UKC

Just reading through some details of an Ultra this year and found this in the advisory notes.

'There is extensive research to support the claim that NSAIDs (ie. ibuprofen/ paracetemol etc) greatly increase a runners chances of reaching a stage of renal shutdown.'

'If not treated, renal shutdown can cause permanent impairment of kidney function'

Wasn't aware of this. Will do some more research i think.

In reply to Darren09:

If you take a load of them ( i.e. more than recommended ) in order to grind through and finish then that seems fair enough to me.

Terms like greatly increase are a minefield. It can greatly increase the risk from 0.000005% to 0.000015% for example. Even then what does that mean ? % of what ?

It needs more clarifcation.

Does taking normal doses whilst running = a bigger risk than not running or is it just a general warning not to overdose in roder to finish ?

In reply to Darren09: Yeah, they aren't good. I take a few 400 mg pills but probably won't go over 2 grams.

The other thing is alcohol after a hard run, your body then can't deal with the lactic acid and you can end up in serious shit.

During boston marathon I took a 1200mg ibuprufen and was seriously dehydrated, and it killed me, my gut wall just fell to pieces. I was in a mess.

In reply to IainRUK:

I remember that story being a good one. Go on, shock us with the gory details again.

In reply to biscuit:

Yes. See http://www.westhighlandwayrace.org/info/medical.htm (written by my doctor, who's pretty expert in this field), starting at:
'Anti-inflammatory medications such as ibuprofen (Brufen), diclofenac (Voltarol) and mefenamic acid (Ponstan) are fluid retaining and should be avoided before or during the race.'

And going on to read the stuff about over-hydrating and kidney failure.

In reply to Darren09:

If you need to take pain killers during an ultra isn't tat saying your body sent really ready for the distance yet?

In reply to Beat me to it!:

No.. its just trying to tackle the inflammation.

In reply to Beat me to it!:

No, i don't think so..... could be taken for headache/minor pain etc.

In reply to Darren09: If you need anything other than water and grub you aren't ready in my opion Having to tsake pain killers of any type is not good news when you are pushing your body. Inflamation/ headaches etc happen for a reason - think of them as a warning. Sometimes it's a braver decision to quit.

In reply to mikekeswick: Well I'm ranked second in Britain over 100km and I've never finished an ultra, nor marathon, without ibuprofen..

In reply to Darren09:

I used not to take them when younger, but certainly have for the last few years (I'm now 60) and I do find them pretty essential once over 6 hours, especially to keep the swelling down in my joints and help my leg muscles.
Last Sunday I completed a solo unsupported Leventon's Line and was on my feet for nearly 22 hours, I took 3 x 400mg of Ibuprofen in that time, the most I have ever taken but I needed them. Can't say I've ever noticed any problem.

A number of friends are GP's (mainly 50+ years old) and they all guzzle them down on long distance efforts.

In reply to Moley:
I would point out that all these drugs (non-steroidal anti-inflammatories) do have a reduction in renal blood flow as a side effect. Not usually a problem unless you go crazy with the doses, but I would suggest that the advice leaflet is pointing out that some people will have a problem with fluid balance after/during an ultra - if you combine that with a chunky dose of ibuprofen/diclofenac/etc you might well push yourself onto a shortlist (actually quite a long list!) for a new kidney. As with all of these things, it's about the individual knowing their limits & 'listening' to their body (and judicious maintenance of fluid balance) which is probably less of a problem if you're doing/have done this a lot. In terms of 'noticing a problem', you won't until you've lost >75% kidney function.

lardbrain at work

For what it's worth, i reckon this is probably also quite important in alpinists, especially if they're old-school and don't drink much during the day...

Was it Don Whillans (at the bar) who said 'i have a terrible fear of dying of dehydration'?!

In reply to Darren09:
How strange, was just talking with my wife about dosages of medicines and she was telling me about a soldier she saw when she was in Iraq who had acute renal failure after taking the recommended dose for two weeks for an injury. Apparently quite common either due to a reaction or to high a dosage.

Cheers

Toby

In reply to Toby_W: Lloyd Taggart, of fell running fame, had a major reaction to taking a tablet a few years back, luckily someone found him and they got him an ambulance. He'd had used them for years no issues at all.

I'd be very wary about taking them for more than a few times and for the odd race. I can't think of a time I've taken them in training.

In reply to IainRUK:


I've heard about the NSAIDs/Kidney issue for a few years so always steer clear on anything post-marathon distance and try to limit them in general during training.

Yesterday I ran a 62km trail race with about 3800m +/- in the French Alps, with temps touching the low 30s so heat and dehydration were a big problem. However there was still free beer on offer at the end and even a bottle of Merlot (although I never saw anyone have any so maybe it was for the aid crew) at the final feed station!

