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Because NSAID (non-steroidal anti-inflammatory) medications are a suggested elimination while on the Autoimmune Protocol, I often get questions asking for alternatives. While you may need to remain on these medications (especially if your doctor advises you to) during the elimination diet, others like myself have been successful at finding alternatives to managing pain.
Why avoid NSAIDs while on the Autoimmune Protocol?
NSAID medications cause irritation to the lining of the small intestine, causing it to become more permeable (worsening “leaky gut” or intestinal permeability). One of the major goals of the elimination diet is to eliminate all substances (food, medication, or otherwise) that contribute to this inflammation and permeability of the gut.
The decision to eliminate NSAIDs is not an easy one — if you are in chronic pain you may not be able to do without, but it is in your best interest to check with your doctor to get guidance and see about alternatives. If at some point on the elimination diet, your pain is significantly decreased, you may be able to wean off of of them (with guidance from your doctor, of course). Whether or not you decide to forgo NSAIDs during your protocol is a personal decision and one best involving your doctor.
If you are experiencing daily, chronic pain (like that from rheumatoid arthritis) your decision may be different than if you are having occasional pain (like headaches or menstrual pain). For those who are interested in exploring a more natural approach to pain management, I have compiled a list of the following options I’ve experimented with myself that are not as hard on the gut as NSAIDs can be.
White Willow Bark
White willow bark is an herb (salix alba) that has the same active component (salicin) as NSAID medications, but instead of being intact, the molecule is digested and assembled outside the gut and thus does not affect the gut lining in the same way. Its mechanism of action is similar, making it a great alternative to NSAIDs. Unfortunately, because it needs to be fully digested before it can start working, it takes up to 2 hours to take effect. If you are trying to “get ahead” of pain, this task can be made very difficult by how slow-acting this remedy is.
When I have used white willow bark, I am sure to take it before I think I will need it, and then set a timer so that I am always “ahead” of the pain. This works in situations like menstrual pain, but doesn’t in the case of unexpected pain like a headache.
I’ve used this brand in the past at a dosage prescribed for me by my naturopath. White willow bark is a pretty safe herb, but those with an ulcer history, stomach problems, or bleeding disorders should be extra cautious. Be sure to do some research and consult your doctor if you are taking other herbs and/or medications or are going to be using it on a daily basis.
If you’d like to learn more about white willow bark, I’ve written an article about it here.
Ginger and Turmeric
Ginger (zingiber officinale) and turmeric (curcuma longa) have been used for thousands of years in ayurvedic and Chinese medicine to treat inflammation and pain, among other symptoms. This literature review found that both of these rhizomes are clinically effective at managing pain. Their mechanism of action seems to be similar to that of NSAIDs, making them a good alternative to consider.
While both turmeric and ginger can be taken in supplement form, sometimes even in combination, they can also be effectively used as spices in cooking, steeped in tea, or juiced fresh. I like to include a lot of fresh ginger and turmeric in my meals every week, and I get a bottle of this juice (caution seed spice reintro) when I am feeling especially achy. Both of these spices have such wonderful flavor that I actually prefer to use them liberally in my cooking, but for those with specific needs the measured dose that a supplement provides might be more simple.
Ginger and turmeric should be used with caution for those with bleeding disorders, as they tend to thin the blood. You should check with your doctor if you are on blood-thinning or other medications as they can be contraindicated here.
Cramp bark (viburnum opulus) is an anti-spasmodic herb that has been used for centuries for pain due to cramping. It works phenomenally well for menstrual pain, and is especially quick-acting (sometimes in a matter of minutes) when used in tincture form (caution for those very sensitive to gluten — it is very difficult to find products that are safe here, so do your research!).
I’ve used this brand at a dosage prescribed for me by my naturopath. Cramp bark is a pretty safe and well-tolerated herb, but be sure to do some research and consult your doctor if you are taking other herbs and/or medications concurrently.
A lot of times, pain can be due to muscle tightness, which is worsened by the way we tend to constrict the area of our bodies where we are experiencing this pain. Sometimes this can be relieved, either partially or in full, by belly breathing exercises. Here is a YouTube video with some great exercises you can try.
Don’t underestimate the power of this step. In my experience, it works more effectively for acute pain than chronic pain, but I’ve had many situations where my pain level has gone from through the roof to minimal just by getting my breathing under control.
I originally went off NSAIDs when I embarked on my elimination diet in 2012, as recommended by many of those advocating for the Autoimmune Protocol. Up until this point, I managed my monthly menstrual pain with Motrin (an NSAID). When I started feeling cramps on the first day of my period, I would take one pill and then repeat every 6 hours for the first 24 hours; with that treatment I had minimal pain and my life was unaffected.
When I attempted to get through that first cycle without NSAIDs, I was shocked to find out exactly how much pain I was in. It was a miserable experience that I did not want to relive. My sister introduced me to white willow bark, which provided just enough relief so that I wasn’t completely miserable, but my day was still interrupted. I learned to “take a day” whenever my cycle came.
After six months of being on the Autoimmune Protocol, as well as a good change in my thyroid medication, I found my monthly pain greatly decreased. I could now go without the white willow bark, and experienced minimal pain. This continued for over a year, and I attribute it to the favorable changes that go along with hormonal balancing. (I also experienced an elimination of my cystic acne during this time.)
About a year ago, something shifted however, and I experienced a return of my monthly pain (without a return of any other symptoms, thyroid or otherwise… which was puzzling). This time, white willow bark didn’t seem to put a dent in it, and I started exploring these other options. Today I’m happy to report I am no longer experiencing extreme pain during my cycle with the combination of turmeric and cramp bark. I start taking the turmeric a week before my cycle, and I drink the juice/cook with it on the first day of my period. I take the cramp bark tincture as prescribed by my naturopath, 6 to 8x/day while I have cramps. It really is an amazing herb, and works within minutes. With the combination of those supplements plus a heating pad and belly breathing, things are much more bearable.
Like I said, pain management while on the Autoimmune Protocol can be a tricky situation and not everyone may be able to completely go off of NSAIDs initially. If you’ve been considering alternatives, I hope this article has given you some ideas to explore.
Have I missed anything? What do you use to manage the pain without NSAIDs?