Arthritis: Aspirin, Antacids and Acid-Blockers

Healing Joint Pain Naturally: Safe and Effective Ways to Treat Arthritis, Fibromyalgia, and Other Joint Diseases
by Ellen Hodgson Brown

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Aspirin

Aspirin, the grandfather of anti-inflammatories, has long been the most popular treatment for arthritis. Americans collectively pop more than 80 million aspirin tablets daily. Critics question whether the Food and Drug Administration (FDA) would allow this drug on the over-the-counter market if it were introduced today because of its potentially serious side effects; but it has been around in pill form since 1899 (longer than the FDA itself) and was grandfathered in without testing.

How aspirin works wasn't discovered until more than seventy years after it appeared on the market. The mechanism involves natural substances called prostaglandins, which are released when cells are injured or stimulated. One type, called PGE2, alerts the body to disturbances in normal function by increasing the awareness of pain. Other prostaglandins contribute to the heat and swelling of inflammation and promote the coagulation of blood. Aspirin interferes with the body's biosynthesis of these prostaglandins, thereby suppressing inflammation and the awareness of pain.

The problem is that prostaglandins perform normal body functions that are suppressed along with the inflammatory process. Some prostaglandins help to regulate the flow of blood through the kidneys and the filtration and excretion of sodium and toxins. When aspirin inhibits these functions, the result can be fluid retention and the buildup of nitrogenous wastes in the blood. Other prostaglandins have a direct action on stomach cells. They inhibit acid production and prevent acid damage to the lining of the stomach. When these prostaglandins are suppressed, acid can eat holes in the stomach and intestines. This unwanted side effect is the largest single cause of disease and death due to aspirin and other NSAIDs. Aspirin also causes an excretion of vitamin C in the urine that is three times normal; it can cause iron deficiency from blood loss from irritation of the intestinal lining; it prevents blood from clotting; and it blocks the effects of interferon, one of the substances by which the immune system fights off infections and other ills.

Non-Aspirin NSAIDs

Non-aspirin NSAIDs include ibuprofen (Motrin, Advil), indomethacin (Indocin), naproxen (Naprosyn, Aleve), and piroxicam (Feldene), among other popular options. The non-aspirin NSAIDs were originally thought to have an advantage over aspirin in that they were better tolerated and produced less gastrointestinal distress. But the FDA eventually proclaimed that the safety of one NSAID could not be clearly distinguished from another.

All NSAIDs, including aspirin, inhibit the synthesis of prostaglandins. NSAIDs can also provoke asthma in some people. A British study found that people over sixty who took non-aspirin NSAIDs were three times as likely as nonusers to be hospitalized with bleeding gastric and duodenal ulcers. In another study, elderly people who took ibuprofen regularly were found to be four times as likely to die from ulcers and gastrointestinal bleeding as those not taking it.

Concerns about the side effects of NSAIDs have led the FDA to require new labels that state in part: "Serious gastrointestinal toxicity such as bleeding, ulceration, and perforation can occur at any time, with or without warning symptoms, in patients treated chronically with NSAID therapy." All of the currently available NSAIDs are now thought to have roughly equivalent pain-relieving effects, and all are known to cause stomach damage.

Acetaminophen (Tylenol and other brands) is an over-the-counter analgesic that is easier on the stomach than NSAIDs; but it doesn't qualify as an anti-inflammatory, because it doesn't reduce inflammation. It therefore isn't much help for arthritics; and while it is easier on the stomach than NSAIDs, it still isn't safe taken over long periods, since it can cause fatal damage to the liver.

Antacids and Acid-Blockers

As many as 25 percent of people taking NSAIDs at any given time have evidence of ulcers detectable by clinical testing, but most of these ulcers have no symptoms and will heal on their own. The danger comes when an ulcer forms near a blood vessel or grows too large. It can then cause severe pain and other serious complications. Since in its early stages the ulcer goes unnoticed, a serious stomach bleed can come on suddenly, often requiring transfusions and surgery.

Many arthritics try to avoid this result by taking antacids or acid-blockers (Tagamet, Zantac, Pepcid AC) preventatively. But a Stanford study reported in 1996 found that this could do more harm than good. The first symptom of an ulcer is usually heartburn. By masking heartburn symptoms, the drugs allow ulcers to get much larger before they are detected. People taking acid-blockers were found to be more than twice as likely to be hospitalized for gastrointestinal complications as those not taking them. Acid-blockers also come with their own list of side effects, and one of them is joint and muscle pain. Again, they result largely because the drugs block natural processes.

Stomach acid has beneficial functions, one of which is to kill bacteria in the stomach. Without the acid, you run the risk of infection by salmonella and other undesirables. Because acidblockers don't cure ulcers but only mask symptoms, they have to be taken for life by ulcer patients. They have been called "annuity medicines" for drug companies, since they can cost several dollars a day.

Copyright © 2001 by Ellen Hodgson Brown.

About the Author

Ellen Hodgson Brown is a health writer who specializes in alternative medicine. Her books include The Alternative Pharmacy (with Dr. Lynne Walker) and The Key to Ultimate Health.