I slogged my way round in 10 hours (sans-ibuprofen), the climbs were brutally steep and to be honest I was more worried about hypotraemia and drinking too much water as its just natural when you can't cool down. A lack of any natural water sources like streams and waterfalls to dip into made it worse.

I had a beer and a glass of wine with dinner afterwards though and seem to be OK. Cramps again were the biggest problem but massages at the end laid on by the fire brigade helped there.

In reply to yorkshireman:

Good effort !

Interesting info. I didn't know it could be a potential problem even in normal doses.

In reply to IainRUK:

Doesn't mean that's the right thing to do though...

By way of contrast I've never taken a pill, or even considered it, in any of the marathons or ultras I've done.

In reply to r0b: It frees up the legs.. pop one and you feel a response pretty fast. I'm just saying that after winning numerous ultra's and marathons, setting the record for a few (neuces 50k Texas, Flat rock 50k cansas), selected to compete internationally for Wales over 100km in 2009, 10, 11, 12, 13, now selected to compete for GB, that my body is ready to run an ultra.

But what are your pb's? I'd suggest that slow jogging is less inflammatory than say 100km on target where you run at around 7:00 min mile pace for 62 miles.. you will get inflammation, and I just think popping a few anti-inflammatory is pretty normal and does not suggest my body isn't ready to compete.. TBF I run 90-100 miles a week, so it is ready to compete..

It's legal, I'm in no way performance enhancing, and to be honest I think my performances have suggested I set my body up well to compete ultra-distance runs.

I probably actually took less when I ran the UTMB in 29 hrs back in 2009, then I did 3 weeks later at a 100km race on the roads that took 7:40. Its just a totally different situation. I would say experience the 100k's then make the statements..

In reply to IainRUK:
[...]

How do those two go together?

In reply to owlart: Because one is banned.. If you use the strictest term everything is a performance enhancer.. sugar, caffiene especially.. salt.. you take them you enhance performance.

All I'm saying to you, and Rob, is run a 100k on the roads, get experience, then come back and make statements about what or what is not acceptable...

In reply to IainRUK: Ok, I see. It's legal performance enhancing rather than non performance enhancing.

In reply to owlart: Go and get some experience.. anything enhances performace. In sport, those of us that compete, who are eligible for drug testing, know what we can and cannot take.

You're trying to be smart.. talking about a subject you have zero experience in...

A body can't run 100km without additional food.. well it can't run optimally, it can't run optimally without the odd anti-inflammatory. I'm fairly sure I actually ran the winter Paddy Buckley off no use of anti inflamms but that was a hill walk over 25 hrs.. not a relentless hard run.

In reply to IainRUK:

2:52 marathon, 16th in Lakeland 50 2010 (10:30) is my best ultra performance. Not that it's really relevant.

No problem with you doing whatever you want in races (legally!) but I don't think you really have any evidence to support the use of NSAIDs in general. And it's not something I feel inclined to try.

In reply to IainRUK:

Oh come on now, comparing food and NSAIDs is ridiculous!

In reply to r0b: Ok.. well I don't think the LD50 in 10 hours + is comparable to 100k on the roads.. I've not done the LD 50 but I've done the fling, WHW, DoH, Cross Timbers, UTMB so have some experience of off road ultra's but they are incomparable to 100k's on the road. Absolutely incomparable.

In reply to r0b: Why? As said, just run 100k on the road.. but hey or we can talk from a position of no experience.. which is ridiculous..

In reply to Darren09:

I used them on a 100miler and the drs on the checkpoint were actively encouraging their use to people. They really make a difference.

Having said that, I was suffering from really bad back ache the week before a marathon so I took some on the morning so I could run better. My guts gave up, I died on my feet and I had really bad DOMs for days afterwards and I think the profen did that.

My unscientific conclusions is therefore that taking them to deal with inflammation during races is fine. Pre-emptive taking doesn't help at all.

Habitual use of painkillers is foolish. Save it for 'the day.'

In reply to r0b: Tbh I think statements like the body isn't ready if you use them, is ridiculous.

You want to reduce that inflammation, it's like cold baths, anecdotally, they make a huge difference. Maybe I could do that.

You run your style, I'll run mine, we both run within the rules of the sport so why judge what is suitable?

In reply to Eric the Red:

I'm fairly sure that was the issue at Boston, I was severly dehydrated anyway, but then the ibuprofen on an already struggling stomach was just too much. Certainly if I felt stressed in other than just muscle aches or tightness I'd not take them.

I also only race seriously a few times a year. Training I'd never touch them. You should monitor how much, how often, how your stomach feels.

In reply to IainRUK: No, I'm not trying to be smart, you're just being too senstitive and defensive. I was trying to understand what you meant when you said it wasn't performance enhancing. Now you've explained, I understand.

