Ibuprofen before a long run or race is a poor trade: it does not make you faster, and it raises medical risk. Trials link it to more kidney stress, gut injury and low blood sodium. The risks rise with distance, heat and dose. No food or supplement is a safe "natural ibuprofen" either. This article explains what the studies found, what to do instead, and when to see a doctor. It is general information, not medical advice.
Is it safe to take ibuprofen before running?
For a short, easy run, an occasional standard dose is unlikely to cause harm in a healthy person. The picture changes in long or hot events. Running already diverts blood away from the kidneys and gut. Ibuprofen and other NSAIDs (non-steroidal anti-inflammatory drugs) block prostaglandins, which help keep blood flowing to those organs. Stack the two, and the organs that are already stressed lose part of their protection.
The habit is common. In one ultramarathon trial, the authors noted that up to 75% of ultramarathon runners take NSAIDs during competition (Lipman et al., 2017). The studies below explain why that is worth rethinking.
What did the ultramarathon ibuprofen trial find?
The strongest evidence comes from a randomised, double-blind trial. It ran during 50-mile (80 km) desert ultramarathon stages in the Gobi, Atacama, Ecuador and Sri Lanka (Lipman et al., 2017). Eighty-nine runners took either ibuprofen 400 mg every four hours or a placebo.
- Acute kidney injury developed in 52% of the ibuprofen group and 34% of the placebo group.
- The number needed to harm was 5.5. Roughly one extra runner in every five or six developed kidney injury because of the drug.
- Kidney injury was also more severe in the ibuprofen group.
- Greater weight loss during the race (a sign of dehydration) raised the odds of kidney injury.
The trial was small, and the confidence interval was wide. Even so, the direction was clear, and the authors concluded that ibuprofen increased kidney injury rates.
What happened at the Western States 100?
Researchers studied 54 finishers of the 160 km Western States Endurance Run (Nieman et al., 2006). Twenty-nine took ibuprofen: 600 mg the day before and 1,200 mg on race day. Twenty-five avoided all medication.
- Finish times were the same: about 25.8 hours with ibuprofen and 25.6 hours without.
- Perceived effort was the same.
- Muscle damage markers and soreness in the following week did not differ.
- Ibuprofen users had higher markers of endotoxemia (gut bacteria products leaking into the blood).
- They also had larger rises in C-reactive protein and several inflammatory cytokines.
In other words, the drug taken to blunt inflammation was linked to more of it, and it bought no speed.
Does ibuprofen damage the gut during exercise?
A controlled lab study tested this directly (Van Wijck et al., 2012). Nine trained men took 400 mg of ibuprofen twice before cycling, and also completed cycling, rest and rest-plus-ibuprofen conditions.
Cycling alone raised a blood marker of small-intestine injury. Ibuprofen plus cycling raised it the most, with a peak of 875 pg/mL versus 474 pg/mL for cycling alone. Gut permeability also increased most after cycling with ibuprofen. The authors concluded that NSAID use by athletes "is not harmless and should be discouraged."
Can NSAIDs cause low sodium (hyponatremia) in endurance events?
Exercise-associated hyponatremia means blood sodium falls too low. Mild cases cause nausea and headache. Severe cases can cause confusion, seizures and death. Drinking more than you lose is the main cause (Wharam et al., 2006).
NSAIDs appear to add risk. At the 2004 New Zealand Ironman, researchers sampled 330 athletes after the race (Wharam et al., 2006). Thirty percent had used NSAIDs. Overall, hyponatremia was uncommon at 1.8%, but NSAID use was significantly linked to it. NSAID users also had lower sodium and higher creatinine, a marker of kidney strain.
What about a big-city marathon?
A cohort study surveyed 3,913 runners from the 2010 Bonn marathon (Küster et al., 2013). Runners who took painkillers before the race had almost five times the rate of adverse events. The risk grew with dose.
Nine runners reported hospital admission. Three had temporary kidney failure after ibuprofen. Four had bleeding and two had heart attacks after aspirin. None of the runners who avoided painkillers reported a hospital stay. This was a self-reported survey, so it cannot prove cause, but the pattern matches the trials.
Do NSAIDs blunt training adaptation?
Possibly, at high doses. In an 8-week leg training trial, young adults took 1,200 mg of ibuprofen or 75 mg of aspirin daily (Lilja et al., 2018). Thigh muscle volume grew 7.5% in the low-dose aspirin group and only 3.7% in the ibuprofen group. Some strength gains were also smaller.
A review concluded that NSAIDs can interfere with muscle and strength gains in young people (Lundberg & Howatson, 2018). The authors noted it is not yet known whether this reduces performance in elite endurance athletes. Their advice was a risk-benefit analysis and professional guidance before using these drugs for training or racing.
| Study | Setting | Main finding with NSAIDs |
|---|---|---|
| Lipman 2017 | 80 km desert ultramarathon stages, 89 runners | Kidney injury 52% vs 34% on placebo |
| Nieman 2006 | Western States 160 km, 54 runners | No speed gain; more endotoxemia and inflammation markers |
| Van Wijck 2012 | Lab cycling, 9 trained men | Most small-intestine injury with ibuprofen plus exercise |
| Wharam 2006 | Ironman, 330 athletes | NSAID use linked to hyponatremia |
| Küster 2013 | Bonn marathon, 3,913 runners | About 5 times more adverse events with painkillers |
| Lilja 2018 | 8-week training trial | Smaller muscle growth on 1,200 mg/day ibuprofen |
What is a safer approach to pain on race day?
