Ibuprofen and endurance exercise

As it's spring marathon time again I thought I'd pick up a subject that my clients and friends regularly ask me about - ibuprofen and endurance exercise.

Ibuprofen and other Non Steroidal Anti Inflammatories (NSAIDs) are a common part of many endurance athletes’ arsenal. However, people often don't realise the potential risks involved with taking them during exercise.

What are the dangers?

The risks for your internal organs can be severe, and even fatal. The impact on kidney function has been well-document over the years, and a study in 2017 showed increases in Acute Kidney Injury (AKI) among endurance runners that took NSAIDs.

Aside from affecting kidney function (ultrarunner Erik Skaggs partly attributes his renal failure post-100k race to ibuprofen), a study conducted in 2011 showed evidence that taking ibuprofen when exercising led to increased intestinal leakage. To break that down, when you’re exercising digestion becomes a luxury and blood flow is diverted away from the intestines. Because of this, some of the starved cells become traumatised and start to leak. This is something that can happen anyway during an endurance event, but the study found this was significantly increased by ibuprofen. For someone that takes it on a regular basis, this could have serious long term consequences. In 2013, a 23-year-old runner taking part in the Brighton Marathon died of bowel ischaemia after he reacted badly to ibuprofen and sports supplements. Another study conducted around the Western States 100 mile run found that participants that were regular ibuprofen users had traces of colonic bacteria in their bloodstream. Yet despite the risks, many runners continue to pop them like tic-tacs, even during a marathon. I can only assume this is down to a lack of education on the subject, and people not fully understanding the risks. A few years ago I got into a heated debate with a fellow runner during the Brighton marathon after I saw him offering ibuprofen to another runner, mid-run. Needless to say, I stepped in to shout some professional advice at him.

What's in the box?

It's important to remember NSAIDs aren’t just lurking in that box of Nurofen - but also include topical pain relief gels such as Voltarol or ibuprofen gels, and also drugs like naproxen.

Ibuprofen in the right situation and context can be a good thing, but pain is the body’s way of telling you something is wrong, so masking it with anti-inflammatories can only be a bad thing in my opinion, especially during exercise. Some doctors suggest sticking just to paracetamol if you really require pain relief. And if you’re on any medication you should always speak to your GP before you begin training for an endurance event or long distance run.