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The Healthiest Water to Drink: Is There Such a Thing?

The science is clear: Staying hydrated and drinking enough water has health benefits.

Hydration can help lubricate and cushion joints, protect sensitive tissues in your body, flush out waste and keep your immune system and even your skin healthy.

Yet when it comes to bottled water, there are several types on the market: spring, purified, mineral, artesian and even alkaline. Is any type best?

It turns out that might come down to personal preference, as more research seems to be needed for a definitive answer.

“For the price, I’m going to get spring water,” said Dr. Eddie Fatakhov, a physician and nutritionist at the Center for Internal and Integrative Medicine in Alpharetta, Georgia. “Because I know it came from the spring.”

Spring, purified, mineral, artesian: What’s the difference?\

Spring water comes from an underground source and must be collected at the spring or through a borehole tapping the spring’s source, according to the International Bottled Water Association.
The association defines purified water as water that has been highly treated – through distillation, deionization or other suitable processes – in order to meet certain standards before being sold.

Mineral water is natural water that has a constant level and relative proportions of mineral and trace elements – containing no less than 250 parts per million total of dissolved solids, according to the water association. No minerals can be added to it.

Then there’s artesian water, which is derived from a well that taps a specific layer of rock or sand.
You also might have seen alkaline water on store shelves; it has a higher pH level than tap water. A pH level is a measure of how acidic or basic water is. Seven is a neutral pH. Higher pH levels are more alkaline, or basic; lower pH levels are more acidic.

“Tap water has a pH of roughly around 7, and alkaline water is closer to about 8 or 9,” Malina Malkani, a registered dietician nutritionist and spokeswoman for the Academy of Nutrition and Dietetics, told CNN in January.

Could alkaline water provide any special health benefits? “There’s really not a lot of evidence either supporting of the health claims that are made about alkaline water or refuting the claims,” Malkani said.

In other words, the jury is still out.

Malkani noted that “if all the body systems are functioning as they should be, the blood pH isn’t going to vary too much. So it’s a misconception that you can, by drinking an alkaline water, drastically affect the pH of the body.”

Illnesses are common causes for changes in the blood pH level. Diabetes can make your blood more acidic, but kidney problems can make it more alkaline. Certain foods, including dairy products, also can make your blood more acidic.

It is more common for companies to manufacture alkaline water, but natural alkaline water can occur when water picks up minerals from areas such as springs, when it passes over rocks in the environment.

“Alkaline compounds are salts and metals that, when added to water, make it more basic,” Malkani said.

All in all, the general consensus among health experts for now is that making sure you are drinking enough water is more important than the type of water you prefer.

The National Academies of Sciences, Engineering, and Medicine recommend that men drink an average of about 3.7 liters (125 ounces) of water each day and that women drink about 2.7 liters (91 ounces). That water can come from beverages and foods, according to the recommendations.

So, for men and women respectively, “that’s 15 cups of water and 11 cups of water, from the eight cups we were taught to believe,” Fatakhov said.

Women who are pregnant or breastfeeding need additional fluids to stay hydrated, according to the Mayo Clinic, which noted that the Office on Women’s Health recommends that women who breastfeed consume about 13 cups of fluids a day.

“North America is dehydrated,” Fatakhov said, and that’s a problem because “83% of your lungs is water. If you take the heart and the brain, 73% is water. If you take the bones, about 31% is water. If you take the kidneys and muscles, about 76% is water. Your body is made up of water.”

‘Water boosts energy’

Water not only benefits your health, it could help you control your weight.

A study published in the Annals of Family Medicine in 2016 found a significant association between not being adequately hydrated and having an elevated body mass index, known as BMI.
BMI is determined based on a person’s height and weight. Having a BMI of 30 or higher is categorized as obese.

The study was based on data from 9,528 people ages 18 to 64, whose levels of hydration were measured in urine samples. Those whose samples showed inadequate hydration tended to have higher BMIs and higher odds of being obese, compared with the hydrated adults.

Water can benefit weight management because staying hydrated helps you better understand when you are actually hungry, and it can boost your metabolism and energy.

“Because of our high water content, it makes sense that our bodies need water to keep our systems functioning. So the next time you hit that afternoon slump, drink a glass of water to increase your energy levels,” Fatakhov said.

