STORY AT-A-GLANCE
- Commonly prescribed to treat pain, nonsteroidal anti-inflammatory drugs
(NSAIDs) are linked to an increased risk of heart failure in people with Type 2
diabetes
- Data show people with diabetes have twice the risk of heart failure
without using NSAIDs, and have a higher risk of chronic low back pain and
degenerative lumbar spine disorders, which may increase the potential they use
NSAIDs
- Decades of research have not supported a correlation between cholesterol
and heart disease; Dr. Malcolm Kendrick asserts there is a thrombogenic
pathology responsible for heart attacks. He recommends avoiding NSAIDs as they
trigger platelet aggregation, making blood clots more likely
- Heart failure occurs when the heart muscle doesn't function efficiently.
Data show that supplementation with omega-3 fats and vitamin D lower
complications from, and risk of heart failure
- Anti-inflammatory properties of some foods and supplements have
demonstrated efficacy similar to diclofenac, a nonsteroidal anti-inflammatory
drug commonly prescribed for mild to moderate arthritis. Consider curcumin,
Frankincense, capsaicin, omega-3 fats and fermented and cultured foods to help
lower inflammation and control pain
Nonsteroidal anti-inflammatory drugs (NSAIDs)1 are used to treat mild to
moderate pain. Research2 presented at the European Society of Cardiology in
August 2022 demonstrated that these over-the-counter pain medications can
increase the risk for heart failure in individuals who have Type 2 diabetes.
NSAIDs are used to treat such conditions as back pain, sprains and strains,
headaches, migraines, osteoarthritis and menstrual cramps. Low back pain is a
common global issue that is the leading cause of years lived with disability.3
According to the World Health Organization,4 the number of people globally with
diabetes rose from 108 million in 1980 to 422 million in 2014. According to the
CDC,5 6.2 million adults in the U.S. have heart failure and roughly 37.3
million Americans have diabetes.6
Unfortunately, those with Type 2 diabetes have a higher risk for heart failure
when using anti-inflammatory medications and have a higher incidence of chronic
lower back pain, which may prompt the use of NSAIDs. There is also a strong
association between people with Type 2 diabetes and degenerative lumbar spine
disorders,7 which can cause low back pain.
Newly diagnosed Type 2 diabetes is also linked with an increased risk of
chronic lower back pain,8 with a higher incidence found in women than in men.
One 2017 study9 analyzed the relationship between the progression of diabetes
and back pain. The data showed that patients with uncontrolled diabetes had an
increased development of chronic back pain.
Nonsteroidal Anti-Inflammatory Drugs Linked to Heart Failure
The current study10 presented at the European Society of Cardiology in
Barcelona, Spain, demonstrated that short-term use of NSAIDs is associated with
heart failure in individuals with Type 2 diabetes.11
The scientists wrote12 that a previous association had been made between NSAIDs
and an increased risk of heart failure in the general population.13,14 They
sought to determine if using NSAIDs with Type 2 diabetes could increase the
risk of heart failure, given that people with Type 2 diabetes have twice the
risk of heart failure without using NSAIDs.15
The researchers included 331,189 participants whose average age was 62 years.
Those who used NSAIDs claimed prescriptions of ibuprofen, diclofenac, naproxen
and celecoxib. The researchers did not include over-the-counter use of NSAIDs
in the analysis.
They recorded a median follow-up of 5.85 years, during which 23,308 people were
hospitalized for the first time with heart failure. Researchers then separately
analyzed the individuals who reported they took NSAIDs and found that there was
an increased risk of hospitalization for heart failure with the use of
diclofenac or ibuprofen. They did not find the same risk in those who took
naproxen or celecoxib.
However, only 0.9% of the participants took naproxen and 0.4% took celecoxib.
Researchers believe that the lack of association between those two NSAIDs and
heart failure might have been due to the small percentage of participants who
took the prescription medications.
