Apirin good; Advil / Ibuprofen / Tylenol / Acetaminophen bad

Sometimes you notice things…

Sometimes the spouse does…

Sometimes they matter…

In this case I’d noticed that I was particularly lethargic while the spouse had noticed a tiny tinge of jaundice to the eyes (that resolved the same day). A bit of digging…

Some months back I’d swapped the “pain killer of choice” for arthritic moments from aspirin to ibuprofen. No particular reason other than that I had been nagged about stomach bleed risks by the medical establishment to the point of being a bit paranoid about it.

I was unwilling to swap to Tylenol / Acetaminophen for the simple reason that it is the leading cause of liver damage from drug overdose. Mixed with even modest quantities of alcohol you can end up needing a liver transplant; though the package insert tries to make it sound like you have to be a raving alcoholic; that isn’t the case. The two work to lower the threshold for liver damage and the overdose level for acetaminophen is a small distance above the normal dose. It has a narrow range between therapeutic and toxic dose.


Because acetaminophen (APAP) is the most widely used pharmaceutical analgesic and antipyretic agent in the United States and the world (contained in >100 products), it is reported by the American Association of Poison Control Centers to be one of the most common pharmaceuticals associated with both intentional and unintentional poisoning and toxicity. Acetaminophen toxicity is the most common cause of hepatic failure requiring liver transplantation in Great Britain. In the United States, APAP toxicity has replaced viral hepatitis as the most common cause of acute hepatic failure and is the second most common cause of liver failure requiring transplantation.

Acetaminophen is also known as paracetamol and N -acetyl-p-aminophenol (APAP). This agent is available in the United States as 325-mg and 500-mg immediate-release (IR) tablets, and as a 650-mg extended-release (ER) preparation marketed for the treatment of arthritis. Various children’s dissolvable, chewable, suspension, and elixir formulations of APAP are available. Acetaminophen is a component of many over-the-counter (OTC) cold and analgesic medications and prescription combinations, including codeine-acetaminophen (Tylenol #3) and oxycodone-acetaminophen (Percocet).


Acetaminophen is hepatotoxic if taken in overdoses, and for adults, more than 7.5 – 10g/d are considered an overdose (2002 FDA Advisory Meeting). The currently recommended maximal therapeutic dose is 4 g/d, however, instructions for use are often confusing. One product states that up to two 500 mg extra strength tablets can be taken every 4-6 h as required, but not more than 4 g/d. If the condition for which acetaminophen is taken extends over more than 18 h, even with the longer (every 6 hr) interval, there is a chance to go over the recommended daily dose.

So just a ‘double dose’ can be toxic and sometimes the label directions put you close to that. (the article goes on to show how following those directions and being a bit un-careful about the 4 gm / day can cause an overdose). Add a bit of wine with dinner or some beer at the beach and that toxic threshold drops. How much? That isn’t clear…

So I’ve generally avoided Tylenol / acetaminophen.

Once, when I was at the first aid station at the Sharks Game with a headache asking for an aspirin and specifically told the guy I’d had a couple of beers and did not want acetaminophen due to the liver risk, I was handed a generic acetaminophen and told it didn’t have any Tylenol in it… It is incredibly hard to avoid and it is very easy to take a Tylenol and some cold medicine that also has acetaminophen and get a double dose.

So I’m very sensitive about the issue.

But apparently not quite paranoid enough.

Aches and Pains

I’ve had sporadic arthritis. I’ve pretty much traced it back to foods. Primarily “cow stuff” but lately tomatoes too. It is easy to avoid beef and eat pork or lamb instead, but my weakness is beef burritos and ice cream. Oh, and marinara sauce…

About January I’d not yet figured out the tomato reaction (even though it is listed in The Arthritics Cookbook.) So I’ve had some ‘aches and pains’. Then the weekend marathon of schlepping tool boxes and lead batteries had brought some aches and pains as well.

Due to the aspirin and bleeding paranoia nag, I’d bought a bottle of Ibuprofen about last January. Didn’t think much of it. But I’d “upped” my use of Advil / Ibuprofen from ‘nearly none’ to ‘nearly daily’ due to those kinds of things. But I didn’t particularly worry about the wine every so often nor the occasional beers. ( I probably average about a bottle of wine per week, or less some weeks. Occasionally I’ll down a whole bottle in one day. At 100 kg, that’s not a whole lot.)

But what I had not done was be paranoid enough to check for Advil / Alcohol interactions to see if the same risks exist to the liver from that mix as exist with Tylenol / Acetaminophen.

So it caught me a bit by surprise when the spouse said she thought the whites of my eyes were tiny bit yellow last night. (Today all is fine). WHAT was different about yesterday? I’d had a glass of wine AND ibuprophen. Not much else.

So off I went to look things up…


Both alcohol use and Advil use may contribute to liver damage. Advil may, rarely, cause abnormal liver functioning and liver damage on its own. Although Advil and other brands of ibuprofen are usually safe when taken as directed and for a short period of time, the risks of liver damage with ibuprofen use increase with long-term use. Elevated liver enzymes, which indicate damaged liver cells, may occur in up to 15 percent of patients who regularly use NSAIDs, including Advil, according to Drugs.com. Alcohol use is also associated with liver damage, and combining alcohol with NSAIDs like Advil may quickly result in significant liver damage as alcohol activates enzymes that cause NSAIDs to be even more liver toxic than usual.