In reply to IainRUK:

I haven't made any statements like that, and I have no problem with you using them (as I said in my earlier post). I just don't thing your personal experience is sufficient evidence for a recommendation for others to use NSAIDs in races, that's all.

In reply to r0b:

In no way have I recommended them.

I've said I use them. I have in what 2? 3? posts documented the issues, why they can get you in serious shit. thats all.

In reply to IainRUK:

OK, I think we agree then Good luck in the Trail Worlds.

In reply to r0b: Thanks.. daunting to say the least..

In reply to Darren09: Ian you sound like a guy who knows his own mind
I know mine and the way I see it is if I were to need anything more than food and liquids I am not ready. I regulary run marathon and over distances with nothing more than water and a bit of food with zero problems.
If you feel you need pills to perform at your best then so be it, i'm just saying that your route isn't mine. Your body wasn't made to need anything more than a good balanced diet and water. Good balanced diet is easy to say but not so easy to actually achieve.

In reply to mikekeswick:

I know but the body really isn't meant to run 100km on road..

I could probably do a marathon without but 100km on the roads is brutal. I actually find it far harder on my body than being out for 25-30 hours on things like the UTMB. It's just not natural.

In reply to mikekeswick:

Your body hasn't evolved to need a lot of things that we use habitually from clothes to drugs. It doesn't mean we don't necessarily need them.

Toothpaste. You don't NEED it but you're a lot healthier with it than without.

On a race day, why not 'eat' something that improves performance and has been proven to have few side effects? If you're racing, you want to go as fast as possible surely?

In reply to mikekeswick:

If I took that line then I'd have given up running a long time ago, and probably hill walking as well. Damaged cartilage and the beginnings of arthritis cause pain (though not as much as sitting at a desk all day). I don;t think I could get through a full day on the hills (at any speed) without painkillers.

In reply to Darren09:
As I've said above, I have no problems with the idea of taking them. But when I was younger I managed without - but I didn't do much over 30 miles.

I would say to those that don't take them, you may well change your ideas when you start heading towards 60 years old and want to continue running distances (or jogging as it has become!). I either take them and enjoy my long outing (I'm ok without up to 25 miles/ 5 hours over the hills) or don't continue - there is only so much elderly arthritic joints can take without a little help.

And as for 100k on the road, you can take anything you bloody want to get round as far as I'm concerned. Good luck.

In reply to yorkshireman:

Good effort. And I love the thought of handlebar-moustached sapeur pompiers laying down their axes and oiling up their hands made me chuckle over lunch. Chapeau!

In reply to mikekeswick:


Is there an obvious distinction between taking painkillers to enhance performance and taking, say, steroids to enhance performance? In either case without drugs, a less good performance would result. And, it seems, in either case careless use of drugs results in death! It all seems a bit arbitrary to me.

In reply to MG:

???????????????????????????????????????????????????????????

Bonkers !

In reply to MG:

Of course it's arbitrary, all drug testing is. It's ultimately about creating a level playing field.

In reply to MG: Its entirely arbitrary.

Caffeine is banned. 8 cups of coffee a day is over the limit..

6 cups is OK..

Most have limits which are allowable.

Whats the point in having standards.. you can actually take a number of banned substances at low levels. Its why when people say 'oh there was a mistake'.. it's dubious as often to fail a test you need to be sky high..

I took pseudo-ephidrine as a decongestant by mistake once, well on purpose but did not realise it was back on the banned list, the reality was I needed to eat tubs of the stuff to be above the threshold.

But a number of day to day food items are on the banned list, just at a certain value. Yet most ultra runners will 'use' caffeine to further performance. Certainly numerous runners I know will forgo caffeine for weeks prior to an event so they can then get an additional benefit..

Thats just the reality of the rules.

In reply to IainRUK: http://www.wada-ama.org/en/Resources/Q-and-A/2012-Prohibited-List/

Caffeines OK again.. thought it was banned still.

In reply to IainRUK:

Caffeine isn't banned any more. From WADA (2012 Prohibited List):

"What is the status of caffeine?
The status of caffeine has not changed from last year. Caffeine was removed from the Prohibited List in 2004. Its use in sport is not prohibited.
Caffeine is part of WADA's Monitoring Program. This program includes substances which are not prohibited in sport, but which WADA monitors in order to detect patterns of misuse in sport.
The 2010 and 2011 Monitoring Programs did not reveal global specific patterns of misuse of caffeine in sport, though a significant increase in consumption in the athletic population is observed."

In reply to IainRUK:

Do you come up with Google's tax strategy as well

In reply to biscuit:


How so?

In reply to IainRUK:


Fair enough!

In reply to MG: Because painkiller don't enhance.. they just sustain..

