NSAIDs: Feeding the Inflammatory Fire
Updated: Jul 6, 2021
We are commonly taught that at the root of disease is inflammation. It seems to be common knowledge that following a reduction in inflammation, there's a decrease in the onset of various pathologies. On par with the villainization of cholesterol, the common narrative of inflammation does not tell the whole story, and can be harmful to health. What is often forgotten is that short term inflammation in response to acute injuries, wounds or internal damage is integral to the body's ability to heal.
The problem occurs when inflammation lingers too long. This occurs due to suppressed immune function, stress, low protein intake, poor dietary choices or a combination of these things. The shift from acute to chronic inflammation is when we start to see the negative impacts that arise from the inflammatory process. Inflammation can be considered a helpful mechanism that when not controlled, can spread and become more of a low-grade problem.
The use of NSAIDS to combat inflammation, whether it be acute or chronic, disrupts the body's innate inflammation regulation system. NSAIDS, block inflammatory pathways downstream, however they don’t stop inflammation from occurring. What they do inhibit, is the natural resolution of inflammation. When utilizing NSAIDs for acute conditions, the inflammation isn't able to totally resolve on its own and can contribute to a chronic inflammatory response. Due to NSAIDS perpetuating chronic inflammation, their use is correlated to an increased risk for several pathologies including peptic ulcers, acute renal failure, strokes, heart attacks, and poor cerebrovascular outcomes. In addition to this, they can disrupt gut function and tax the liver.
NSAID use inhibits a class of proteins called prostaglandins, which is largely responsible for the havoc they exert on the body.
Prostaglandins and Inflammation
One of the ways the body mediates inflammation is through prostaglandins. Fun fact, prostaglandins were given their name after being isolated in the prostate of a sheep! Prostaglandins are short-lived hormone-like factors that are synthesized by specific Omega 6 and Omega 3 fatty acids such as EPA and AA.
All prostaglandins are considered to be physiologically active lipid compounds and also referred to eicosanoids. They are biosynthesized at the site of tissue damage or infection. They are found in almost all cells in the human body, and regulate cellular activity on a moment-by-moment basis. They play important roles in how the body responds to injury, illness and in females, even assist in regulating the reproductive system! Prostaglandins play a role in ovulation and in labour as well as synthesizing mucosal membranes in both sexes.
While there are over 30 different prostaglandins, that have been identified, there are three main series of PG’s.
These series are meant to work in harmony. Each series has its own job to do in the healing process and when this is disrupted, be it through the use of NSAIDS or due to physiological imbalance, this can present as painful periods, arthritic pain or chronic pain that doesn’t seem to have a specific cause. If the balance of prostaglandins is disrupted over the long term, we see the incidence of chronic disease increase.
The Origins of Prostaglandins
Both PG Series 1 and 2 are derivatives of Omega 6 fatty acids. They can be converted from the omega 6 essential fatty acid Linoleic Acid. This omega 6 fatty acid can be enzymatically changed into other omega 6s in the following order : LA -> GLA -> DGLA -> AA . This conversion is done with the help of specific enzymes, which can be potentially blocked by the presence of EPA, NSAIDS,nutrient deficiencies and more.
PG Series 3 is made from Omega 3 fatty acids. While they can be created from the essential omega 3 fatty acid ALA, there are many steps that must occur for ALA to be converted into other omega 3s, before finally becoming the omega 3 required for conversion into PG3. The omega 3 pathway looks like this : ALA -> SDA -> ETA -> EPA -> DHA
PG Series 1
PG Series 1 is converted from DGLA, an Omega 6 Fatty Acid. It helps to keep blood platelets from sticking together, regulates Ca metabolism and helps decrease inflammation.
PG Series 2
PG Series 2 is converted from AA, another Omega 6. This is considered the "fight or flight" PG series, because it increases inflammation, helps platelets stick together and increases blood clotting. PG 2 is very helpful when we are injured.
PG Series 3
PG Series 3 is converted from EPA. This series is similar to series 1, as they also help to keep blood platelets from sticking together, reduce blood pressure and more. The key player in this equation is not the PG series themselves, but actually the EPA, whose very presence is the single most important factor for preventing the release of AA from membranes, which means less AA being converted into PG2. EPA and PG Series 3 are the reason why we hear so much about the benefits of fish oil for reducing inflammation.
Prostaglandins and NSAIDS
Traditionally we see clients covering up inflammation with NSAIDs, rather than working with the body’s natural mechanisms to regulate inflammation. Having a conversation with clients on the benefits of regulating inflammation through other methods can collapse the time on healing and provide long term relief.
NSAIDs block the synthesis of prostaglandins. Depending on the type of NSAID, they do this through inhibiting the Cox2 pathway.
Through using NSAIDS, the signal (ie- pain) that tells us something is off in the body, gets blocked. It only blocks the signal, while what is wrong in the body is left unattended, to progress and cause more damage. The NSAID does not address the upstream inflammation, in fact it does not address the inflammation at all. If anything, NSAIDS promote inflammation in the long run, because they inhibit the very molecules needed to regulate it.
Excessive production of prostaglandins isn’t conducive to health either. Like everything, we need a balance in the body. The solution to increased prostaglandin synthesis is to curb the inflammatory response from the top down- not merely interrupt it half way through, as is the case with NSAID use. Remember that prostaglandins are needed to resolve inflammation, when their production is down regulated in the presence of inflammation- the inflammatory response continues on a positive feedback loop.
In addition to this, NSAIDS block the production of prostaglandins across the board, and therefore interrupt metabolic processes in the body that require the presence of prostaglandins to function properly.
When it comes to helping clients regulate inflammation, it’s paramount to regulate the prostaglandin response. This can be done through reducing NSAID use, and incorporating antiinflammatory practices into daily life. Getting to the root of inflammation is the best course of action for sustained healing to occur. Click here to download our free course on how to reduce inflammation through the diet. The exact steps we take with our clients!
Authors: Co-Founders of Fiore Health, Sidney Shindle & Lisa Kowalyk