So one wonders if about 1/2 the days out of 4 months is “long term use”… and how much overlap with a glass of wine is an issue…

Liver Disease

Over time, using Advil, alcohol, or especially both substances together may lead to diseases of the liver such as cirrosis, hepatitis, jaundice and liver failure. When used long-term or in higher-than-recommended doses, sustained liver damage from Advil use may result in hepatitis, jaundice and even complete liver failure. Heavy alcohol use may also cause these liver diseases and others without Advil use, but even when used in moderate amounts, such as three drinks nightly, alcohol may contribute to liver damage and disease if you are also taking an NSAID like Advil. Therefore, it is of utmost importance to never use alcohol and NSAIDs such as Advil together.

Oh Great…

Well, the good news is that the liver is very good at regenerating and there have only been one or two times I’ve had ibuprophen with wine in the same day. So most likely whatever “compromise” there was is/was transitory. (Today, everything seems fine.)

Still: You would think folks would be making it a bit more clear that BOTH of those drugs (and how many others?) are potentially lethal at common levels of use and mixed with common levels of alcohol use (and don’t even get me started about the 1 Litre / Day wine consumption in some European countries and what THAT means about pushing Tylenol and Advil there).

That puts me back at Aspirin.

Being a bit paranoid, I decided to do some more “digging” about it. The “Livestrong” article tossed aspirin in the same bucket as the other NSAIDS with respect to alcohol, but was it true?


Aspirin shown to help prevent liver damage

Published on January 27, 2009 at 1:43 AM ·

According to scientists at Yale University ordinary aspirin may help prevent liver damage in millions of people suffering from the side effects of common drugs, alcohol abuse and obesity-related liver disease.

The new study by researchers at Yale School of Medicine suggests that aspirin may help prevent and treat liver damage from a host of non-infectious causes.

Dr. Wajahat Mehal from the Digestive Diseases and Department of Immunobiology, says research with mice has shown that aspirin reduced the number of deaths caused by an overdose of acetaminophen, best known as paracetamol.

Dr. Mehal says many agents such as drugs and alcohol cause liver damage, and they found that aspirin blocks a central pathway responsible for such liver injury.

He says aspirin could be used on a daily basis to prevent liver injury and suggests that promising drugs which have failed clinical trials because of liver toxicity might be resurrected if combined with aspirin.

Dr. Mehal says the strategy offers the exciting possibility of reducing a lot of pain and suffering in patients with liver diseases, using a new and very practical approach.

Aspirin it seems counteracts new mechanisms of acetaminophen or paracetamol-induced liver damage – overdoses of acetaminophen account for most drug overdoses in most Western countries.

Such overdoses cause two waves of liver damage – the first wave of liver cell destruction is a result of the toxic nature of acetaminophen – the second wave is mediated by molecules of the immune system, which is activated in response to the initial acetaminophen-induced liver damage.

A daily aspirin is already recommended to prevent heart attacks in people at high risk of having one and recent research has shown that aspirin can help treat heart attacks – doses of between 75 milligrams and 325 milligrams help thin the blood; it has also been suggested women who take aspirin once a day may slightly reduce their risk of the most common type of breast cancer.

The study is published in the latest issue of the Journal of Clinical Investigation.


Not only is it not accused of causing liver damage, it is asserted to help prevent damage from drugs like alcohol and Tylenol / Advil.

Needless to say, I’ve taken an aspirin…

In Conclusion

As we all prepare for various celebrations, especially those of us in the USA with Memorial day, I’d like to suggest making sure you have a bottle of aspirin in the medicine cabinet for “the day after” and perhaps also for “the day before and the day of”…

I’m pretty sure I’ve had no long term damage from my ‘couple of months’ of being uncareful and not paranoid enough about Over The Counter medications. I do feel just a bit annoyed at having been “caught” by an effect to which I was already sensitized, simply from being a bit too lax and not paranoid enough.

So today the “energy” level is rising, the eyes are clear and white, and all is well with the world. Oh, and I’ve dumped the ibuprophen from the pill case and put aspirin back in.

With luck, that’s all that will come of it.

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About E.M.Smith

A technical managerial sort interested in things from Stonehenge to computer science. My present "hot buttons' are the mythology of Climate Change and ancient metrology; but things change...
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38 Responses to Apirin good; Advil / Ibuprofen / Tylenol / Acetaminophen bad

  1. Ian W says:

    There are some that say that Salicylic Acid should be considered a vitamin. it is named after the willow tree Salix from which it has been obtained for millenia. It is actually formed in plants as a defense against pests. So organic vegetables and fruit tend to contain significantly more of it than those grown with pesticides. Studies have shown that it is present in far greater amounts in organic vegetables and fruits – (for example http://www.organicag.org/organic/orgvconv/142.html )

    It would appear that the farming community with their use of pesticides have reduced the presence of good salicylic acid and replaced it with the bad pesticide residue. Its better to eat vegetables and fruit that does not look cosmetically good due to insect or other damage – as it will have natural salicylic acid which has significant benefits of thinning the blood and assisting the liver.

  2. Andrew Newberg says:

    I have known about the overdose risk of Tylenol for some time…it helps when you dad is an EMT/fireman and regularly dealt with suicide.

    The increase toxicity when combining acetaminophen and booze makes me concerned over one on my occasional use of Nyquil. Sounds like that is a deadly combo…

  3. Sandy McClintock says:

    Interesting! I will switch back to Aspirin too.
    I presume you saw the likely effect of Aspirin in reducing the spread of cancer through the body?
    This research followed those that had taken daily small Aspirin doses for ‘blood thinning’.

  4. adolfogiurfa says:

    You have to try one 500 mg. aspirin daily(after eating breakfast) and the natural bark “Cat´s Claw” as anti-inflammatory and anti carcinogenic.