“Think about it like this: I tell you to drink water, and you drink water. Your body has to convert that water back to your body temperature. So if you drink cold water, your body has to turn it back to body temperature,” he said. “That’s why they say it’s better to drink cold water than hot water if you’re trying to burn calories.”

If you think you’re not drinking enough water, the US Centers for Disease Control and Prevention offers some tips:
=> Carry a water bottle with you throughout the day for easy access to water.
=> Choose water instead of sugar-sweetened beverages, even when eating out.
=> Add a wedge of lime or lemon to water to help improve taste.
=> Try chilling freezer-safe water bottles for easy access to ice-cold water throughout the day.

CNN Digital Expansion 2016 Jacqueline Howard
By Jacqueline Howard, CNN
Wed March 20, 2019
source: www.cnn.com

glass_water

Top Ten Reasons to Oppose Water Fluoridation

There are many reasons to oppose water fluoridation, including safety concerns and health risks.

Reason #1 to Oppose Water Fluoridation: Fluoridation is a violation of the individual’s right to informed consent to medication.  Within a community water supply, fluoride is being added to the water of everyone, even if some people do not want it and still others do not even know about the fluoride being added to the water or about its health risks.  Informed consumer consent is needed for water fluoridation, especially because of the alarming lack of safety for this chemical and its health risks.
Reason #2 to Oppose Water Fluoridation: Fluoride is not an essential nutrient. Fluoride is not a required component for human growth and development. In fact, fluoride has been recognized as one of 12 industrial chemicals known to cause developmental neurotoxicity in human beings. Researchers have repeatedly challenged the alleged safety and effectiveness of fluoride.
Reason #3 to Oppose Water Fluoridation: Hundreds of research articles published over the past several decades have demonstrated potential harm to humans from fluoride at various levels of exposure, including levels currently deemed as safe. Fluoride is known to impact the cardiovascular, central nervous, digestive, endocrine, immune, integumentary, renal, respiratory, and skeletal systems, and exposure to fluoride has been linked to Alzheimer’s disease, cancer, diabetes, heart disease, infertility, and many other adverse health outcomes, including fluoride toxicity.
Reason #4 to Oppose Water Fluoridation: People are now exposed to fluoride from an array of sources.  Since water fluoridation began in 1940s, an array of products containing fluoride have been introduced to the average consumer including water, dental products, pesticides, fluoride supplements, other prescription drugs, and many other sources. There is no current accurate estimate of just how much fluoride people are taking in from all of these sources. However, dental fluorosis is recognized as the first visible sign of fluoride toxicity. It is likewise a warning signal of the human health risks associated with fluoride exposure. According to 2010 data from the Centers for Disease Control and Prevention (CDC), 23% of Americans aged 6-49 and 41% of children aged 12-15 exhibit fluorosis to some degree
Reason #5 to Oppose Water Fluoridation: A “one dose fits all” level is unacceptable.  Susceptible populations with low body weights, such as infants and children, and individuals who consume increased amounts of water, such as athletes, military personnel, outdoor laborers, and those with diabetes or kidney dysfunction, can be more intensely effected by fluoride.  Additionally, fluoride is also known to impact each individual differently based on allergies, nutrient deficiencies, genetic factors, and other variables. Notably, a bottle-fed baby in a fluoridated area gets up to 200 times more fluoride than a breast-fed baby, resulting in an increased risk of dental fluorosis and other adverse effects.
Reason #6 to Oppose Water Fluoridation: There is not a wide-spread understanding about how fluoride interacts with other chemicals.  This issue is crucial to understanding risks of artificial water fluoridation, as the multiple chemicals to which we are exposed to can produce distinct reactions and interactions. For example, the fluoride added to many water supplies attracts lead, which can be found in certain plumbing pipes. Likely because of this affinity for lead, fluoride has been linked to higher blood lead levels in children.
Reason #7 to Oppose Water Fluoridation: Does it even work to prevent tooth decay?  The trend of decreased decayed, missing, and filled teeth over the past several decades has occurred both in countries with and without the systemic application of fluoridated water. This suggests that increased access to preventative hygiene services and more awareness of the detrimental effects of sugar are responsible for these improvements in dental health. Research has also documented decreases of tooth decay in communities that have discontinued water fluoridation.  Even proponents of fluoride have suggested that fluoride primarily works to reduce tooth decay topically (i.e. scrubbing it directly onto to teeth with a toothbrush), as opposed to systemically (i.e. drinking or ingesting fluoride through water or other means).
Reason #8 to Oppose Water Fluoridation: Ethical questions have been raised in regard to the use of fluoride, especially because of fluoride’s ties to the phosphate fertilizer and dental industries. Furthermore, researchers have reported difficulties with getting articles published that are critical of fluoride, and an urgent need for an appropriate application of the precautionary principle (i.e. first, do no harm) related to fluoride usage has emerged.
Reason #9 to Oppose Water Fluoridation: Fluoridation discriminates against those with low incomes. Research has indicated that fluoride does not aid in preventing pit and fissure decay (which is the most prevalent form of tooth decay in the U.S.) or in preventing baby bottle tooth decay (which is prevalent in poor communities). Also, research has suggested that in malnourished children and individuals of lower socio-economic status, fluoride can actually increase the risk of dental caries due to calcium depletion and other circumstances. Moreover, people on low incomes are least able to afford avoidance measures (reverse osmosis or bottled water) or medical and dental treatment for dental fluorosis and other fluoride-related ailments.
Reason #10 to Oppose Water Fluoridation: It also poses threats to animals (pets and wildlife), as well as the environment at large.  Animals are exposed to fluoride in the environment through pollution of air, water, soil, and food. It is important to consider their overall fluoride exposure as a result of each of these sources. Harmful effects of fluoride, including species vulnerability, have been reported in an array of wild animals. Even domestic pets have been subjects of reports raising concerns about fluoride exposure, especially through their water and food.
source: iaomt.or
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12 Benefits of Lemon Water

