Endurance runners who take the painkiller ibuprofen during very long runs double their risk of acute kidney injury, a study by researchers at Stanford University School of Medicine and other institutions have found.
The study, which was published July 5 in the online publication Emergency Medicine Journal, could point to a significant need to eliminate ibuprofen use during ultramarathons and to switch to other less damaging medications and remedies.
As many as 75 percent of ultramarathoners use the over-the-counter anti-inflammatory drug during endurance runs to reduce pain, according to Dr. Grant Lipman, director of Stanford Wilderness Medicine and the study’s lead author. It is common for runners to take ibuprofen before, during and after the races to relieve pain and reduce joint swelling, said Lipman, who has been a medical director of ultramarathon events throughout the world and has seen its use firsthand.
Ibuprofen decreases blood flow to the kidneys, but previous studies of its impact on runners did not show negative effects, he said. Lipman and his colleagues did not expect to find an increased rate of kidney injury in the 89 study participants who completed the trial. But the ultramarathoners who took ibuprofen had an 18 percent higher rate of kidney injury compared to those who took a placebo in the double-blind randomized study, he said.
“Basically, for every five runners who took ibuprofen, there was one additional case of acute kidney injury. That’s a pretty high rate,” he said.
The participants were given either the drug or a placebo during a 50-mile section of one of four different seven-day, 155-mile ultramarathons. They were not allowed to take ibuprofen for at least 12 hours prior to the 50-mile section of the race. Prior to the competition, they were given a small bag containing either 400 milligrams of ibuprofen or were given sugar pills and instructed to take the pills every four hours.
Forty-seven percent of the runners took ibuprofen; 53 percent took the placebo. Of the total 89 runners, 39 had acute kidney injury at the end of the 50-mile section of the race, according to the study.
The findings could be significant considering the increasing popularity of ultramarathons. Worldwide in 2015, there were 1,357 such events with more than 70,000 people finishing the races every year, Lipman said.
But while endurance runners and distance runners should be cautious about taking ibuprofen during competitions, Lipman said the study doesn’t mean that the average athlete would necessarily face similar consequences. He noted the study’s conclusions relate to endurance runners and do not necessarily apply to the entire population.
Acute kidney injury is common in ultramarathoners — with or without ibuprofen — and has been found in 34 to 85 percent of all ultramarathoners, Lipman said. They are highly susceptible to dehydration that causes reduced blood flow and rhabdomyolsis, a breakdown of muscle tissue that releases muscle-fiber contents into the bloodstream. These tissues can harm the kidneys. Adding ibuprofen to the mix increases the danger of kidney damage, Lipman said.
“Studies show that for most people, this acute kidney injury is usually resolved within a day or two after the race. However, numbers of runners have ended up being hospitalized from renal failure,” he said.
Lipman is also an endurance runner who took ibuprofen, he said. He has since switched to acetaminophen (such as Tylenol) for pain relief and takes ice baths after racing to reduce swelling.
Dr. Brandee Waite, associate professor of sports medicine at University of California, Davis, who was not involved in the study, said the information can help runners make informed choices about using nonsteroidal anti-inflammatory drugs for pain management during ultramarathons. The study is also a step toward helping doctors establish evidence-based recommendations for ultramarathon patients.
Stanford co-authors include Dr. Kate Shea, clinical instructor of emergency medicine, Mark Christensen, doctor of osteopathic medicine and a clinical instructor of emergency medicine and Dr. Rebecca Higbee, Stanford-Kaiser emergency medicine resident. Researchers at the University of Colorado, Harvard University and Washington University in St. Louis also contributed to the study.
“Acute kidney injury is common in ultramarathoners — with or without ibuprofen — and has been found in 34 to 85 percent of all ultramarathoners,”
Remember when running was a sport? a healthy sport, not an obsession, not a vicious competition.
Any drug taken before a Sport is cheating does’nt matter if is over the counter…
Vitamin I is a healthy part of a balanced ultramarathon.