    @Sandy: That´s what “Cat´s Claw” positively does. As you know Aspirine (Acetil-Salycilic acid) was originally extracted from Weeping willow´s bark

    All the rest anti-inflamatories are either good paint removers :-)

  5. tckev says:

    As someone that has arthritic joints for some years now. The doc is always trying to get me on to some new wonder drug or other but thankfully I just stick with aspirin. Those other drugs were far too expensive and have a tendency to permanently stop you feeling pain.
    When I’m aching badly (during cold damp weather) I’ll take it till my ears ring (tinnitus is a sure sign that your close to your aspirin limit) . Occasionally I’ve been stuck and had to use ibuprofen but it really screws-up my digestion.
    I will not use Acetaminophen as I feel it is too toxic. Never let your cats get hold of Acetaminophen – it’s deadly to them.
    If aspirin were invented now they’d have to ban it as it is just too good a medicine.

  6. p.g.sharrow says:

    As I have been taking Advil every evening for joint and muscle pain so I could sleep, your post is of great interest to me. I have been avoiding acetaminophen for its’ risks and aspirin for the stomach and bleeding problems. This means I need to rethink my regimen. Thank you. pg

  7. gallopingcamel says:

    Those NSAIDs worked wonderfully for me especially the prescription ones like Bextra. However, regular checks for liver problems were needed in some cases (Acetominophen & Naproxen). Besides the risk of liver failure one needs to watch one’s blood pressure. Mine went through the roof whenever I took any of these products for extended periods of time.

    Like you I was sensitive to animal fats so I went on a diet with no dairy products, hamburgers, steak etc. Within ten days the pain from my arthritic joints had diminished to the point that I dropped the daily NSAIDs altogether. I still take 600 to 800 mg of Ibuprofen after a “Flare Up” but it is usually a single dose.

    Later I found that limited amounts of animal fat (if one likes pizza or milk in one’s tea) is OK if you take plenty of fish oil. I take 4 grams per day plus at least one meal of oily fish per day. That enables me to drink traditional British tea and eat an occasional steak or pizza.

    I also take one Aspirin per day but that is because I refuse to take Coumadin in any form. Anyone who understands anything about blood chemistry will tell you that Vitamin K analogs will interfere with blood clotting in ways that are potentially deadly. Forty years ago I insisted that my staff wear gloves when handling Coumarol related compounds. They did not argue when I showed them the chemical composition of “Warfarin” rat poison.

  8. AMG says:

    Hi Ian W. – you are half right in that organic fruit and vegies contain more salicylates but wrong in that it is good for you. One of the biggest issues today is sensitivity to salicylates. One of the major allergy units in Australia (Royal Prince Alfred) has studied this for a long time, and has come up with a diet that reduces salicylates. It has proved to be a miracle for lots of children and adults who were told they had an ‘allergy’ or asthma but could not control it . As it is a sensitivity level, you can experiment to find your own tolerance. With me it means mostly cutting out tomatoes, mushrooms and strawberries.
    I am also surprised to hear about supposed dangers of paracetamol. In Australia it is commonly used as does not irritate the stomach like asprin. I believe the toxic levels that are being quoted are far too low; I was ill about 13 years ago and had lots of pain and took lots of paracetamol with no side effects. And drank wine at the same time. I have some medical background and would only take asprin in an emergency if no paracetamol around.

  9. Ian W says:

    Hi AMG, I am well aware of the potential allergy issues both my siblings have severe psychological reactions to pharmaceutical amounts of aspirin. From what you are saying with an allergy to tomatoes, mushroom and strawberries – there may be more than just salicylates at issue.

    Paracetamol is one of the most dangerous over the counter drugs. If someone overdoses on paracetamol even if they go to hospital all the doctors can do is watch them die – unless they can set up a liver transplant inside 48 hours. If it was being introduced as a new drug now it would almost certainly not be allowed to market except as a prescription drug. Unfortunately, paracetamol/acetomenophen is added to all sorts of over the counter medications and it is extremely easy to get to close to the fatal dose. If someone takes a decongestant drink (extra strength cold and flu) and a brand-name headache capsule, their liver is being pushed close to the edge. If they wake up at night and mistakenly take another decongestant or another paracetamol/acetomenophen NSAID that could be fatal. See http://www.patient.co.uk/doctor/Paracetamol-Poisoning.htm

    You should be cautious about using paracetamol/acetomenophen.

  10. Pascvaks says:

    Imagine yourself a few hundred thousand years ago (or more;-), you’re dropped on your head (or backside) into another era by Time Machine, you have no innate skills to speak of though you know the theory to life in these times, what guild/profession could you possibly sign up for that might guarantee your existance for a little while… (remember too that the locals probably think you’re a god and/or demon)… ready? How about Witch Doctor? Think about it, really. And, I hear the pay and perks are pretty good too. There just has to be a very long line of Witch Doctor genes in everyone on the planet today. There’s always has been and, likely, always will be a tremendous demand for theropeudic products and the salesmen who create, make, and sell these elixers, pills, rubs, concoctions, etc., of life, health, and happiness. I’ll bet anything that when we get up “There” and check the records in the BIG Library, that Beer, Wine, Whiskey, etc., were all invented by Witch Doctors. Now remember, “Willow Bark”, you’ll be rich and happy in no time.

    PS: Stay away from Witches, they’re the ones who boil things in pots and want you to drink it; real Witch Doctors don’t use Pots! (I said potS;-)

  11. Kevin B says:

    Being both old and a golfer, I have a dodgy back, (and neck), so I was taking pretty regular doses of Ibuprofen. Then I had a TIA and was put on a daily small dose of aspirin. as well as dipyridamole and crestor, (a rosuvostatin). And I felt worse and worse and worse. It got to the point that I had given up all the pills except the small dose of aspirin. Then I had a doctor’s appointment and he had my blood tested. I ended up having 5 units of blood transfused.