Further analysis showed that the strongest association was found in
participants who used NSAIDs infrequently, and in patients who were older than
65 years. There was no association in individuals who were younger than 65
years or who had normal hemoglobin A1c levels. Dr. Anders Holt, one of the
researchers in the study concluded:16
“This was an observational study, and we cannot conclude that NSAIDs cause
heart failure in patients with type 2 diabetes. However, the results suggest
that a potential increased risk of heart failure should be taken into account
when considering the use of these medications. On the contrary, the data
indicate that it may be safe to prescribe short-term NSAIDs for patients below
65 years of age and those with well-controlled diabetes.”
Are Blood Clots a Root Cause of Heart Disease?
For the past six decades, U.S. dietary advice has warned against eating
cholesterol-rich foods. The claim is that dietary cholesterol promotes arterial
plaque formation, which leads to heart disease. Yet, even with overwhelming
evidence to the contrary,17,18,19,20 dogmatic thinking has been persistent.
Decades of research have failed to demonstrate a correlation between dietary
cholesterol and heart disease. The 2015-2020 Dietary Guidelines for Americans
addressed this shortcoming, announcing that “cholesterol is not considered a
nutrient of concern for overconsumption.”21
However, a mere five years later they reversed the decision. The 2020-2025
Guidelines22 recommend lowering trans fats and dietary cholesterol. Of course,
trans fats should be limited or even eliminated, but it is absurd for the USDA
to revert to its old recommendations since cholesterol is not the cause of
heart disease.
In an interview with Dr. Malcolm Kendrick23 in early 2022, we discussed the
underlying mechanism for heart disease and the pathological processes that
cause blood clots to form on the arterial walls. The thrombogenic hypothesis of
heart disease asserts when these blood clots are not eliminated, they become a
vulnerable point over which other blood clots will form. Over time, this
appears as an atherosclerotic plaque.
When endothelial cells are damaged, a clot forms to help repair the area. This
is then covered by endothelial progenitor cells to help create a new
endothelial layer. This repair process is gradual and nearly always ongoing.
Problems occur when the damage and clotting process happens faster than the
repair process.
In this case, plaque begins to build up, which thickens the arterial wall and
forces blood through a narrower gap. There are several common causes of
endothelial damage24 such as viral infections, smoking, diabetes, high blood
pressure and exposure to heavy metals, such as lead, aluminum and arsenic.25
In his book, “The Clot Thickens: The Enduring Mystery of Heart Disease,”
Kendrick reviews many different strategies that can lower your disease risk,
one of which is to avoid using NSAIDs, such as ibuprofen, naproxen and aspirin.
Although these drugs effectively inhibit inflammation in the body, they also
cause platelet aggregation by blocking COX-2.26,27 In other words, they
activate your blood clotting system, which makes blood clots more likely.
Omega-3 and Vitamin D May Lower Heart Failure Complications
Heart failure, which is sometimes called congestive heart failure, happens when
the heart muscle doesn't function as efficiently as it should. This causes
blood to back up and sometimes fluid to fill the lungs. Health conditions that
can trigger heart failure are high blood pressure, coronary artery disease,
obesity and diabetes.28
Data from a 2022 study29 published in JACC showed that people with Type 2
diabetes had a lower risk of hospitalization for heart failure when they used
omega-3 supplements. Data were gathered from the vitamin D and Omega-3 Trial
(VITAL),30 which started in 2010.
The parent trial engaged 25,871 men and women to evaluate dietary
supplementation with vitamin D3 or omega-3 fatty acids and the impact it had on
developing heart disease, stroke or cancer in people who did not have a history
of these health conditions. Participants used the supplement for a five-year
intervention phase and researchers continued with ongoing follow-up.
Data from the ancillary study,31 in which the researchers evaluated whether
omega-3 supplementation could lower the risk of the first heart failure with
hospitalization or recurrent hospitalization, showed it reduced the
hospitalization rate for the first heart failure by 0.69 in participants who
had Type 2 diabetes when it was compared against taking a placebo.
They also found it effectively reduced recurrent hospitalization in Black
participants. The data did not show a benefit for preventing heart failure in
individuals who did not have Type 2 diabetes. There is also evidence from
multiple studies that vitamin D has a significant cardioprotective effect.
