: foods high in saturated fats; red meats; dairy products; foods high in omega-6 fatty acids like corn and peanuts; foods with a high glycemic load like bread/bagels, white rice/grains, cereals, crackers, cookies, and more; and sodas, juices, and “diet” foods + drinks to name a few. Now, of course I’m not saying you need to eliminate these foods from your diet - many are beneficial for performance athletes! I would suggest that performance athletes aim to balance foods high in omega-3 fatty acids, increase vegetables, deeply-colored fruits, whole grains, and cook with anti-inflammatory spices.2(877)

We often hear a diet high in the components listed above referred to as the Mediterranean Diet. What may be confusing is that the Mediterranean Diet does not consist of specific recipes like we see with conventional or popular diets. I like to think of this as a completely unique diet to you that prioritizes yummy foods you find enticing, delicious, filling on physical, mental, and social levels AND includes high levels of omega-3s, veggies, fruits, whole grains, and delicious spices.

Keys to keep in mind when adjusting to inflammation-reducing dietary intake:

• Fats - find a balance of saturated and unsaturated fats. Balance here can be found by balancing fats that come from animal and plant products. Digging deeper to address inflammation, it’s important to specifically balance unsaturated fats: omega-3s and omega-6s. I recommend somewhere between a 1:1-1:4 ratio of omega-3 to omega-6. So for every one gram of omega-3s, there should be 1-4 grams of omega-6s. Yummy omega-3 foods include flax, chia, walnuts, and cold water fish like salmon. Yummy omega-6 foods include most vegetable oils and soy. We can dig deeper into these types of unsaturated fat, but this is the general overview of balance in this category.2(870-871) Other fats you might consider are olive oil, coconut oil, and nuts (not peanuts).

• Carbohydrates - finding a balance of whole and simple grains can be challenging in today’s fast-paced society. But it’s entirely possible and not necessarily time-consuming to get it right. Whole grains provide the fiber that simple grains lack. They also include nutrients that support inflammation reduction, such as B-vitamins, magnesium, zinc, vitamin E, and more! These nutrients are most closely associated with our main lab marker for inflammation: C-reactive protein, and have been shown to help reduce levels of this specific inflammatory marker.

• Fruit + Veggies - These food groups, often looped into carbohydrates, are incredibly high in many, many nutrients that are beneficial for the body in numerous ways, including reducing inflammation. The idea of ‘Eating the Rainbow’ comes in handy as a helpful reminder to mix it up!

• Protein - Specifically, plant-based protein sources like legumes can have the most positive influence on inflammation reduction. An option for balance here is implementing a ‘Meatless Monday’ or a ‘Tofu Tuesday’ to help reduce your consumption of red meat (mainly), poultry, and pork products.

• Fish - Often grouped with fats and protein, fish such as tilapia and salmon are a great source of unsaturated fatty acids. It’s important to be mindful of possible toxins in these fish. Fish is great in low quantities, maybe once or twice weekly. Be aware that overconsumption may increase mercury, lead, and other toxins our body is not as efficient at eliminating.

• *BONUS - Dark chocolate contains numerous antioxidants that are beneficial in squashing free radicals that could contribute to your inflammation!

• Water - I will ALWAYS mention water when it comes to addressing any number of body ailments and balancing nutrient consumption. I could go on and on, but instead I’ll just reference one of my favorite books and send you directly here to buy a copy.

At eMpower performance, I maintain a three-prong approach to wellness. In addition to nutritional considerations, you should also take a peek at how your mindfulness and movement behaviors may contribute to prolonged inflammation.

• Movement - Are you moving on a regular basis? It doesn’t have to be heart-pumping cardio every day, but a walk around the block, 5-minutes of boogie-ing in your living room to your favorite song, or an energetic yoga practice can all be options for movement.

• Mindfulness - Are you taking a few minutes out of your week for breath and intentional/mindful thought? Join my 21-Day Mindfulness Challenge (free for the month of August)? Give it a try!

Sources

1 Pizzorno J, Katzinger J. Clinical Pathologies: A Functional Perspective. Mind Publishing, Inc.: BC Canada; 2012.

2 Rakel D. Integrative Medicine. 4th Edition. Elsevier: Philadelphia, PA; 2018.