    Turns out that my leaky heart valve, (did I mention that), had caused some angio dysplasia in my gut, (areas where the blood vessels move to the surface of the skin like a birthmark, not good in the acidc environment of the small intestine), and these had started bleeding and wouldn’t stop,

    It’s no fun getting gut shot by a laser from the inside, but it did the trick.

    Anyway, the point of all this medical history is that the doctors blamed, (in order of decreasing culpability), the ibuprofen and the aspirin for causing the leaks and keeping them open, so switching to advil may not do your gut any good anyway. NSAIDS, (Non-Steroidal Anti-Inflamatory Drugs), partly work by opening your blood vessels to allow the blood to bring all the body’s healing powers to bear.

    These days, I only use a topical ibuprofen cream when my neck or back flares up in order to relieve the discomfort locally, or a codeine and paracetamol tablet to help me sleep if it’s too bad.

    Incidently, I no longer take the statin or dypyridamole since they were causing problems of their own, though I now have to take thyroxine for my hypothroidism, a protien pump inhibitor to lower my gut acid and Ramipril to keep my BP down, To coin a phrase, “Drugs, eh. Can’t live with ’em, can’t live without ’em.”

  12. adolfogiurfa says:

    @Pascvaks: PS: Stay away from Witches, they’re the ones who boil things in pots and want you to drink it; real Witch Doctors don’t use Pots! (I said potS;-)
    LOL! Witches usually are too involved in reproduction, so they may give you a concoction to immediately “fall in love”. This is usually done by making you to drink the seeds of “Datura Ferox”, its effect is lowering your “will” as to manage you easier. (as you see women’s´ “business” as usual).
    One more thing: Witches used to FLY and gather among them in what was called “Sabaaths”, using an ointment which they applied all over their bodies, having as the main chemical “belladonna”, which caused them to enter a trance like state so they “flew” in their astral body.

  13. Pascvaks says:

    LOL- OK, so Witches aren’t all bad. You’re right. Come to think of it, you have to boil a mess of something to get Whiskey don’t you? See, there you go, it’s foolish to glump everyone in a general statement. There’s Good Witches and there’s Bad Witches, all depends on what (or who;-) they’re boiling.

    PS: Belladonna sounds like it’s just as good as Willow Bark, gotta’ remember that to. You know, just in case, one day, maybe;-)

  14. DocMartyn says:

    US Figures:-
    Acetaminophen overdose is the leading cause for calls to Poison Control Centers >100,000/year
    causes more than 56,000 emergency room visits per year
    2,600 hospitalizations per year
    458 deaths due to acute liver failure each year.
    Acetaminophen poisoning is the cause of 50% of all acute liver failure (U.S. Acute Liver Failure Study Group registry)
    Acetaminophen causes liver failure due to depleting glutathione, the major thiol based antioxidant and a major xenobiotic conjugation/detoxification.
    We have known for decades that its toxicity can be eliminated by co-administration with the very cheap, non-toxic antioxidant; N-acetylcysteine (NAC). Indeed, Acetaminophen formulated with this antidote is available and sold.
    What the FDA will do is make it illegal to sell Acetaminophen in the absence of NAC.
    If all Acetaminophen sold in the USA came with NAC, the USA would be a healthier and nicer place to live.

    This one really pisses me off, we know exactly what to do to solve a pressing public health issue and do f*** all.

  15. E.M.Smith says:

    Looks like they can fry your kidneys too:


    Acute Kidney Failure

    Some patient case reports have attributed incidents of sudden-onset acute kidney failure to the use of over-the-counter painkillers, including aspirin, ibuprofen, and naproxen sodium. Some of these patients experienced acute illnesses involving fluid loss or decreased fluid intake. Other patients in these reports had risk factors such as systemic lupus erythematosus, advanced age, chronic kidney disease, or recent heavy alcohol consumption. These cases involved a single dose in some instances and generally short-term analgesic use of not more than 10 days.

    Acute kidney failure requires emergency dialysis to clean the blood. Kidney damage is frequently reversible, with normal kidney function returning after the emergency is over and the analgesic use is stopped.

    So folks with Lupus need to be especially careful.

    Analgesic Nephropathy

    A second form of kidney damage, called analgesic nephropathy, can result from taking painkillers every day for several years. Analgesic nephropathy is a chronic kidney disease that over years gradually leads to irreversible kidney failure and the permanent need for dialysis or a kidney transplant to restore kidney function. Researchers estimate that four out of 100,000 people will develop analgesic nephropathy. It is most common in women over 30.

    The painkiller phenacetin has been taken off the market because of its association with analgesic nephropathy. Recent studies have suggested that longstanding daily use of analgesics such as acetaminophen or ibuprofen may also increase the risk of chronic kidney damage, but this evidence is not as clear.

    In view of these findings, people with conditions that put them at risk for acute kidney failure should check with their health care provider before taking any analgesic medicine. People who take over-the-counter painkillers regularly should check with their primary care physician to make sure the drugs are not hurting their kidneys. The physician may be able to recommend a safer alternative and can order regular tests to monitor their kidney function.

  16. E.M.Smith says:


    Just found about a half dozen comments in the SPAM queue for this thread (probably for a high count of drug names? as many SPAM are pushing online drugs). You ought to scan the comments above for the additions. (Two of mine where in the queue too… so
    It’s not about you” ;-)


    Interesting idea about the fats. I’d presumed it was something in the protein fraction. ( I can do fine with butter, for example, but not lean beet). I’ll have to do some more isolation tests for the different components.