Celebrities and naturopaths won’t start their day without guzzling a glass of lemon water. Here’s what this a.m. habit can and can’t do for your health.

Lemon water may help you lose weight

Lemon water may be a dieter’s best friend. “The polyphenols in lemon may aid in reducing appetite,” registered dietician Erin Palinski-Wade, RD, CDE, author of Belly Fat Diet for Dummies. Rodent studies have shown that the polyphenols in lemon do help to prevent weight gain. Plus, she adds, “when you drink a glass of water, especially before a meal, this helps to fill your stomach, offsetting the amount of food needed to feel satisfied.” Lemon-flavored water is also a healthy option to replace your morning glass of orange juice—think of all the calories saved! To make lemon water, use whole lemons (not lemon juice in a bottle). “Try squeezing the juice from one lemon into 8 to 12 ounces of water,” Palinski-Wade says. You can also grate in a bit of the zest (just wash the lemon first). “Enjoy it cold or warm, but if you will be having it to promote weight loss, drink it chilled with ice,” she says.

It helps keep you from getting sick

We’ve all heard that vitamin C, which is found in citrus fruits like lemon, gives your immune system a boost (more on vitamin C later). But one of the benefits of lemon water is helping to prevent infection. “Certainly the acidic environment in the stomach serves as a barrier, deterring pathogens from gaining a foothold and causing illness,” says Roxanne B. Sukol, MD, medical director of the Cleveland Clinic’s Wellness Enterprise. “Ingestion of highly acidic foods, including lemon juice, contributes to the acidic environment.” According to The Cleveland Clinic, chemicals in lemon known as phytonutrients have antioxidant properties that can also help protect the body from disease.

It aids digestion

Another one of the benefits of lemon water is that the acids help to digest food. “The citrus flavonoids in lemon aid the acid in the stomach in breaking down food, which may improve overall digestion,” says Palinski-Wade. “Warming the water seems to provide the greatest digestive benefits.” Aiding digestion is especially important as we get older because the amount of acid in our stomach declines with age. One study showed that over 30 percent of men and women over age 60 had atrophic gastritis, a condition marked by little to no stomach acid. In addition, if you add lemon slices and zest to your water, you may be able to harness some of the benefits of pectin, a fiber found in the pulp and peel. Many studies have shown fiber to improve digestion and gut health.

