NSAID's .. non-steroidal anti-inflammatory drugs ..

These are excellent pain relievers and effectively reduce inflammation just as the name suggests, without the nasty side effects of steroid drugs such as cortisone or prednisone. Unfortunately, they do have side-effects of their own, including stomach upset, possible stomach ulcers and .... fluid retention and edema!! For those of us with chronic pain conditions, these drugs are a mixed blessing .. they allow us to function comfortably, but the edema and weight gain can be so frustrating

Ibuprofen (Motrin, Advil) is the most commonly available, although naproxen (Aleve) is available over-the-counter in the US (and now also in Canada). Many of the NSAID's which are available by prescription-only also have this tendency .. eg. Celebrex.


Why do NSAID's cause fluid retention?

NSAID's block the formation of certain "bad" prostaglandins which cause inflammation and pain. However, they also block some "good" prostaglandins too .. in particular those that are needed do keep blood vessels in the kidneys dilated. When blood vessels in the kidneys are constricted, then the flow of blood is reduced, which in turn reduces the glomerular filtration rate (GFR), or the rate at which the kidneys filter blood. This slowed filtration rate causes a bit of a backlog in the bloodstream which leads to increased blood pressure, so the body relieves the pressure by causing some of the excess water-fluid to seep through the blood vessel walls and into the tissues. The reduced filtration rate also causes the kidneys to retain sodium and potassium.

For most people, this effect is temporary and transient; it clears up once the NSAID is out of the system. However, persons with kidney disease, the elderly and also liver disease need to use these with caution, or even not at all. Also persons taking ACE-inhibitors for blood pressure, and potassium-sparing diuretics such as spironolactone should not use NSAID's without discussing with their dr. This includes aspirin!


What to do if you need to take NSAID's?

1. Take fish oil supplements. The omega-3 fatty acids have anti-inflammatory effects of their own, by also inhibiting the formation of "bad" prostaglandins. Minimum 3 capsules per day (1000mg per capsule) .. make sure they're fresh! Or .. eat 4 - 5 servings of fatty cold-water fish per week, such as sardines, mackerel, and salmon. Avoid canned fish in soybean, cottonseed or "vegetable" oil .. choose only water-pack or olive oil, or packed in its own juices. Those other oils are high omega-6, and will undo any benefit from omega-3 EFA's in the fish.

2. Don't stop taking prescribed medication without consulting your doctor. The anti-inflammatory benefit usually outweighs the temporary fluid retention.

3. Reduce sodium intake, and avoid using potassium supplements or salt-substitute while taking NSAID's. Use salt-free herbal blends instead, eg. Mrs. Dash.

4. Ensure adequate hydration by drinking at least 8 x 8 fl. oz. glasses of water daily ... Despite the fluid retention, it's important to prevent dehydration which will further compound reduced blood flow to the kidneys. In other words, keep them kidneys flushed!

5. Avoid caffeine and alcohol, as these promote dehydration.

6. Increase fiber - especially fiber from vegetables - and ensure adequate fat intake. Nuts and seeds are excellent as well. Fiber and fat together help to avoid constipation, which can worsen the fluid retention.

hth,

Doreen