    FWIW I can have all the lamb, goat milk, goat cheese, etc that I want. Similarly all the pork, lard, bacon, etc. It’s just “cow stuff” that’s a problem. Have to try adding more omega 3 fish products and see how it goes ;-)

    Also FWIW the Carl’s Jr. / Green Burrito chicken burrito is a very nice alternative to the beef and they make a pretty darned good Turkey Burger too. Between those two they have now replaced {Burger King, Taco Bell, Mac”D”s} as my “first thought” fast food place when “on the road”. ( Jack In The Box has the B’Fast Jack so is also a good alternative, but gets old after a while…)

    @Sandy McClintock:

    Anti cancer too, eh? Nice…


    Tylenol / Acetaminophen / paracetamol was widely pushed on/in the medical community here, too. For a while it was handed out like candy as the “safe” alternative to aspirin. The result is in the liver damage / transplant statistics.

    Yes, you can sometimes take an “over double” dose and you can sometimes take them in proximity to alcohol consumption. The liver recovers from a lot of “near but not quite lethal” damage. Unfortunately, for many folks, they blow out the liver.

    I’d rather risk an ulcer / stomach bleed than a dead liver.

    Look in the stats in the literature, especially the UK where it’s THE major cause of liver transplants.

    @Kevin B:

    Wow. What a story…

    FWIW, with my family history of colon cancer, a tendency to ‘bleeding’ also means that the early colon defects would be more likely to show up as blood in the stool prior to lethal metastasis. So, for me, a little extra tendency to bleed is a feature… But hopefully not enough to have a laser cooking my insides…

    I’m also not eating these things by the handful. More like one or two aspirin on a day “with issues” and they tend to come in groups of 3 or 4, then skip a few. Aspirin ought to be zero issues at those does levels; where ibuprofen can be a clear problem.

  17. E.M.Smith says:

    @Andrew Newberg:

    Hadn’t thought about things like Nyquill having both alcohol and acetaminophen pre-mixed….


    That about sums it up… What pisses me off is that I knew about Acetaminophen, but not Ibuprophen. The only reason it isn’t Ibuprophen causing all the liver transplants looks like just a question of how much of each is sold…


    You’re welcome. See my comment below about diet and how it can help. Also remember that high omega 6 / low omega 3 makes for a tendency to inflammation while high omega 3 / low omega 6 lowers tendency to inflammatory response.

    In short: Avoid grain oils (corn / soybean) and use more mono-unsaturates (olive and some safflower). Avoid grain feed meat (feed lot beef) and have more grass fed (Buffalo?, lamb, goat) along with fish. Have “free range” chicken (they eat grass and bugs that eat grass) and less pen fed (that have grains high in omega 6) and buy “high omega 3” eggs.

    It can make a big difference (and tastes a lot better than pills anyway ;-) and learn to love bread made with flax…


    My spouse had a stomach bleed from too much aspirin over too long a time. I seem to be able to eat it like candy. There may be individual variation here. For me, thinking back on it, several things had immediate onset with the swap to Advil / Ibuprofen (and not related to co-consumption of alcohol). Some lower back pains ( kidney’s complaining?) some increase of mild lethargy ( early liver function reduction?) etc.

    So a ‘reasonable working theory’ would be that some of us are more Aspirin tolerant and some of us are more “phen” tolerant and you need to know which you are.

    So looks like you and me are “Aspirin guys” while the spouse is not. (She is also a teetotaler so has no complications with beverages).

    I do strongly recommend trying the Arthritics Cook Book (the one in the link by Dr. Dong) as it’s just wonderful to have complete relief without the drugs. I’d had a couple of decades of “no problem” from just avoiding beef. ( At the first time around it was the only thing to which I reacted). Last couple of years it came back, but just a week or three back I re-did the simple diet (rice, fish, vegetables) and was better. A re-trial showed a new sensitivity to tomatoes ( and I’d been eating tomato sauces regularly…). As of now, skipping beef and tomatoes and I’m at zero arthritic problems again…. (Modulo “Misery Monday” from the last couple of weeks as we have Ice Cream Sunday… and I’m still working on NOT eating the ice cream ;-}

    But along the way had picked up some “new” issues. That in retrospect were directly the result of the Ibuprofen. Dang it.

    At any rate, I dumped the ibuprofen and the “new issues” are all slowly resolving. I avoided the beef / tomato and almost avoided the ice cream… and I’m approaching “no problems” and “no pain” with “no drugs”.

    We’ll see.

    But please if you have arthritis pain, try the cookbook. (Or the simple test of just eating fish, rice, and vegetables NOT including fruits like tomatoes… so things like carrots, celery, squash, peas, …) and having no beef / mammals / fruits …

    Boring, but after a week you ought to know. At that point, zero pain is a nice motivation for learning to cook more Japanese / Chinese / French Mediterranean… and less “meat and tomato sauce”.

    I still have my occasional Beef Brisket and Lasagna with tomato sauce, cheese, and sausage in it. Just more rarely and knowing what the price might be. (Usually it takes 2 or 3 days of exposure for something to develop, so I can get away with a “one a week” treat…)

  18. Verity Jones says:

    Thanks again E.M. lots of good advice here. I rarely take painkillers. If I need them I tend to take half the recommended dose and, if that’s not enough to make the pain bearable, take the rest half an hour later. If I have a mild headache I’m more likely to figure out the cause (dehydration?, tension?) and treat the source before reaching for drugs. If I have anything like and infection that needs painkillers I usually figure that alcohol isn’t a good idea, but an ‘injury’ wouldn’t trigger such caution so I’ll be more aware in future.

    Actually my husband is the one more likely to reach for drugs for any pain, and more likely to imbibe these days too (I’m practically off alcohol as I just fall asleep).

