Your painkiller might be building the pain

A famous ultrarunner took 800mg of ibuprofen a day so he could keep running through the pain.

He stopped. The pain went away.

That’s the story going around, told on a podcast, and it ends exactly where a good story should , full episode👇

Which is the first reason to slow down before you do anything with it.

One man. One anecdote. No before, no after, no way to know if it was the ibuprofen leaving or the running easing or his body finally getting a break. A tidy ending on a podcast is not a study, and “it worked for a 50-year-old who runs a hundred miles for fun” is the exact kind of evidence this newsletter exists to question.

But underneath the anecdote is a real mechanism, and the mechanism is worth your time even though the story isn’t proof.

If you take a daily anti-inflammatory, do not stop it because of this post. Some are prescribed for reasons that matter, and some should not be stopped suddenly. This is a conversation to have with your doctor, not a newsletter. Read on for what to ask.

Start with who does this, because it tells you whether it applies to you.

A daily 800mg habit is what you build when your job is running through pain. Ultra-athletes, soldiers, people whose whole identity depends on not stopping. The pill is not treating a condition. It is silencing a signal so the body can be pushed past where it wants to go.

That is a completely different situation from a 58-year-old taking an anti-inflammatory because a knee hurts, or because a doctor put them on one. Same drug, opposite purpose. One is muffling an alarm to keep running. The other is managing real pain from a real problem.

The story is about the first person. Most of your readers are the second. Before you take any lesson from it, notice that the lesson was written on a body that isn’t yours.

Here is the part that holds up, because it comes from research and not from a phone call.

Anti-inflammatory painkillers — the class that includes ibuprofen and naproxen, the ones you buy without a prescription — work by blocking an enzyme that drives inflammation and pain. That same enzyme also helps maintain the protective lining of your stomach and small intestine. Block it everywhere, and you dull the pain, but you also thin the shield that keeps your own gut from digesting itself.

Most people know these drugs can upset the stomach. Fewer know they damage the small intestine further down, where you feel nothing at all.

In one study of people who took these drugs regularly, damage to the small intestine lining showed up in 71% of them, against 10% of people who didn’t take them.

Source: Graham et al., Clinical Gastroenterology and Hepatology, 2005.

Seventy-one percent. That is not a rare side effect in a warning leaflet. That is most people who take them often, carrying damage they can’t feel, in a part of the gut nobody thinks about.

Here’s the idea worth taking seriously, stated carefully.

A damaged gut lining leaks. When the barrier that’s meant to keep gut contents in starts letting things through, the body reads it as a threat and mounts an inflammatory response. Inflammation is also what drives a lot of pain.

So the possibility the thread is circling is a loop: you take an anti-inflammatory for pain, it damages the gut, the damaged gut drives its own inflammation, and that inflammation feeds back into more pain. The thing you took to lower inflammation quietly raises it somewhere else.

Is that loop proven to be why one runner’s pain vanished? No. That’s a mechanism that could explain an anecdote, not a demonstrated cause. But the individual pieces — these drugs damage the gut, a damaged gut drives inflammation — are real and documented. The honest version is: plausible loop, real parts, unproven in any single person’s story.

What lives in your gut sits right in the middle of this, and it’s a subject on its own. Coach Dylan walked through it in You’re not fat. Your gut is starving., including the 2021 Stanford trial where fermented foods raised gut diversity while a high-fibre diet barely moved it.

Back to the pain.

Three honest gaps.

Nobody has shown that stopping an anti-inflammatory makes chronic pain go away. One man on a podcast is a story, not a finding. His pain easing when he stopped could be the drug, could be the rest, could be a hundred things that changed at the same time, and there is no way to pull them apart from a phone call.

Nobody can tell you, from a study, whether the gut damage is driving your pain specifically. The 71% figure tells you damage is common. It does not tell you it’s the cause of what you feel, and anyone who says otherwise about your body has never examined it.

And the third gap is the one that matters most for you. Nobody reading this knows why you’re taking the drug in the first place. Some of these are prescribed for conditions where the benefit clearly outweighs the gut cost. Some protect against things far more serious than an irritated intestine. The right answer for a runner silencing an alarm is not the right answer for someone whose doctor prescribed the drug for a reason. Only the doctor who knows your case can weigh that, and I’d rather say that plainly than pretend a newsletter can.

Certainty is what the supplement industry sells. This is a real mechanism with a genuinely open question sitting on top of it.

The pushback here is important, and it’s medical.

These drugs are not villains. For a lot of people they are the difference between moving and not moving, between sleeping through the night and not. Untreated pain has its own costs — it wrecks sleep, drops activity, feeds depression, and drives people toward far worse things than ibuprofen. Frightening someone off a drug that’s genuinely helping them, over a gut mechanism they may not even have, could do more harm than the pills ever would.

Concede all of it. If a drug is keeping you functional and your doctor knows you’re on it, the story of one runner is not a reason to stop.

The correction still holds, narrowly and honestly.

Not “throw the pills away.” The correction is: if you’ve been taking a daily anti-inflammatory for a long time, on your own, without anyone checking what it’s doing to your gut, you’re carrying a real and common risk you were probably never told about. That’s worth a conversation. Not a panic, and not a newsletter telling you to quit. A conversation, with the person who can actually see your case.

For years the take in this space — including here — was simple: anti-inflammatories are the safe, boring, over-the-counter option, and the real risks are the prescription stuff. That was lazy. “Available without a prescription” got quietly treated as “harmless with daily long-term use,” and those are not the same sentence. Common and casual is not the same as consequence-free, and I repeated the easy version for a long time.

Three things you can do this week, none of which is stopping a medication on your own.

→ Count your real weekly dose before you do anything else. Not the label. What you actually take, honestly, across a week. Most people who lean on these have never added it up, and you can’t have a useful conversation with a doctor without the real number.

→ Book the conversation, don’t make the decision. If you’ve been on a daily dose for months or years, that’s the week to ask your doctor two things: is this still the right tool for me, and should we check what it’s doing to my gut. Bring the number from above. Let them weigh it.

→ Never stop a prescribed anti-inflammatory suddenly on your own. Some are protecting against things you can’t feel, and some cause problems when stopped abruptly. The move is a conversation, not a cold-turkey quit prompted by a podcast.

Useful. None of it is the plan.

What the free half leaves out is the part that actually helps once you and your doctor have decided anything — the anti-inflammatory foods with real evidence behind them, the gut-repair basics for someone who’s been on these drugs a long time, and the protein and movement approach that takes load off the joints that started this whole thing.

Below: the anti-inflammatory foods with actual evidence, the gut-repair basics after long-term NSAID use, and the joint-load approach that treats the source of the pain instead of muffling it.