Whether you’re a marathon runner or struggling with arthritis, why you should be careful taking anti-inflammatories, says PROFESSOR ROB GALLOWAY

This coming Sunday over 50,000 people will take part in the London Marathon; it’s just over 26 miles of blood, sweat and tears – and then adrenaline when the runners cross the finish line.

They’ll end the day with lifelong memories, raise millions for charity and, most importantly, get a massive health boost from months of training.

But even if the benefits of running far outweigh the harms if you’re otherwise healthy, there are risks: and some won’t finish the race and may end up with a serious medical emergency.

Many of you reading this will never go long term and may think that none of this is relevant to you.

But if you take anti-inflammatory tablets such as ibuprofen or use a pain-relieving anti-inflammatory gel, think again.

Let me explain: two weeks ago it was the Brighton Marathon, where I have been medical director for the past 12 years. I’ve seen the problems a massive race can cause, and this year was no exception.

As I write, one of our runners is still in hospital with heat stroke and kidney failure, his life saved by the medical team on the course.

In the 20s, he was just coming towards the end of the race when he collapsed. His temperature was above 41c (106f) and we used a specially designed cooling pad (I-CWIK) developed by the military. This young man is now on dialysis because running this race damaged his kidneys so badly.

Heatstroke and kidney failure may well have taken the life of the legendary Greek soldier Pheidippides in 490 BC. – after running from Marathon to Greece to proclaim ‘victory’, he dropped dead (his feat was commemorated in the first marathon held at the Greek Olympics in 1896).

Although we don’t fully understand the complexities of these two conditions, something the Brighton marathoner told me has implications not just for next Sunday’s runners, but for all of us. (And helps explain why this otherwise fit and healthy man became so dangerously ill).

The day after his race, he said that to avoid developing knee pain during the marathon, he took an ibuprofen tablet just in case as he was leaving.

Anti-inflammatory tablets such as ibuprofen, naproxen and even gels such as Voltarol are types of NSAIDs – non-steroidal anti-inflammatory drugs. They work by inhibiting an enzyme called cyclooxygenase (COX), which is involved in inflammation.

During vigorous physical activity and in hot weather, the body loses its ability to regulate temperature (partly due to increased heat production from the muscles working so hard; while dehydration and blood flow diverted away from the skin to the vital organs means that you sweat less ).

NSAIDs make this worse in a number of ways, including reducing the kidneys’ ability to control fluid balance in the blood. But not everyone is affected in the same way.

In a study published late last year in the Journal of Science and Medicine in Sport, we gave runners small thermometers to swallow before the race: the results showed that some runners who experienced temperatures above 40c (104f) had no symptoms while others suffered. heat stroke (with symptoms such as confusion, muscle stiffness and kidney failure).

So something other than body temperature was at play, causing them to collapse. One theory is that heat – from hot weather or hard exercise – causes bacteria to leak out from the intestines. NSAIDs – even a single-use tablet according to our Brighton runner – can also make our gut more leaky. The bacteria enters the bloodstream and can cause symptoms similar to sepsis – low blood pressure, confusion and high heart rate.

In addition, some people after running have a greater amount of muscle damage, which produces a protein in the blood – creatine kinase – that stops the kidneys from working. And yes, NSAIDs also reduce blood flow to the kidneys. So a perfect storm against kidney failure.

There is an important message to this in non-runners as well.

A few years ago, a 58-year-old carpet fitter came to A&E lethargic, with poor concentration and itching. Blood tests showed that he was in urgent need of kidney dialysis.

And after assessing him, the reason became clear: He had developed knee pain after years of knee drops. On his own, he couldn’t afford a day off from work, so he would take ibuprofen daily, as well as liberally use Voltarol gel. His long-term use of NSAIDs had caused kidney failure.

While the dialysis machine took over the function of his failing kidneys, he had the anti-inflammatory drugs stopped to allow his kidneys to heal, and then two weeks later he was out of the hospital and not on dialysis. But it had been a close shave.

When it comes to marathons, is it just the tablets that are dangerous or are the gels also a risk? The answer is that we are not sure: we know that gel is absorbed into the blood and therefore can theoretically cause problems, especially when used excessively.

This is why runners for the Brighton Marathon (now organized by London Marathon Events) were sent specific pre-race medical advice which stated: ‘Do not take anti-inflammatory medication before, during or for 24 hours after the marathon. . . Anti-inflammatory gels are safer than tablets, but can also cause problems during marathons and avoid them before or during the event.’

Unfortunately, most people do not read the posted advice and get advice from friends or social media.

It’s not just a one-off for endurance training that’s a concern: using them over a long period of time, no matter who you are, is a risk.

This includes gels as well as tablets. Voltarol gel actually states on its product information sheet that it should not be used for more than 14 days unless otherwise directed by a doctor.

While most people will know about the risks of long-term NSAIDs in terms of bowel problems such as bleeding, many will be unaware of the risks of kidney problems and heat stroke.

So when it comes to summer, it’s so important to avoid long-term use of these drugs – and try to avoid heat stroke, especially if you’re older, because poor kidney function with age puts you at a higher risk.

This, combined with the warning that NSAIDs are associated with a greater risk of heart attack, heart failure and stroke (inhibition of inflammation also leads to water and salt retention and higher blood pressure), is why I now advise my patients to only to take them for a short period of time.

When I go on a long run myself, I avoid any type of NSAID, even as a single dose.

And for those with chronic pain, such as arthritis, my advice is to seek other forms of relief – such as heat-type gels, cold water swimming and paracetamol.

We have become over medicated when it comes to managing pain and we don’t always think about the side effects of medication.

NSAIDs can provide temporary relief, but in the long term they can be very risky.

As for runners, a single dose of an NSAID before a race may help you get to the starting line, but they may jeopardize your safe finish.

As my patient told me when I left his ICU bed: ‘I had no idea that my ibuprofen tablet could be causing my problems. Please tell others so they know and don’t suffer like I have.’

@drrobgalloway