Next Sunday more than 50,000 people will participate in the London Marathon; It’s just over 26 miles of blood, sweat and tears, and then adrenaline, as the runners cross the finish line.
They’ll end the day with memories to last a lifetime, raise millions for charities, and most importantly, get a huge health boost from months of training.
However, although the benefits of running far outweigh the harms if you are otherwise healthy, there are risks: some will not finish the race and may end up with a serious medical emergency.
Many of you reading this will never undertake a long career and may think that none of this is relevant to you.
Professor Rob Galloway has been medical director of the Brighton Marathon for 12 years.
But if you take anti-inflammatory tablets like ibuprofen or use an anti-inflammatory painkiller gel, think again.
Let me explain: two weeks ago it was the Brighton Marathon, of which I have been medical director for the last 12 years. I’ve seen the problems a massive race can cause and this year was no exception.
As I write, one of our runners is still in the hospital due to heat stroke and kidney failure; The medical team on the tour saved his life.
He was in his twenties and nearing the end of his degree when he collapsed. Its temperature was above 41°C (106°F) and we used a specially designed cooling capsule (I-CWIK) developed by the military. This young man is now on dialysis because running this race severely damaged his kidneys.
Heat stroke and kidney failure may well have claimed the life of the legendary Greek soldier Pheidippides in 490 BC. C.: after running from Marathon to Greece to proclaim “Victory”, he fell dead (his feat was commemorated in the first marathon held at the Greek Olympic Games of 1896). .
While we don’t fully understand the complexities of these two conditions, something the Brighton marathon runner told me has implications not just for next Sunday’s runners, but for all of us. (And helps explain why this otherwise fit and healthy man became so dangerously ill.)
The day after running, he said that to avoid developing knee pain during the marathon, he took an ibuprofen pill just in case while out.
Marathon runners should be careful when taking anti-inflammatories like Nurofen, says Professor Rob
Anti-inflammatory pills like ibuprofen, naproxen, and even gels like Voltarol are types of NSAIDs (nonsteroidal anti-inflammatory drugs). They work by inhibiting an enzyme called cyclooxygenase (COX), which is involved in inflammation.
During strenuous physical activity and in hot weather, the body loses its ability to regulate temperature (partly due to increased heat production from hard-working muscles; while dehydration and blood flow directed from skin to vital organs means you sweat less). ).
NSAIDs make this worse in several ways, including reducing the kidneys’ ability to control the fluid balance in the blood. But not everyone is affected in the same way.
In a study published late last year in the Journal of Science and Medicine in Sport, we gave runners small thermometers that they swallowed before the race: the results showed that some runners who experienced temperatures above 40 ° C (104 ° F) had no symptoms, while others suffered from heat stroke (with symptoms such as confusion, muscle stiffness, and kidney failure).
So something else besides body temperature was at play and caused them to collapse. One theory is that heat (from hot weather or strenuous exercise) causes bacteria to leak out of the intestines. NSAIDs, even a single tablet, according to our Brighton broker, can also make our gut more permeable. The bacteria enters the bloodstream and can cause sepsis-like symptoms: low blood pressure, confusion, and elevated heart rate.
Additionally, after running, some people suffer a greater amount of muscle damage that produces a protein in the blood, creatine kinase, that prevents the kidneys from working. And yes, NSAIDs also reduce blood flow to the kidneys. So a perfect storm for kidney failure.
There is an important message about this for non-runners as well.
A couple of years ago, a 58-year-old carpet installer came to the ER lethargic, lacking concentration, and itchy. Blood tests showed that he urgently needed kidney dialysis.
And after evaluating him, the cause became clear: he had developed knee pain after years and years of kneeling. As he was self-employed, he couldn’t afford a day off and so he took ibuprofen daily, in addition to liberally using Voltarol gel. His long-term use of NSAIDs had caused kidney failure.
While the dialysis machine took over the function of his failing kidneys, stopping the anti-inflammatory medications allowed his kidneys to heal, and two weeks later he was released from the hospital and off dialysis. But she had been very close.
During strenuous physical activity and in hot weather, the body loses its ability to regulate temperature.
When it comes to running marathons, is it just the pills that are dangerous or are the gels also a risk? The answer is that we’re not sure: we know that the gel is absorbed into the blood and therefore could theoretically cause problems, especially when used in excess.
This is why, for the Brighton Marathon (now organized by London Marathon Events), runners were sent specific medical advice before the race which stated: “Do not take any anti-inflammatory medication before, during or during 24 hours after the marathon.” . . Anti-inflammatory gels are safer than pills, but they can also cause problems during the marathon race, so they should be avoided before or during the event.
Unfortunately, most people don’t read advice sent or receive it from friends or social media.
It is not just a specific resistance exercise that is worrying: using them for a prolonged period, by anyone, is a risk.
This includes both gels and tablets. In fact, Voltarol gel indicates in the product information leaflet that it should not be used for more than 14 days.
While most people are aware of the risks of NSAIDs taken long term in terms of intestinal problems such as bleeding, many will ignore the risks of kidney problems and heat stroke.
That’s why when summer hits, it’s very important to avoid long-term use of these medications and try to avoid heat stroke, especially if you’re older, because poorer kidney function with age puts you at greater risk.
This, combined with the warning that NSAIDs are linked to an increased risk of heart attack, heart failure, and stroke (inhibiting inflammation also causes water and salt retention, and higher blood pressure), is why I now advise my patients to take them only for a short period.
When I’m about to do a long run, I avoid any type of NSAID, even a single dose.
And for those suffering from chronic pain, such as that caused by arthritis, my advice is to look for other forms of relief, such as thermal gels, cold water swimming and paracetamol.
We have become overmedicalized when it comes to pain management and we don’t always think about the side effects of medications.
NSAIDs may provide temporary relief, but in the long term they can be very risky.
As for runners, a single dose of an NSAID before a race may help them get to the starting line, but could put them at risk of reaching the finish line safely.
As my patient told me when I got out of his intensive care bed: ‘I had no idea my ibuprofen tablet could cause my problems. Please tell others so they know and don’t suffer like me.’
@drobgalloway