Lemon water gives you a vitamin C boost

Citrus fruits are a great source of vitamin C. According to the United States Department of Agriculture, a fourth of a cup of lemon juice yields 23.6 mg of vitamin C, about a third of the recommended daily allowance for women and a fourth for men. Vitamin C is a powerful antioxidant that helps protect cells against free radicals, and according to the National Institutes of Health, this could even help protect us again cardiovascular disease and cancer. And although we don’t think much about this ailment anymore, “vitamin C prevents scurvy, a disease of weakened connective tissue that results in bleeding gums, among other symptoms,” says Dr. Sukol. Connective tissue is also crucial for wound healing.

Lemon-Water

 

It keeps you hydrated

Hydration is not a direct benefit of the lemon properties themselves, but rather, drinking flavored water might entice you to consume more of it. “Fluids, in general, provide hydration, however, some people struggle to drink an adequate amount of water per day simply because they find water boring or do not enjoy the taste,” Palinski-Wade says. “Adding lemon to water can enhance the taste, making it more appealing to some, helping them to drink more and improve hydration.” Although the old rule was to drink eight 8-ounce glasses a day, nutritionists now recognize that the amount will vary based on what you weigh, how active you are, and where you live. One test to make sure you’re getting enough? Your pee should be nearly clear—if it’s yellow or dark, you need to drink more.

It may help you look younger

The vitamin C in lemon juice might actually help your skin as well, definitely one of the benefits of lemon water. One study from the U.K. showed that higher vitamin C intakes were associated with fewer wrinkles. “Because vitamin C is a nutrient that can fight off free-radical damage, it can protect skin,” Palinski-Wade says. This could be due to vitamin C’s effects on collagen, which helps make up the connective tissue under the skin. “In addition, the hydration from the water helps skin stay more subtle and provides a more youthful appearance,” she adds. Your skin is an organ, and hydration helps it function at its best.

It may help liver function

Another one of the benefits of lemon water is helping your liver to do a better job being the body’s filter. “Boosting overall hydration can help to improve the function of all organs in the body, including the liver,” Palinski-Wade says. “In addition, animal studies have found that the citrus flavonoids in lemon may protect the liver against toxins and reduce fat in the liver, protecting against fatty liver disease.” Your liver is the body’s natural mechanism for flushing out toxins; so although claims of “detoxification” from lemon juice aren’t exactly proven, helping the liver to work better could benefit your body.

It increases your potassium levels

We generally associate potassium with bananas, but it turns out lemons are a good source as well. “Potassium is found in large amounts primarily in fruits and vegetables,” Dr. Sukol says. “It is an element that is essential for cell function and metabolism, transmission of nerve signals.” According to the University of Maryland Medical Center, potassium, an electrolyte, helps to conduct electricity throughout the body. This nerve-muscle communication helps skeletal-muscular function—which is why you need it when you get a Charlie horse. (Here’s why you might want to skip lemon water at a restaurant, though.)

It makes you more regular

Along with helping your gut and liver, lemon-flavored water can be part of a healthy way to help you go to the bathroom. “Increasing fluid intake can help to promote regular bowel movements,” Palinski-Wade says. ” If adding lemon to your water helps you to drink more fluid throughout the day, this may help you to become more regular.” And although lemon juice doesn’t provide much fiber, getting in pulp and zest from the peel could help boost the fiber content, which helps you go as well.

It helps prevent kidney stones

Kidney stones often develop as a result of dehydration, so one of the benefits of lemon water is that it helps flush out your kidneys and prevent these painful deposits. “Some kidney stones result from precipitation of calcium salts,” Dr. Sukol says. “Acidification of the aqueous—or watery—environment in which this occurs is thought to reduce the likelihood of precipitation, and therefore prevent the formation of some stones. Purely a chemical reaction.” So in other words, the acid from the lemon can help keep the stones from coming together. Although lemon-flavored water is thought to be a diuretic, this hasn’t been proven—rather, increased urination is likely the result of drinking more fluid. Either way, it’s helpful for keeping kidney stones at bay.

It freshens breath

When it comes to personal hygiene, it may help your mouth smell cleaner. “The citrus in lemon water may help to reduce the growth of bacteria in the mouth, which may lead to fresher breathe,” Palinski-Wade says. The only problem is that the acid in lemon juice could, over time, erode the enamel of your teeth. Try drinking it through a straw to reduce exposure to your chompers.

