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Just Say No To Cox-1 & Cox-2 Inhibitiors: Five Necessary Steps to Fight Inflammation

by Dr. Stephen Gangemi on February 21, 2005

February 18, 2005 was an important day for drug makers, namely Merck and Pfizer, as the decision to keep their Cox-2 inhibitor drugs on the market looks ever so promising. Advisory groups to the Food and Drug Administration have recommended that the benefits of the Cox-2 inhibitors, (Vioxx, Celebrex, and Bextra), outweigh the risks. This in turn sent Merck, (maker of Vioxx), and Pfizer, (maker of Celebrex and Bextra), stock shares up 13 and 7 percent respectively. Not bad for a one day return in the bank. Now let’s consider the health returns.

Cox-1 and Cox-2 inhibitors selectively block an enzyme that is responsible for inflammation. They are a type of nonsteroidal anti-inflammatory drugs (NSAIDs) because these medications essentially fight inflammation. Drugs such as aspirin and ibuprofen and to some extent diclofenac, block both the Cox-2 and Cox-1 enzymes while other such as Vioxx and Celebrex block just the Cox-2. The reason so many doctors like the heavy duty Cox-2 meds is because they do not block the Cox-1 enzyme, which helps the stomach make a beneficial prostaglandin (a hormone-like chemical messenger), to protect the stomach lining. This is why NSAIDs often times cause stomach and gastrointestinal ulcerations. However, like all medications, there are risks and side effects. And in the Fall of 2004 when news resurfaced that the Cox-2 inhibitor Vioxx was responsible for cardiovascular problems such as heart attacks, turmoil erupted and it was pulled from the shelves. Merck’s stock plummeted and medical doctors threw up their arms as they knew no other way to get their patients out of pain other than revert back to the NSAIDs. I covered this in November 2004. We have now gone full circle, so ironically enough it is a good place to pick up again here in 2005.

Unfortunately many patients are at the mercy of their physicians who only know, well, what they know. They know no natural method of fighting inflammation and most do not understand that inflammation can be blocked by means other than medications. The often simple process of achieving more anti-inflammatory prostaglandins in the body over the pro-inflammatory prostaglandins is all about dietary and lifestyle habits.

First and foremost, if you want to accelerate inflammation, or start the process if you haven’t already, go eat some hydrogenated “trans” fats. You don’t have to eat too much because the half-life of a trans fat is 51 days. So the cookie or bread you eat today that most likely has some partially hydrogenated vegetable oil in it will still be more than half available in 7 weeks. This is why so many people who are told to “limit their trans fat intake” see absolutely no change in how they feel. You won’t see a change by just cutting it down, you have to eliminate it completely; it comes down to simple biochemistry.

So the first and most important step in fighting inflammation is to stay away from anything that says partially hydrogenated, margarine, shortening, or anything that is deep fried. Be cautious of labels that scream “No Trans Fats!” as the fine print often states that is “per serving” and if you read the ingredients you will often see a partially hydrogenated oil of some type. Not only do trans fats promote inflammation (which the Cox-2 enzyme is in part responsible for), they also block the anti-inflammatory enzymes. To me it sounds much more reasonable to go on a hydrogenated fat-free diet before you try a Cox-2 med or any NSAID for that matter.

The second step in fighting inflammation would be lower your intake of vegetable oils and refined carbohydrates. A high carb diet, especially one that is refined, converts many of these anti-inflammatory prostaglandins in your body to pro-inflammatory prostaglandins. So keep your diet of corn, canola, safflower, and soy oil to a minimum (zero is best) and snack on healthy nuts and seeds such as walnuts, cashews, and sunflower seeds. Substitute your cooking vegetable oil with extra virgin olive oil and make sure you use some every day, adding it as close to the end of meal preparation as possible as heating too high will easily destroy the highly beneficial monounsaturated fat. Limit, or better yet – eliminate, grains such as bread and pasta; limit/eliminate white sugars; eliminate soft drinks and even fruit juice. Use honey, preferably local raw honey, to sweeten what you need to sweeten. ** Extra virgin olive oil and local raw honey – get them in your diet! Coconut oil for cooking and coconut milk in your diet are great too.

The third step is to increase your dietary Omega 3 “good fats” such as fish oil and flax oil. Perhaps I should say “get some in your diet” rather than increase as many people ingest absolutely none. Due to the high amounts of contaminants in fish these days, such as mercury, eating fish more than once a week is usually not recommended. Fish such as mackerel, salmon, and tuna (steaks, not the canned stuff), are high in the Omega 3 anti-inflammatory fats. Consider taking a fish oil supplement that is third party certified to be free of contaminants. Flax oil is also very beneficial. Just like fish oil, it converts into the anti-inflammatory prostaglandin but it is higher up on the cascade of prostaglandin formation. Therefore, it is much easier for something to go wrong which stops flax oil from ever helping you fight inflammation. Trans fats will block any healthy benefits of flax oil from ever being achieved, and so will a lack of certain nutrients – which brings us to step four.

