Over-the-counter and prescription nonsteroidal anti-in­flammatory drug (NSAID) medications like ibuprofen and aspirin are frequently used for joint and spine-related in­flammatory pain. Most NSAIDs work by reversibly inhib­iting the activity of cyclooxygenase (COX)-1 and COX-2, the enzymes that produce proinflammatory prostaglandins (PGs). PGs are hormonelike substances with diverse roles in the human body, principally the processes that lead to the classic signs of inflammation: redness, swelling and pain. However, recent studies suggest that NSAIDs can lead to se­rious side effects such as myocardial infarction, gastrointes­tinal bleeding and ulcers, and stroke. Therefore, although NSAIDs can be effective, natural anti-inflammatory supple­ments may provide a safer, yet potent alternative treatment for inflammatory pain relief. Natural products have served mankind for thousands of years traditional herbal rem­edies have been the main source of medicine for treating many different diseases throughout history, and modern medicine, in many cases, has advanced due to the use of natural products as lead compounds for the pharmaceutical industry. Since COX-2-mediated PG synthesis and free rad­ical production are responsible for numerous inflammatory conditions, it is widely believed that phytochemicals with potent COX-2 inhibitory effects will demonstrate signifi­cant analgesic and anti-inflammatory activity. This article will introduce some of the natural anti-inflammatory agents and foods that produce similar anti-inflammatory activity like classical NSAIDs, but with less side effects.


Curcumin

Curcumin is a natural substance present in turmeric, the spice that gives curry its characteristic yellow color. Cur­cumin acts as an anti-inflammatory by inhibiting COX2 expression, thereby blocking the synthesis of PGs. Some clinical studies have shown that curcumin’s anti-inflam­matory properties may help many inflammatory diseases, from arthritis to ulcerative colitis. One study on curcum­in maintenance therapy for ulcerative colitis showed that 2 grams of curcumin a day in combination with prescription medication had significantly better clinical efficacy in the prevention of relapse in patients with quiescent ulcerative colitis. Thus, although it may not help during an active in­flammation flareup, curcumin seems to be a promising and safe way to prolong disease remission.


Omega-3 fatty acids

Fish oils contain omega-3 polyunsaturated fatty acids (PUFAs). Many of the biological functions of PUFAs are moderated via lipid mediators produced by fatty acid oxy­genases such as COXs, lipoxygenases, and cytochrome P450 monooxygenases. The anti-inflammatory effect of omega3 PUFAs is believed to occur by binding to oxygenases to re­duce the formation of proinflammatory lipid mediators. Thus, fish oil warrants consideration for effective treatment for arthritis, especially rheumatoid arthritis.


Coffee

For most people, coffee is the first drink consumed in the morning to help them get through the day. Recently, many studies suggested that coffee can also fit into a healthy life­style and act as an anti-inflammatory agent – largely due to the fact that it is rich in antioxidants, such as hydrocinnam­ic acids and polyphenols, that neutralize excess free radi­cals to reduce inflammation. One study showed that regular coffee drinkers had lower circulating levels of inflammatory markers compared to nonregular coffee drinkers, which may partially mediate the inverse associations of coffee with cancer and other chronic diseases. However, contradictory effects have also been reported. Some people may have in­creased inflammation after coffee consumption. Therefore, a deeper understanding of potential impacts of coffee intake on individuals is needed.

Although natural herbal medications may help alleviate side effects from NSAIDs, there may be potential adverse in­teractions between some of the commonly used herbal med­ications and analgesic drugs. Therefore, if you are interested in taking herbal medication, it is still important to consult with physicians before taking these herbal remedies to de­termine the best anti-inflammatory medication for you.


References:

Maroon JC, Bost JW, Maroon A. Natural anti-inflammatory agents for pain relief. Surg Neurol Int. 2010 Dec 13;1:80. doi: 10.4103/2152-7806.73804. PMID: 21206541; PMCID: PMC3011108.Koehn, F., Carter, G. The evolving role of natural products in drug discovery. Nat Rev Drug Discov 4, 206–220 (2005). https://doi.org/10.1038/nrd1657

Attiq, A., Jalil, J., Husain, K., & Ahmad, W. (2018). Raging the War Against Inflammation With Natural Products [Review]. Frontiers in Pharmacology, 9. https://doi.org/10.3389/fphar.2018.00976 https://health.clevelandclinic.org/turmeric-health-benefits/https://www.cghjournal.org/article/S1542-3565(06)00800-7/fulltext#secd23498439e880

Loftfield, E., Shiels, M. S., Graubard, B. I., Katki, H. A., Chaturvedi, A. K., Trabert, B., Pinto, L. A., Kemp, T. J., Shebl, F. M., Mayne, S. T., Wentzensen, N., Purdue, M. P., Hildesheim, A., Sinha, R., & Freedman, N. D. (2015). Associations of Coffee Drinking with Systemic Immune and Inflammatory Markers. Cancer Epidemiol Biomarkers Prev, 24(7), 1052-1060. https://doi.org/10.1158/1055-9965.Epi-15-0038-t

Cleland LG, James MJ, Proudman SM. Fish oil: what the prescriber needs to know. Arthritis Res Ther. 2006;8(1):202. doi: 10.1186/ar1876. Erratum in: Arthritis Res Ther. 2006;8(4):402. PMID: 16542466; PMCID: PMC1526555.Tomoaki Ishihara, Mio Yoshida, Makoto Arita, Omega-3 fatty acid-derived mediators that control inflammation and tissue homeostasis, InternationalImmunology, Volume 31, Issue 9, September 2019, Pages 559–567,https://doi.org/10.1093/intimm/dxz001

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