It may boost metabolism

Lemon water is a great addition to your morning routine because it could jump-start your metabolism, helping you keep a healthy weight and be active. “Staying hydrated and drinking ice-cold water has been shown to provide a metabolism boost,” Palinski-Wade says. “Aim to drink at least three cups per day to help fire up your metabolism while providing a feeling of fullness that may help you to eat less.” Drinking your lemon-flavored water cold could have even more of a beneficial effect. “Chilling it may provide an even greater metabolism boost as the body needs to warm the water to body temperature during digestion,” she says.

BY TINA DONVITO
source: www.rd.com


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What Are Oxalates?

What is oxalate?
Oxalate is a naturally occurring molecule found in abundance in plants and humans. It’s not a required nutrient for people, and too much can lead to kidney stones.

In plants, oxalate helps to get rid of extra calcium by binding with it. That is why so many high-oxalate foods are from plants. In humans, it may work as a “prebiotic,” feeding good bacteria in the gut.

How does the body process it?
When we eat foods with oxalate, it travels through the digestive tract and passes out in the stool or urine. As it passes through the intestines, oxalate can bind with calcium and be excreted in the stool. However, when too much oxalate continues through to the kidneys, it can lead to kidney stones.

Calcium oxalate kidney stones are the most common type of kidney stone in the North America. The higher your levels of oxalate, the greater your risk of developing these kinds of kidney stones.

What is a low-oxalate diet?
If you are at high risk for kidney stones, lowering the amount of oxalate that you eat may help reduce this risk.

However, new research indicates that boosting your intake of calcium-rich foods when you eat foods that are high in oxalate may be a better approach than simply eliminating it from the diet. As they digest, oxalate and calcium are more likely to bind together before they get to the kidneys, making it less likely that kidney stones will form.

What causes oxalate buildup?
Foods that are high in vitamin C can increase the body’s oxalate levels. Vitamin C converts to oxalate, and levels over 1,000 milligrams (mg) per day have been shown to increase oxalate levels.

Taking antibiotics, or having a history of digestive disease, can also increase the body’s oxalate levels. The good bacteria in the gut help get rid of oxalate, and when the levels of these bacteria are low, higher amounts of oxalate can be absorbed in the body.

What can reduce oxalate?
Drinking enough fluid each day can help clear kidney stones or even keep them from forming. Spreading liquids throughout the day is ideal. Choosing water over other drinks is preferable.

Getting enough calcium is also helpful. Getting too little calcium can increase the amount of oxalate that gets to the kidneys, which will increase the risk of kidney stones.

Lowering your salt intake can also lower your risk of kidney stones. High-salt diets tend to cause more calcium to be lost in the urine. The more calcium and oxalate in the kidneys, the greater the risk of kidney stones.

How is oxalate measured?
Lists that provide the oxalate content in foods can be confusing. The oxalate levels reported in foods can vary depending on the following factors:

  • when the foods are harvested
  • where they are grown
  • how their oxalate levels were tested

 

oxalates





High-oxalate foods
Foods that are highest in oxalate include:

  • fruits
  • vegetables
  • nuts
  • seeds
  • legumes
  • grains

High-oxalate fruits include:

  • berries
  • kiwis
  • figs
  • purple grapes

Vegetables that contain high levels of oxalate include:

  • rhubarb
  • okra
  • leeks
  • spinach
  • beets
  • Swiss chard

To reduce how much oxalate you get, minimize consumption of:

  • almonds
  • cashews
  • peanuts
  • soy products

Some grain products are also high in oxalate, including:

  • bran flakes
  • wheat germ
  • quinoa

The following foods are also high in oxalates:

  • cocoa
  • chocolate
  • tea

High-calcium foods
Increasing your calcium intake when eating foods with oxalate can help lower oxalate levels in the urine. Choose high-calcium dairy foods such as milk, yogurt, and cheese. Vegetables can also provide a good amount of calcium. Choose among the following foods to increase your calcium levels:

  • broccoli
  • watercress
  • kale
  • okra

High-calcium legumes that have a fair amount of calcium include:

  • kidney beans
  • chickpeas
  • baked beans
  • navy beans

Fish high in calcium include:

  • sardines with bones
  • whitebait
  • salmon

How to avoid kidney stones
To lower your risk of kidney stones, add a high-calcium food to a meal that contains a food with higher levels of oxalate.