  19. dearieme says:

    Pharmacies in Britain are required to limit the amount of paracetemol you can buy on a single visit. It’s said to reduce the suicide rate by paracetemol overdose.

  20. adolfogiurfa says:

    ….and not to say about pseudo-ephedrine…you just pass away to the other side in a matter of seconds…

  21. adolfogiurfa says:

    And LAST BUT NOT LEAST: This is why the World Health Organization already has a GLOBAL GOVERNANCE working through binding agreements with the majority of countries…
    These guys don´t need a global governance through “Global Warming” anymore….They will give you a pill to you old bad smelling goats and a vaccine to your grand children, and, very soon, an implanted chip, just for parents to take care of their children…….
    I tell you these guys are winning,once again, for themselves, another picnic in the desert. In my country it has been already implemented an ID card which will replace all old ID´s and credit cards……Big Brother is here!, well…at least until December 21st. 2012, or….if the Mayans made their calculations wrongly,….well, I will leave it to old red hair people´s ingenuity….

  22. wayne says:

    That was a very thoughtful post E.M., I’m grateful. Just bought a large bottle of ibuprofen a week ago due to some dental work and many of your questions were also going through my mind… aspirin or ibuprofen or even some of the stronger NSAIDs? I have always preferring aspirin when the pain is mild, have never personally had stomach problems from aspirin, but when in real pain, I have to admit ibuprofen will really knock it out. But now, I think I am going to op on two aspirin and one ibuprofen when in real need to see if that is just as effective, I had never considered the liver aspect and it sounds like aspirin needs to be in the mix. That’s some much needed information.

  23. gallopingcamel says:

    My aim is to avoid the need to take powerful drugs on a daily basis. But for my good fortune in discovering that fish oil made it possible to handle the pain of arthritis (in almost every joint) without NSAIDs I would probably have perished many years ago owing to diseases promoted by high blood pressure.

    So why does fish oil help? My understanding is that increasing one’s intake of Omega 3 fatty acids changes the composition of the prostaglandins manufactured in our bodies. Prostaglandins based on Omega 3 fatty acids are less likely to trigger the inflammation processes that cause joint pain.

  24. adolfogiurfa says:

    @gallopingcamel . Seek for “Sacha-Inchi Oil”

  25. Petrossa says:

    I use Boswellia for my arthritis. As a painkiller is use 1 gram of paracetamol with 120 mg opium powder. Luckily i can’t stand NSAID’s at all, so even taking one makes me violently ill.

  26. Power Grab says:

    I’m closer to 60 than 50. I have been using cod liver oil for about 10 years. I usually take a tablespoonful whenever I take it. And I take it right before bed. It helps me sleep through the night. Now that it’s summer, though, I am not taking it. Good stuff! It’s also good for chasing a sore throat away, if we take it as soon as we noticed any throat discomfort.

    I eat plenty of animal foods (beef, eggs, milk, butter, etc.) and cannot connect them with any sort of pain. On the contrary, grains and sugar are what give me what teensy bits of joint pain I have ever had. That and lack of exercise.

    I tend to not even keep painkillers around unless I know relatives are coming for an extended visit. I’m not sure, but I think I have a little bottle of small aspirin pills somewhere. I should probably check its expiration date.

    Another thing that many people like for dealing with nagging pains, and I do keep this around, is organic apple cider vinegar. Some take it in a spoon. When I take it, I mix a tablespoon in a glass of water.

    I think my pharmacist remembers me because I hardly ever darken their door. The last two times I visited there, it was to have a fasting cholesterol test done, to have the numbers in hand in case they started coercing us at work to have a test done. So far, I have dodged that bullet. I refuse to take their stinkin’ drugs.

    I don’t care about my cholesterol numbers, but it was interesting to note that when I gave up wheat, the main number dropped almost 30 points. And when I dropped sugar, two weeks later it had dropped another 20 or so points.

    My sister was amazed at my test score. She said it was as low as hers gets when she avoids fat diligently. Heh-heh. I’ve been telling her for 10 years that it’s not the dietary fat that raises those numbers. I guess she really didn’t believe me. Now I have it in black and white. She’s a lab technician, so maybe she will accept that. ;-)

  27. E.M.Smith says:


    Um, paracetamol is just another name for Acetaminophen / Tylenol…


    Paracetamol INN (play /ˌpærəˈsiːtəmɒl/ or /ˌpærəˈsɛtəmɒl/), or acetaminophen USAN Listeni/əˌsiːtəˈmɪnəfɨn/, is a widely used over-the-counter analgesic (pain reliever) and antipyretic (fever reducer). It is commonly used for the relief of headaches and other minor aches and pains and is a major ingredient in numerous cold and flu remedies. In combination with opioid analgesics, paracetamol can also be used in the management of more severe pain such as post-surgical pain and providing palliative care in advanced cancer patients.

    So while I’m glad it works for you, but don’t take it with any beer or wine ;-)


    My Mum used to feed me Cod Liver Oil anytime I was looking like having a cold of flue. Seemed to work well. Maybe I need to ‘take a tip from Mom’ and see what it does for arthritis…

    The cholesterol numbers are very interesting…

  28. jim says:

    I was having pain in various joints until I started going to the gym. 2 hr/wk elliptical, 0.75 or so weight machines, then stretches. My joint pain is almost non-existent now and I’m over 60. I do also take aspirin every day, but had been doing that before the advent of exercise.

  29. E.M.Smith says:


    Exercise damages muscle fibers, that make Human Growth Hormone to stimulate repair, some of which floats of into the blood causing repair elsewhere too…. We need a basic level of exercise for normal repair elsewhere in the body.

