September 2025

Over The Counter

• Should You Use NSAIDs
• Antihistamines – Pros & Cons
• PPI – Use & Side Effects
• Do Supplements Worth The $$?

They are sold off the counter and found in all medicine cabinets. We reach out to them for any ache and pain, from simple headaches to tooth or back pain. The packaging comes with a note that includes all side effects, but if you are honest with yourself, you never read it. In fact, the writing is so tiny that it is not meant to be read, so cut yourself some slack.

Should You Use NSAIDs?

What is inflammation?

Inflammation is the adaptive immune system response to tissue damage and infection. When cells sense tissue damage, they send immune messengers that trigger an immune response. 

The immune response includes:

• Redness – Capillaries are dilated, so more blood carrying nutrients and white blood cells can reach the injured area, leading to red color and puffiness. 
• Swelling – The tissue close to the injury is flooded with fluids that can whisk away toxins, which further increases the swelling.
• Heat – The cleaning and fixing efforts require a lot of energy, which increases metabolism in and around the injured tissue, producing heat.
• Pain – results from fluids pressing on nerves, increasing their sensitivity.

Remember! Inflammation is the body’s healthy functional response to tissue damage.

A Tidbit Physiology

To better understand how NSAIDs work, we need to look at the chemical cascade that happens when tissue is damaged and how NSAIDs interfere in that chain reaction.

The membrane of every body cell is built from two layers of phospholipids.

When a cell gets injured or infected, it releases some of these lipids from its membrane to form eicosanoids, chemical messengers that inform other cells in the neighborhood that an alarming event is occurring, so they better get ready to protect the hood.

The lipids released by the cells are called arachidonic acid. Arachidonic acid is then modified to create two enzymes, Cox and Lox. NSAIDs block the activity of the COX enzyme. 

Cox enzyme is produced in inflammation. To understand how NSAIDs work and their downside, you need to understand COX enzymes.

There are two types of COX enzymes: COX-1 and COX-2. (How creative is that?)

COX1 Enzyme:

COX-1 enzyme has a protective role in the body. You might want to think of it as the housekeeping personnel making sure that everything runs smoothly.

Some of the things that COX-1 does are:

• Building a protective mucus layer around the gut to help protect your gut from digestive acids and food bumping against the walls of the digestive tract, creating tissue damage. 
• Producing substances that allow blood platelets to stick together, leading to blood clots.

NSAIDs inhibit the COX-1 enzyme production. What does it mean?

When you inhibit the production of COX-1 enzymes, you reduce the protective layer over your digestive system, increasing the risk of peptic ulcers and inflammation.

Inhibiting the COX-1 enzyme production will reduce the body’s ability to create clots. If you consider using NSAIDs following surgery to reduce pain, keep in mind that clotting is part of the body’s way to stitch itself together. NSAIDs might not be the right medicine to go for after surgery.

COX2 Enzyme:

If COX 1 enzyme is your housekeeping crew, COX2 is activated in emergencies and functions as your police and fire department. (just the opposite, they build the fire)

Some of the things COX2 does are:

• COX2 is the messenger that recruits the body to produce the inflammatory response, AKA redness, swelling, heat, and pain.
• COX2 produces messengers that dial up the brain’s temperature thermostat, creating fever.

NSAIDs inhibit the COX-2 enzyme production. What does it mean?

COX2 enzymes are the alarm bells of your immune system; without inflammation, the body can’t heal itself, and without alarm bells, you don’t even know something is wrong. Shutting down your alarm bell is not in your best interest. 

One more side effect of NSAIDs 

When you block the COX pathway, your body is left with all this arachidonic acid, meaning it will produce more LOX enzymes.

LOX enzyme produces Leukotrienes that will increase mucus and inflammation in the airways, which might lead to constriction. 

Therefore, using NSAIDs could be problematic for people with asthma and increase allergic response. Frequent use of NSAIDs increases your risk of food allergies, seasonal allergies, and asthma.

COX and Lox enzymes don’t just promote inflammation; they also reverse inflammation and return harmony to the system. When COX is blocked by NSAIDs, LOX enzymes can still initiate the anti-inflammatory process, but with less efficiency.

When the body is not equipped to resolve inflammation, you are left with simmering ambers, or sustained low-grade inflammation that, over time, increases the risk of chronic conditions such as autoimmune disease.

Like with any decision, there is always a price to pay. I am not suggesting you never use NSAIDs, but make an informed decision and consider when they will provide the most benefits for the more minor side effects.

As always, I suggest that you use this information to open a discussion with your PCP.

But generally, I would recommend:

• Avoid using NSAIDs for more than a couple of days.

• If you have an acute disease, feel uncomfortable, and are having difficulty resting, use NSAIDs to help your body get the rest it needs to heal.
• Avoid NSAIDs if you have asthma or if you are post-surgery. 
• Use bone broth and demulcent herbs to restore the gut barrier when using NSAIDs