For example, if you add wheat germ to your oatmeal, be sure to add some milk as well. If you are cooking spinach, don’t feel guilty about combining it with pizza or lasagna. If you have a craving for a berry smoothie, add some regular or Greek yogurt to help provide balance.

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Common Painkillers Tied to Kidney Risks for Children: Study

Children taking the common painkillers known as nonsteroidal anti-inflammatory drugs may be at risk for acute kidney damage, particularly when the kids are dehydrated, a new study finds.

Nonsteroidal anti-inflammatory drugs (commonly called NSAIDs), such as ibuprofen (brand names Advil and Motrin), naproxen (Aleve) and ketorolac (Toradol) are used to relieve pain and fever.

“The one thing we did see that seemed to be connected to kidney damage was dehydration,” said lead researcher Dr. Jason Misurac, a nephrologist at Indiana University School of Medicine in Indianapolis.

For the study, which was published in the Jan. 25 online edition of the Journal of Pediatrics, Misurac’s team looked at the medical records of children admitted to Riley Hospital for Children in Indianapolis from 1999 through mid-2010. Over that time, they identified more than 1,000 cases of children being treated for kidney damage.

In nearly 3 percent of the cases, the damage was related to NSAIDs, the study found. Most kids were teens, but four were under 5 years old. All of them had been given NSAIDs before being hospitalized. Since many other cases involved several causes of kidney damage, it is possible some of those also were related to NSAIDs, the researchers said.

Most children who developed kidney damage had been given the recommended dose and had not been taking NSAIDs for more than a week.

In adults, taking NSAIDs regularly for several years has been tied to kidney problems, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. Cases involving children have previously been reported but only rarely.

Misurac noted that most of the children in the study hadn’t been drinking well and also were vomiting and had diarrhea, all of which can lead to dehydration. When someone is dehydrated the kidneys have a way of protecting themselves, which NSAIDs block, resulting in the damage, Misurac explained.

“Certainly in the way NSAIDs affect the kidneys, it’s reasonable to think that dehydration plus an NSAID has more of an effect than just an NSAID by itself,” he said.

Often the signs of kidney problems aren’t apparent, Misurac said. One sign is a decrease in urine; another is stomach pain. “But most kids who have episodes of acute kidney injury have nonspecific symptoms and there’s no one way to tell,” he said.

“If kids are dehydrated and not drinking well, then parents should think twice about using NSAIDs,” Misurac said. Tylenol (acetaminophen), which acts differently than NSAIDs, might be a better choice for children, he said.

For many of the children in the study, the kidney damage was reversed, Misurac said. The damage, however, was permanent for seven patients and they will probably need ongoing monitoring and treatment for declining kidney function, he said.

All the children under age 5 had to undergo dialysis and were more likely to be treated in an intensive-care unit, the researchers said. They also stayed in the hospital longer.

Although the study showed an association between taking NSAIDs and kidney problems in children, it didn’t establish a cause-and-effect relationship.

One expert agreed that NSAIDs can damage the kidneys.

“This is well known. Unfortunately, it is better known among doctors; the public is not as educated regarding this problem,” said Dr. Felix Ramirez-Seijas, director of pediatric nephrology at Miami Children’s Hospital.

Ramirez-Seijas said NSAIDs are “overused and abused, both by doctors and patients.”

For children, most fevers should not be treated; fever is how the body fights infection, he said. “There is a fear of fever that leads to overtreatment,” Ramirez-Seijas said.

In addition, children who take NSAIDs for aches after vigorous exercise also are at risk, because they may be dehydrated, Ramirez-Seijas said.

His advice to parents is to be sure children are well hydrated if they are going take NSAIDs. In addition, he believes that even these over-the-counter drugs should only be used with the advice of a doctor.

“Most people see taking a couple of Advil like taking a sip of water, but it’s not,” Ramirez-Seijas said.

By Steven Reinberg     HealthDay    Jan. 25
 

 

nsaids

 

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

What are NSAIDs and how do they work?