    It also releases endorphins that naturally block pain. “Runners high”…

    Exercise works.

  30. E.M.Smith says:

    Looks like Ibuprofen is “The gift that keeps on giving”…


    Ibuprofen ‘trebles the risk of a stroke’ as doctors warn over dangers of long-term use

    By Sophie Borland
    UPDATED: 06:14 EST, 12 January 2011
    Large regular doses of ibuprofen and similar painkillers could treble the risk of strokes and increase the likelihood of heart attacks, researchers are warning.

    Scientists have found high doses of ibuprofen may carry a similar health risk to painkillers that were withdrawn from the market several years ago on safety grounds.
    Researchers from the University of Bern in Switzerland looked at more than 31 clinical trials involving 116,429 patients.

    They had each taken one of seven commonly-used painkillers, The study, published in the British Medical Journal, found that those who had taken ibuprofen over a long period of time were almost three times as likely to suffer a stroke.

    The painkiller was also shown to raise significantly the risk of heart attacks and deaths caused by heart disease.

    Another commonly prescribed pill, diclofenac, which is also sold under the trade name Rhumalgan, was shown to almost treble the risk of strokes and increase the likelihood of heart disease related death by four times.

    The study also suggested that ibuprofen carried a similar risk of stroke and death from heart disease to rofecoxib, also known as Vioxx, which was withdrawn from the market in 2004 over safety concerns.

    Professor Peter Jüni, of the University of Bern, said: ‘We looked at patients taking these drugs three to four times a day.

    ‘They were mainly being treated for osteoarthritis with a few who had rheumatoid arthritis. A lot of them are elderly who are already have lots of risk factors and these will then be duplicated with these painkillers.

    ‘In terms of stroke, ibuprofen doesn’t look very good. If I was in chronic pain I would not take it as the risks are just too high. I would look at the different options.’

  31. E.M.Smith says:

    And yet more:


    Advil may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term. Do not use Advil just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

    Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.

    Advil may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking Advil, especially in older adults.

    Call your doctor at once if you have symptoms of stomach bleeding such as black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds.

    Advil may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term.

    This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking Advil, especially in older adults.
    FDA pregnancy category D. Taking Advil during the last 3 months of pregnancy may harm the unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using Advil. It is not known whether ibuprofen passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give Advil to a child without the advice of a doctor.

    And, just to round things out, it can screw up your kidneys:


    Kidney function: Long-term use of ibuprofen may lead to a higher risk of reduced kidney function. This is most common for people who already have kidney disease, liver disease, or heart failure; for people who take diuretics (water pills); and for seniors.

    If you have severely reduced kidney function and kidney disease you should not take ibuprofen.
    Potassium levels: There is a risk of high levels of potassium in the blood for people who take NSAIDs, including ibuprofen. People most at risk are seniors; those who have conditions such as diabetes or kidney failure; and those taking beta-blockers (e.g., metoprolol), angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril), or some diuretics (water pills).

    And I ought to have checked for a Wiki at the start, This one is a real gem…


    Erectile dysfunction risk

    A 2005 study linked long term (over three months) use of NSAIDs, including ibuprofen, with a 1.4 times increased risk of erectile dysfunction. The report by Kaiser Permanente and published in the Journal of Urology, considered that “regular nonsteroidal anti-inflammatory drug use is associated with erectile dysfunction beyond what would be expected due to age and other condition”. The director of research for Kaiser Permanente added, “There are many proven benefits of nonsteroidals in preventing heart disease and for other conditions. People shouldn’t stop taking them based on this observational study. However, if a man is taking this class of drugs and has ED, it’s worth a discussion with his doctor”.


    A Canadian study published in the Canadian Medical Association Journal of thousands of pregnant woman suggests those taking any type or amount of non-steroidal anti-inflammatory drugs (including ibuprofen, diclofenac and naproxen) were 2.4 times more likely to miscarry than those not taking the drugs.


    Along with other NSAIDs, ibuprofen has been associated with the onset of bullous pemphigoid or pemphigoid-like blistering.

    Adverse effects

    Common adverse effects include: nausea, dyspepsia, gastrointestinal ulceration/bleeding, raised liver enzymes, diarrhea, constipation, epistaxis, headache, dizziness, priapism, rash, salt and fluid retention, and hypertension. A study from 2010 has shown regular use of NSAIDs was associated with an increase in hearing loss.

    Infrequent adverse effects include: esophageal ulceration, heart failure, hyperkalemia, renal impairment, confusion, and bronchospasm. Ibuprofen can exacerbate asthma sometimes fatally.

    As with other NSAIDs, ibuprofen has been reported to be a photosensitising agent.

    Having stopped for a few days now, I’m already feeling more energetic, have had some lower back discomfort reduce / near ended, and generally don’t feel “yucky” any more. I’d been taking it partly FOR the lower back and “yucky” feelings… Yes, I’m peeved…

  32. Pascvaks says:

    And we thought the FDA worked for US, either I’m getting dumber by the minute or something else is making US that way. Money, Money, Money… never trust a politician with anything that has to do with Money!

    Wait a minute…. ahhhhhhhhhhhh… there’s something real bass ack’wards about our system. EM, we got a problem, right here in River City, and it ain’t Pool.

  33. p.g.sharrow says:

    @E.M.Smith says:
    1 June 2012 at 2:07 am
    YOU are PEEVED! I take Ibuprofen to reduce pain so I can sleep at night and I seemed to have developed some of the problems you describe above. I am tired of being tired and yucky all the time as well. Maybe I need to go back to drinking in the evening as nothing else has worked. Grandpa used to sip whiskey all day long. I just thought it was because of grandma. ;-) pg

  34. E.M.Smith says:


    Liver injury (which Ibuprofen can do in spades) shows up as “feeling yucky and tired”…

    You end up without enough metabolic fuel and with too much backup in the metabolic sewers.