>”Acute kidney injury is common in ultramarathoners — with or without ibuprofen — and has been found in 34 to 85 percent of all ultramarathoners,”
Remember when running was a sport? a healthy sport, not an obsession, not a vicious competition
This individual knows what he/she is talking about. I used to run 5 miles per day (sometimes 7-9). Anyone who’s run considerable distances has noticed blood in their urine from time to time so obviously something is breaking down during the course of this strenuous activity.
Ibuprofen and acetaminophen both have their drawbacks and Vicodin is not a suitable alternative which is why I sometimes relied on some good weed and a cold beer to recover.
This caught my eye quickly.
As a runner … but not an ultra-marathon runner I have concerns about ibuprofen.
There were times when I started running I would develop pain or inflammation that
would push me away from running for days. I learned never to run when I have pain
because it will usually make it worse.
Then I discovered ibuprofen when I had some knee pains. A tablet of ibuprofen
overnight would vanquish my knee pain and inflammation. I was conservative
about its use because I thought it could be just masking pain and that by
continuing to using it during exercise I might injure myself more. That turned out
not to not be true.
Ibuprofen would stop inflammation and pain and I never developed any injury from
it. It was really a godsend in that it eliminated days that I had to wait to run. I
would be very careful about using any kind of painkiller to be able to run if you
could not run without it or were experiencing pain.
It might have helped that I was never a truly fanatical running, but I could run
a medium speed 5-10 miles all at once and that was great exercise and a wonderful
feeling.
What I am reading here is that certain people under certain circumstances run the
risk of acute kidney injury, most of which resolves itself naturally. Is the problem
ibuprofen or fanatical runners who carelessly push their bodies to the breaking point?
That is not really clear to me from this article.
“It is common for runners to take ibuprofen before, during and after the races to relieve pain and reduce joint swelling”
It’s certainly not common for runners to take ibuprofen before an ultra. And it’s less common than it used to be for runners to take NSAIDs during a race.
“Acute kidney injury is common in ultramarathoners — with or without ibuprofen — and has been found in 34 to 85 percent of all ultramarathoners,”
I’m not sure how the article draws this conclusion. I’m not sure how all (or even most) ultra marathoners would have been tested for AKI?
Also, there’s a huge variety in ultra marathons.
The Bay Area and Northern California has ultra marathons happening almost every weekend. I’d venture to guess that acute kidney injury is awfully rare in most of these races. Also, the majority of ultra marathons are 50Ks, which are a not much longer than a marathon.
The study was of runners in a series of relatively extreme multi-day desert races. And it was during the 50 mile stage, after which the runners had already been taxed by multiple days of running in the desert.
Don
Co-owner, ZombieRunner (finisher of 200+ ultras and marathons)
Back when I trained for and ran marathons, I would occasionally have either blood in my urine or coffee-colored urine.
My doctor referred me to a urologist who referred me to a nephrologist.
Turned out it is that constant high-impact jarring caused by pounding the ground for so many miles, that causes blood vessels in the kidneys to break and bleed out into the bladder.
Coffee-colored urine after a run is caused by muscle tissue breaking down, and being an overload of protein on the kidneys– combined with the blood.
> Coffee-colored urine after a run is caused by muscle tissue breaking down, and being an overload of protein on the kidneys– combined with the blood.
Extreme dehydration can also cause or contribute to this condition – the walls of the bladder rub together. Drinking plenty of water (but not excessively – hyponatremia is also dangerous), along with maintaining electrolyte levels, is important for long endurance events.
Don, I’m wondering if you run/ran on concrete/cement?
If so you might want to try the Baylands trails.
I always run on dirt or asphalt trails out there. Once
on a trip east I ran on thick concrete roads in Florida and had
to stop immediately because my whole body was jarred with
every step and it felt like my eyes were bouncing in their
sockets. There is a big difference. I think it is damaging
to run on concrete.
The witch hunt continues. What next — aspirin?