Prostaglandins are a family of chemicals that are produced by the cells of the body and have several important functions. They promote inflammation that is necessary for healing, but also results in pain, and fever; support the blood clotting function of platelets; and protect the lining of the stomach from the damaging effects of acid.

Prostaglandins are produced within the body’s cells by the enzyme cyclooxygenase (COX). There are two COX enzymes, COX-1 and COX-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. However, only COX-1 produces prostaglandins that support platelets and protect the stomach. Nonsteroidal anti-inflammatory drugs (NSAIDs) block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since the prostaglandins that protect the stomach and support platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding.

What NSAIDs are approved in the United States?

The following list is an example of NSAIDs available:

  • aspirin
  • celecoxib (Celebrex)
  • diclofenac (Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex)
  • diflunisal (Dolobid – discontinued brand)
  • etodolac (Lodine – discontinued brand)
  • ibuprofen (Motrin, Advil)
  • indomethacin (Indocin)
  • ketoprofen (Active-Ketoprofen [Orudis – discontinued brand])
  • ketorolac (Toradol – discontinued brand)
  • nabumetone (Relafen – discontinued brand)
  • naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
  • oxaprozin (Daypro)
  • piroxicam (Feldene)
  • salsalate (Disalsate [Amigesic – discontinued brand])
  • sulindac (Clinoril – discontinued brand)
  • tolmetin (Tolectin – discontinued brand)

What are the side effects of NSAIDs?

NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs.

Common side effects are

  • nausea,
  • vomiting,
  • diarrhea,
  • constipation,
  • decreased appetite,
  • rash,
  • dizziness,
  • headache, and
  • drowsiness.

Other important side effects are:

  • kidney failure (primarily with chronic use),
  • liver failure,
  • ulcers, and
  • prolonged bleeding after injury or surgery.

NSAIDs can cause fluid retention which can lead to edema, which is most commonly manifested by swelling of the ankles.

WARNING: Some individuals are allergic to NSAIDs and may develop shortness of breath when an NSAID is taken. People with asthma are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID.

Use of aspirin in children and teenagers with chickenpox or influenza has been associated with the development of Reye’s syndrome, a serious and sometimes fatal liver disease. Therefore, aspirin and non-aspirin salicylates (for example, salsalate [Amigesic]) should not be used in children and teenagers with suspected or confirmed chickenpox or influenza.

NSAIDs increase the risk of potentially fatal, stomach and intestinal adverse reactions (for example, bleeding, ulcers, and perforation of the stomach or intestines). These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these adverse events. NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions. This risk may increase with duration of use and in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.

For what conditions are NSAIDs used?

NSAIDs are used primarily to treat inflammation, mild to moderate pain, and fever.

Specific uses include the treatment of:

  • headaches,
  • arthritis,
  • ankylosing spondylitis,
  • sports injuries, and
  • menstrual cramps.
  • Ketorolac (Toradol) is only used for short-term treatment of moderately severe acute pain that otherwise would be treated with narcotics.

Aspirin (also an NSAID) is used to inhibit the clotting of blood and prevent strokes and heart attacks in individuals at high risk for strokes and heart attacks.

NSAIDs also are included in many cold and allergy preparations.

Celecoxib (Celebrex) is used for treating familial adenomatous polyposis (FAP) to prevent the formation and growth of colon polyps.

With which drugs do NSAIDs interact?

NSAIDs reduce blood flow to the kidneys and therefore reduce the action of diuretics (“water pills”) and decrease the elimination of lithium (Eskalith, Lithobid) and methotrexate (Rheumatrex, Trexall). As a result, the blood levels of these drugs may increase as may their side effects.

NSAIDs also decrease the ability of the blood to clot and therefore increase bleeding. When used with other drugs that also increase bleeding (for example, warfarin [Coumadin]), there is an increased likelihood of serious bleeding or complications of bleeding. Therefore, individuals who are taking drugs that reduce the ability of blood to clot should avoid prolonged use of NSAIDs.

NSAIDs also may increase blood pressure in patients with hypertension (high blood pressure) and therefore antagonize the action of drugs that are used to treat hypertension.

NSAIDs increase the negative effect of cyclosporine on kidney function.

Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking NSAIDs.

 

Medical and Pharmacy Editor: Jay W. Marks, MD  
Pharmacy Author: Omudhome Ogbru, PharmD