Lots Of Recreational Runners Take Drugs To Run

Not the kind of drugs that that elite athletes use like growth hormone or erythropoietin, but common off the counter ones like Ibuprofen. 

Don't believe what I'm writing? Consider the following patients I treated recently. I had a runner who runs ultras and another newbie runner who just started running during the circuit breaker/ lockdown because he couldn't go to the gym. Both had a combination of mild injuries and muscle soreness and instead of taking a break they both gulped down a couple of Ibuprofen tablets and occasionally stronger non steroidal anti-inflammatory drugs (NSAIDs) so they can keep running and training.

Here's what I read. 46% of runners recruited (total 109 runners) recruited during the 2016 London Marathon registration planned to take an NSAID during the race.  Of those 109 runners returning for data collection, 34% had already taken an NSAID on the morning of the race while more than half the runners completing the study (16 out of 28 runners) had taken an NSAID.

Only 13 of the 28 runners (13) correctly stated the risks of taking NSAIDs while only 10 runners (35%) knew the correct safe dose.

NSAIDs while helpful with masking your pain while exercising can cause stomach ulcers, acute kidney injuries and also a risk of strokes and heart attacks (depending on dosage  and how long they are taken).

Under duress of a long distance endurance event, risks may increase. Reduce blood flow and motility in the stomach make tummy problems common even without NSAID use. Muscle damage from racing may increase protein in the blood which can lead to acute kidney damage. This may be worsened by NSAID use. Hyponatremia can also be heightened by use of NSAIDs.

Researchers in UK, surveyed 806 runners in the Parkrun there to find out about usage in a diverse group of runners. A third of  these runners raced marathon distances or higher. Almost 90% of the runners surveyed used NSAIDs (most used Ibuprofen, which does not require prescription by a doctor).

More than half the Parkrun runners took NSAIDs before a run or a race.The longer the run, the more likely they were to take NSAIDs before or during the run. One in ten runners took them during a run and more than 65% took them after a run.

33% of the ultra runners compared to 17.5% of marathon runners took NSAIDs during the event. This is of concern a the longer events already put extra stress on their stomach and kidneys as it is.

Those who do not log longer distances used NSAIDS so that they can keep exercising with pre-existing pain, ongoing medical issues or current injuries. Those who ran further (>40km a week) were more interested in reducing inflammation, soreness, pain and performance enhancement/ improvement.

Almost half the surveyed runners used NSAIDs without any advice from a healthcare professional thought almost all said they would read the advice if it was provided to them.

I, too have taken NSAIDs on the night before and the day of a race. Tried it twice, although I thought they didn't make much of a difference to my performance. Hence, I didn't take them after.

If you're using NSAIDs to run through pain and injury to meet your training/ racing targets, it is counterproductive to the long term health benefits of running especially since NSAIDS can affect healing and recovery. Using NSAIDS occasionally before or after your weekly run is definitely less risky compared to frequent, regular usage during demanding training. Needless to say, they should be avoided while your body is under sustained physiological stress during races.


References

Rosenbloom CJ, Morley FL et al (2020). Oral Non-steroidal Anti-inflammatory Drug Use In Recreational Runners Participating In Parkrun UK: Prevalence Of Use And Awareness Of Risk. Int J Pharm Pract. DOI: 10.1111/ijpp.12646

Whatmough S, Mears S et al (2017). The Use Of Non-steroidal Anti-inflammatories (NSAIDs) At The 2016 London Marathon. BJSM. 51:409. DOI: 10.1136/bjsports-2016-097372.317

Going Bananas?

Ready to go riding with my bananas

I've written before that sports drinks cannot  totally replace your electrolyte losses during exercise. Moreover, sports drinks are manufactured and may contain flavorings and chemicals that you may want to avoid.

And if you're like me and prefer eating real food and drinking lemon water (or just plain water) rather than sports drinks while exercising, then you may be doing enough to replace the carbohydrates to fuel your exercise and even speed recovery.

A preliminary study in 2012 found that cyclists performed better for a strenuous bike ride if they had a banana or sports drink compared to water. The cyclists also had lower levels of inflammation after the ride. That study did not show why and how the carbs were aiding recovery.

The same authors did a new study that was recently published using more sophisticated techniques to track molecular changes inside the cyclist's bodies.

The subjects' underwent a intense 75 km bike ride inside the laboratory. In one ride, they drank only water while in another ride, they had water, eight ounces of a sports drink or half a "Dole" banana every 30 minutes.

The subjects' blood was tested before during and immediately the ride and even 45 hours after the ride. Inflammatory blood markers and metabolites were assessed during and after to test how much stress was taken by them.

When the cyclists' drank only water during the ride, relatively high levels of inflammatory markers were found. These same markers were much lower if the cyclists' had consumed the banana or sports drinks. Metabolite profiles were less stressed regardless of whether they had the banana or sports drink compared to without.

One obvious difference was those cyclists' that ate the bananas had blood cells that produced less COX-2 (a genetic precursor of an enzyme). This was not seen if they drank only water or had the sports drink.

For those interested, COX-2 enzyme stimulates prostaglandin production, which increases the intensity of inflammation. Those of you who take inflammatory medication like Arcoxia or Celebrex tablets note that they are COX-2 inhibitors. They help reduce inflammation.

This study suggest that bananas might perform comparably although it is unknown how bananas affect the cells' gene expression. So instead of popping pills like Arcoxia and Celebrex prescribed to you, you may want to eat more bananas and ginger.

It was calculated by the researches that half a standard banana provided similar carbohydrates as a cup of sports drink and the cyclists' had half every 30 mins. Bear in mind your needs may be different. Some cyclists' also complained of feeling bloated after eating that amount of bananas.

So be warned before you go bananas over ingesting bananas in your next long ride or race.


References

Nieman DC, Gillitt ND et al (2012). Bananas As An Energy Source During Exercise: A Metabolomics Approach. PlosOne. DOI:10.1371/journal.pone.0037479

Nieman DC, Gillitt ND et al (2018). Metabolic Recovery From Heavy Exertion Following Banana Compared To Sugar Beverage Or Water Only Ingestion: A Randomized, Crossover Trial. PlosOne. DOI:10.1371/journal.pone.0194843

*Note that Dole Foods which sells bananas funded both studies. However, they company did not have any involvement in study design, data collection, analysis, decision to publish or preparing the article.