    Were I you (and in fact it’s the same problem I just went through…) I’d drop the ibuprofen. I immediately added aspirin (as it is shown to be protective against the ibuprofen damage) and I’d spend at least a couple of weeks on aspirin just to ‘measure the ibuprofen effect’ before doing anything else. After dropping the ibuprofen, wait a couple of days for the drug to leave the system, then consider the Whiskey;

    If nothing else, just doing a ‘rotation’ through different NSAIDs moves the side effect suite around and lets different parts of you get a rest from the drug.

    Just a reminder:

    The omega-6 vs omega-3 ratio determines how much you have an inflammation response. Modern diets are way high in omega-6 fatty acids ( seed oils like corn and soybean) and deficient in omega-3 ( we don’t eat as much ocean fed fish and grass fed meat).

    This is an artifact of nature taking a short cut with genetics. It makes TWO different hormones that push your state between “inflammed” and “fine” and does so with the SAME enzyme. The body has NO CHOICE. The “choice” comes entirely from the dietary Omega-3 / Omega-6 ratio as that is the raw material that goes into that ONE enzyme and makes the two hormones.

    As we moved to a very “grain fed” diet (for us, and for the animals we eat) we’ve shifted from about a 5 : 1 ratio to more like a 20 :1 (or worse!) ratio.

    The push to remove saturated fats from the diet did not help as they were substituted with Omega-6 plant oils. The push to “factory farming” didn’t help as the eggs, chicken and beef that we used to eat was largely grass fed and got Omega-3 that way; now it is fed soybean / corn mix and is Omega-6 rich. So look for “Grass Fed” meat and “Omega-3” eggs and “Free range” chickens. It really does matter.

    When getting fish, like Salmon, remember that ‘farmed fish’ are fed manufactured feed and do not get the same oils in their diet. The expensive “wild” forms are likely to be better for you.

    Get a jug of Cod Liver Oil and take a spoon of it. Often.

    Get some Flax Seed Oil or learn to love cooking with flax seeds. This stuff is very heat and light sensitive, so it’s in the fridge at Whole Foods. Don’t cook with it as that breaks down the Omega-3, but put it in a salad oil.

    This matters. Really.

    Then get that Arthritics Cook Book. It works really well.

    Yes, it’s boring for the first couple of weeks and it is way more restrictive than most folks need. Still, feeling good is worth it. THEN you can add back some things and find out which things are causing you a problem. Reminder on the short form: Eat fish, rice, non-fruit vegetables. Think Japanese and Chinese minus the red meat and leaving out fruits. It takes about a week for the immune system to “idle down” and stop attacking things, so you have a week to get through.

    It isn’t very hard, really.

    Before I found it, I’d used a system from an immunologist. It was an “elimination diet” where you started eating only “One Food” for a whole week (to let the immune response drop) then added foods back one at a time. I ate potatoes for a week. THEN added chicken for the next week. Now THAT was a hard diet to stick with. (in fact, I rapidly added butter to the potatoes and in ‘week 3’ realized that I could add a ‘complex food’ as one item, then if I reacted, do a ‘binary search’ of the cluster; so added Lasagna ;-) So being able to start with carrots, peas, corn, potatoes, rice, several fish, and more… well, that’s easy.

    Any of it is better than being in pain and blowing out your liver… ( I’m saying this having been through both sides of the issue.)

    I was able to have about 20 years of ‘nearly no discomfort’ just from dropping ‘cow stuff’ (beef and ice cream / milk – but leaving in butter that doesn’t have the protein component). Only after about 20 years have I now reached the point where “Tomatoes must go”. So just because The Arthritics Cook Book says “avoid tomatoes” that doesn’t mean it is guaranteed to be a no-go for you, now. So eliminate ALL the things he says (or conversely, just use eat what he allows) for 2 weeks. Then you know. At that point you can try adding back in ‘other stuff’ and see what is your “no go” food. He “shotguns” all the things his patients have reacted to; collectively. You can tune it to just you.

    It has worked for me. For my spouse. For her sister. For about a dozen other folks who I’ve given copies of the book. It’s not a “flaky diet” or a “fad”. He’s an M.D. and it is based on immunological response to proteins in the diet. (Digestion is not perfect… and the body reuses bits of digested proteins as construction blocks. Your immune system sees these as foreign bits and attacks them. So swap the building blocks and the ‘auto-immune’ response stops.)

    Hope that helps.

  35. p.g.sharrow says:

    @EMSmith; thank you, will try, Ibuprofen is out. Good thing I like boring food, just have to convince the significant other, as she likes to “create” food. At least I cook for myself 4 days of the week. pg

  36. M says:

    For years I had used Ibuprofen for muscular aches and pains. As part of the French healthe service’s free checkups for retirees, my hearing was tested. To my surprise, loss of 30dB low level sensitivity in five years. I had been bothered a bit by tinitus (noise in the ears).

    The doc said “Oh yes, hearing loss is a well known side effect of Ibuprofen”. I wish someone had told me.

  37. … And then there’s the herbal source if aspirin, the safest of them all as its still in its original packaging… White Willow Bark

    As for arthritis, it’s basically Inflamation. Cut all grains and research things like turmeric as an anti inflammatory. Drink a little turmeric tea every day and pay attention to improvements. Turmeric has a blood thinning effect to, so be aware if that applies to you

  38. Pingback: Cancer? Take an Aspirin | Musings from the Chiefio

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