One study found that in patients with congestive heart failure, vitamin D may
serve as “a new anti-inflammatory agent for the future treatment of the
disease.”32 Evidence also suggests that vitamin D has an impact on mineral
metabolism and myocardial dysfunction in patients with CHF. Researchers
concluded that deficiency may be “a contributing factor in the pathogenesis of
CHF.”33
Epidemiological studies have provided strong support that vitamin D has
cardioprotective effects34 and data show that most patients with CHF have
insufficient vitamin D levels, lower than 20 ng/mL.35 More data indicated that
low concentrations of vitamin D3 contribute to a poor prognosis in patients
with heart failure, which may be related to inflammation.36
Furthermore, deficiency is highly prevalent, including in patients with heart
failure and is “a significant predictor of reduced survival.”37 Researchers
found that supplementing with vitamin D was independently associated with a
reduction in mortality in people with heart failure and that lower vitamin D
levels were associated with high body mass index, diabetes, decreased calcium
and hemoglobin levels and female gender.38
Alternative Anti-Inflammatory Foods and Supplements
The anti-inflammatory properties of nonsteroidal anti-inflammatory drugs help
promote pain control. Thankfully, there are alternative strategies that help
reduce the inflammatory process in your body and therefore help reduce pain.
Curcumin is one of those strategies. Curcumin is the major biologically active
polyphenolic compound of turmeric and the compound that give it the
characteristic yellow color. Turmeric has long been used in Indian cuisine and
medicinal use in traditional Chinese medicine and Ayurvedic medicine.39
The safety and nontoxicity of curcumin, even at high doses, have been
documented in human trials.40 It has demonstrated the ability to slow the
progression of osteoarthritis and relieve pain in an animal study,41 and in one
human trial42 with 139 people with knee osteoarthritis, researchers found there
was no statistically significant difference in pain between people taking
curcumin and those taking diclofenac.
Additionally, those taking curcumin had fewer episodes of flatulence,
experienced statistically significant weight loss and did not require an H2
blocker to reduce excess stomach acid, which 28% of those using diclofenac did.
Other anti-inflammatory foods or supplements include:
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Fermented and cultured foods — These work by balancing your gut microbiome and
optimizing your gut flora. Gut dysbiosis can increase the inflammatory response
in your body and contribute to pain.
Fermented foods such as kefir, natto, kimchee, miso, tempeh, pickles,
sauerkraut, olives and other fermented vegetables will help reseed your gut
with beneficial bacteria. Ideally, you'll want to eat a wide variety of them as
each contains a different set of beneficial bacteria (probiotics).
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Omega-3 fatty acids — Marine-based omega-3 fats found in cold water fish are
low in environmental toxins. They are particularly important for brain and
heart health. Get your omega-3 fats from wild-caught Alaskan salmon, sardines
and anchovies. It is also necessary to reduce your omega-6 intake to achieve a
balanced intake of as close to 1-to-1 as possible.
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Matcha tea — This nutrient-rich green tea comes as a stone-ground unfermented
powder. The best Matcha tea comes from Japan and is an excellent source of
antioxidants.
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Herbs and spices — Ounce for ounce, these are the most potent anti-inflammatory
ingredients. One study43 found cloves, ginger, rosemary and turmeric could
significantly impact systemic inflammation. In another study,44 garlic
effectively lowered several biomarkers of inflammation, including C-reactive
protein, TNF-α and interleukin-6.
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Capsaicin — One 2013 animal study45 found capsaicin "produced anti-inflammatory
effects that were comparable to diclofenac," a nonsteroidal anti-inflammatory
drug commonly prescribed for mild to moderate arthritis.
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Frankincense (Boswellia serrata resin) — One paper46 noted Frankincense
"possesses anti-inflammatory, anti-arthritic, and analgesic properties" and is
an inhibitor of leukotriene biosynthesis. This makes it useful in the treatment
of pain and disease driven by leukotrienes, such as inflammatory and
degenerative joint disorders.
Another study47 found Frankincense and myrrh are capable of suppressing
inflammation by inhibiting the expression of inflammatory cytokines.
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