- Do not take NSAIDs "just in case." Pre-emptive dosing is the pattern most of these studies tested.
- Skip them during long or hot events. That is when the kidneys and gut are most stressed.
- Do not overdrink. The Ironman researchers named drinking too much as the principal cause of hyponatremia.
- Treat recurring pain as a training signal. If you need a painkiller to get through runs, something needs assessment.
- Ask your doctor about alternatives. Acetaminophen (paracetamol) works differently and has its own limits, especially for the liver. Whether it suits you is a question for your clinician.
- Check your medications. Blood pressure drugs, diuretics and blood thinners can interact with NSAIDs or with dehydration.
Is there a natural alternative to ibuprofen?
Not in any sense that replaces a drug. The closest food compound is oleocanthal, found in fresh extra virgin olive oil. In 2005, researchers reported that oleocanthal inhibits the same cyclooxygenase (COX) enzymes as ibuprofen in lab tests (Beauchamp et al., 2005). It also produces a similar throat sting. That is why some articles call it "natural ibuprofen."
That label is misleading. The finding came from lab assays, not from people taking oil for pain. The oleocanthal in a normal serving of olive oil is far below a medicinal ibuprofen dose. Olive oil is a food. It is not a painkiller, and it is not a substitute for any medication a doctor has advised. Our oleocanthal page covers the compound in more detail.
Other popular options are in the same position. The IOC supplement consensus reviewed curcumin and tart cherry juice for soreness. It concluded that more research is needed before recommending them (Maughan et al., 2018). Because oleocanthal shares a pathway with ibuprofen, anyone on blood thinners should read who should not take high-phenolic olive oil first.
The non-drug measures with the best support are unglamorous. They include sensible training load, sleep, adequate food and fluids, and time. For food and recovery, see our pillar on olive oil for athletic performance and recovery and the page on olive oil for runners.
When should a runner see a doctor?
Seek emergency care during or after an event for any of these:
- Confusion, severe headache, repeated vomiting, fainting or a seizure. These can signal hyponatremia.
- Very little urine, or none, in the hours after a race.
- Dark brown or cola-coloured urine, especially with severe muscle pain or weakness.
- Black stools, vomiting blood or severe abdominal pain.
- Chest pain, or breathlessness that does not settle with rest.
Book a routine appointment if you need painkillers to train most weeks. Do the same if you have kidney disease, high blood pressure, past ulcers or take blood thinners. Talk to your doctor before taking any NSAID around exercise.
If you enjoy olive oil as part of your daily food, our high-phenolic olive oil measured 635 mg/kg total polyphenols by HPLC. Treat it as food, never as a pain reliever.
Sources
- Lipman GS, Shea K, Christensen M, et al. Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial. Emergency Medicine Journal. 2017;34(10):637–642. doi.org/10.1136/emermed-2016-206353
- Nieman DC, Henson DA, Dumke CL, et al. Ibuprofen use, endotoxemia, inflammation, and plasma cytokines during ultramarathon competition. Brain, Behavior, and Immunity. 2006;20(6):578–584. doi.org/10.1016/j.bbi.2006.02.001
- Van Wijck K, Lenaerts K, Van Bijnen AA, et al. Aggravation of exercise-induced intestinal injury by ibuprofen in athletes. Medicine & Science in Sports & Exercise. 2012;44(12):2257–2262. doi.org/10.1249/MSS.0b013e318265dd3d
- Wharam PC, Speedy DB, Noakes TD, et al. NSAID use increases the risk of developing hyponatremia during an Ironman triathlon. Medicine & Science in Sports & Exercise. 2006;38(4):618–622. doi.org/10.1249/01.mss.0000210209.40694.09
- Küster M, Renner B, Oppel P, Niederweis U, Brune K. Consumption of analgesics before a marathon and the incidence of cardiovascular, gastrointestinal and renal problems: a cohort study. BMJ Open. 2013;3(4):e002090. doi.org/10.1136/bmjopen-2012-002090
- Lilja M, Mandić M, Apró W, et al. High doses of anti-inflammatory drugs compromise muscle strength and hypertrophic adaptations to resistance training in young adults. Acta Physiologica. 2018;222(2):e12948. doi.org/10.1111/apha.12948
- Lundberg TR, Howatson G. Analgesic and anti-inflammatory drugs in sports: implications for exercise performance and training adaptations. Scandinavian Journal of Medicine & Science in Sports. 2018;28(11):2252–2262. doi.org/10.1111/sms.13275
- Beauchamp GK, Keast RSJ, Morel D, et al. Ibuprofen-like activity in extra-virgin olive oil. Nature. 2005;437(7055):45–46. doi.org/10.1038/437045a
- Maughan RJ, Burke LM, Dvorak J, et al. IOC consensus statement: dietary supplements and the high-performance athlete. British Journal of Sports Medicine. 2018;52(7):439–455. doi.org/10.1136/bjsports-2018-099027