EPO for example enhances performance.. your 10k time will drop 2 minutes.

Here's some info.. if there was a significant advantage they would be banned.. for example cortisone is now monitored.. as far as I know, not banned

http://www.issf-sports.org/antidoping/prohibited_substances/qa_prohibited_l...

It is arbitrary.. it has to be.

In reply to MG:

I think it was because you said:


I think to most people the distinction is obvious, hence the comment. I know we can argue forever about where to draw the line, but most people have a fairly common understanding of what counts as PEDs to get a competitive advantage, and using normal OTC medicines to mitigate the adverse effects of endurance sport.

In reply to yorkshireman and IainRUK


I don't really see how it's obvious. Not having knees hurting on every stride for example must make as much difference as having great VO2 capacity in terms of speed, at least potentially.

If its accepted it's arbitrary then fine but I don't see a clear distinction, particularly when both can result in severe injury or death. Both are using drugs to enhance performance with associated risks. I can see a difference with say altitude training or a carefully controlled diet where (within reason) there is no medicial risk

In reply to MG: Altitude training would be a risk.. its why they have a haemocrit count limit, regardless of drugs taken you can be suspended from activity..

And NSAIDS won't stop pain.. they will just reduce inflammation, free the legs, but you certainly feel a lot. More powerful pain killers will be banned.

Its why we have WADA.. they decide what is and what is not ethically acceptable. I think taking 2-3 400mg of NSAID during a race is different from months of artificially raising your RBC through EPO use..

But look at alcohol, in some sports its OK, in others its banned but only above a certain level.

the risks from NSAIDS are minor really, worth being careful about, but not say like takinG EPO which turns your blood to treacle.

In reply to MG:

That's why I said 'to most people'

In reply to yorkshireman: Well most people here seem to think it is to an extent arbitrary. What do you think the obvious distinction is?

In reply to IainRUK: So all a matter of degree. Reasonable.

In reply to MG:

Sorry 5 mins before I need to be on a call, so quick response.

I agree it's arbitrary, always have. However I think the distinction between something like ibuprofen as a means to treat inflammation, and injecting EPO in order to artificially increase your haematocrit level, is an obvious one and if you can't see that then we have to beg to differ.

The philosophical argument about where you draw that line can go on forever and I'd much rather have that conversation over a pint as it won't change the reality of sporting competition (since there's a clearly mandated definition of right/wrong from WADA), but is an interesting thought exercise.

In reply to Toreador: I'm sorry to hear that but of course I was talking about somebody who wasn't carrying injuries or else we get into a whole new debate.
I personally have torn my acl and damaged the meniscus in the same knee - touch wood everything is fine and I get zero twinges from my knees. In fact i'm amazed at just how good I felt after doing my first few marathon distance runs...
Has anybody read Scott Jureks - Run and run book? It was nice when I read it as it confirmed a lot of things i'd worked out for myself.
He talks about use of anti-inflamatories in there...quite interesting.
Another interesting point is the amount of ultra races he was entering and winning with very little recovery inbetween...something which he puts down to eating correctly.

Ian, you need to give up on this thread mate, your never going to get your point across to some people, especially those want to argue black is white.

In reply to Darren09:

Hey all, don't normally posts in these blogs but it caught my eye.

Am in no way an expert sports physiologist but am an anaesthetist and part of the moutnain medicine diploma, as well as being pretty active in the outdoors so have a pretty good handle on the physiology and pharmacology of this.

NSAIDS inhibit the production of a chemical that is involved in inflammation. That is how they have their effect. This chemical is also important in regulating blood flow in the kidney and the protection of the stomach from its own acid. Hence the main side effects are renal failure and stomach ulcers.
NSAIDS will reduce the ability of the kidney to cope with dehydration and increase the likely hood of acute renal failure in water stressed states.. Although this is normally recoverable this is bad news and something you really don't want it. I know of someone who took NSAIDs thro an ultra and ended up in hospital nearly needing dialysis.
If your going to take them make sure your hydrated and peeing ok. I know plenty of folk wh otake them after exercise to help recovery. If you do hydrate and pass urine first.

At the end of the day there will always be people who get away with this and those that don't. Individual anecdotes are meaningless. The most important factor in any area of medicine or indeed physiology and sports performance is your genetics. Choose your parents well! It is impossible to know how you are made up and how your body will respond to drugs.

The max daily dose of ibuprofen is 1200mg. It doesn't really matter how you divide this up as long as you stay with in it in a 24hr period.
Paracetamol works in a different way, the max daily dose is 4g but you must leave 4hr between dose. I know of no reason why you can't take this exercising.

Happy running.

Ben

In reply to benwarrick:
Thanks, that post is informative in easy to understand language. Excellent and explains matters well.

In reply to all.

Its good to talk.