The fourth step is to make sure your nutrient intake is adequate. Magnesium (Mg) is a very common nutrient deficiency today. Mg is lacking in many fast food and refined diets. Additionally, Mg is needed by the body for so many processes, from stress hormone metabolism to bone density health. Mg is a powerful anti-inflammatory nutrient and needed for prostaglandin formation. Zinc, niacin (vitamin B3), and vitamin C are also needed for prostaglandin formation. Lacking these nutrients will leave you pro-inflammatory. Herbs such as turmeric, garlic, ginger, and orange peel (not really an herb) are also very anti-inflammatory. Including these in your diet whenever possible is a good idea.

Not the final or least important step in fighting inflammation, but number five for the purpose of this article, is to exercise – aerobically. Many people are told to exercise but they are not told how, specifically at what intensity. Exercise can be pro-inflammatory as well as anti-inflammatory. You must exercise aerobically if you want to fight inflammation. This is described in detail in the exercise section of my web site by clicking here. You will learn why your heart rate is the most important indicator of exercise intensity and how to properly exercise using it as your guide so you are fighting inflammation, not creating more.

Following these five relatively simple steps often leads to extraordinary results. Sure taking a Cox-2 or NSAID is easier but look at all the health risks associated with these medications. Not only are there risks, but there are substantial risks for not taking these necessary steps to fight inflammation that no medication can substitute for. These include symptoms of sleepenergy problems, PMS, headaches, hormonal imbalances, as well as diseases such as cancers, auto-immune diseases, and diabetes. and

As I always say, everybody is an individual, and what works for one person often does not always work for the next. Following the five steps above, with the advice of a qualified physician, (which can sometimes be an oxymoron), will benefit the way you feel in some way or another. One part of the program may improve you more than another but they are all important. These five steps do not cover everything there is to do to fight inflammation, but they are things I either tell each and every patient or check them for in the office. Often times it is necessary to find what is causing an individual’s inflammation to help them through the problem. Food sensitivities, hormonal imbalances, and medications (typically anti-inflammatory meds interestingly enough) are many times responsible for provoking inflammation. You can read more about inflammation in my two articles by clicking here.

Recent polls show that over 50% of people who were taking a Cox-2 would go back on it, or stay on it, if it is allowed by the FDA. This is despite the fact that these medications can kill you, as they do to many. And if they don’t kill, they will cause other problems such as sulfur depletion, which you can also read more about in my articles mentioned. Sulfur is responsible for cartilage formation and important liver detoxification steps – how ironic.

I'm a board certified chiropractic physician and clinical nutritionist with a passion for true natural health care. I implement dietary & nutritional therapies, exercise & movement practices, and lifestyle changes along with manual therapy techniques to help the body heal and prevent illness and injuries.


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  1. Jill Bangerter permalink

    Hi, Dr. Gengemi.

    I took my mother, who has multiple medical problems and faces back surgery, to her rhumatoid (sp?) doctor, an older fellow with Cleveland Clinic and high in the ranks. When she thanked him for having cured her of her hand problems, he said he had just stopped the symptoms of her osteo arthritis. Long story short: he basically told us it is hereditary, it can’t be stopped, and it is inevitable for me to get it.

    I recently had an x-ray indicating knee arthritis but eliminated the pain from starting to swim laps again, and I am able to swim a mile at this point. My legs hurt when I don’t swim. My husband and I are also following the Paleo diet.

    My question is this: is osteo-arthritis really inevitable for me? Will what I’m doing now keep it at bay?

    If not, I’m not looking forward to my seventies.

    Thanks, and have a great day!


    • A rheumatologist said that osteoarthritis is genetic? Huh? That’s scary that he thinks that way. Wow, I’m sorta speechless. Though a patient of mine recently was told by her endocrinologist that her Type II diabetes was improving because she was making more insulin (that’s Type I); so it’s not the first time I’ve heard craziness.

      • Jill Bangerter permalink

        I can’t believe what you just wrote. It really affirms my opinion that I should have trusted my instincts. Let me outline my history for you just to show you what I’ve been dealing with.

        I’m 62 now and I can remember back to elementary school having awful stomach aches that went through high school. My mom thought I was a hypochondriac and did nothing. (I also broke my ankle and she thought it was in my mind…:) Got married, had 3 kids, always had indigestion. One of my doctors did the tests and said I had an ulcer, hiatal hernia, did the endoscopy, colonoscopy, etc. etc. etc. Nothing. They prescribed omneprazole and other meds. I was on this for years. Didn’t want to be, but it hurt when I wasn’t.

        In the meantime, I did what I thought was right according to gov’t. guidelines and fed my family whole wheat products and what we were told was good for us. I’m an educated person but tend to believe people when they tell me something, so as a working mom, I didn’t really have time or money to get to the source of my problem. I’m an English teacher, not a scientist or researcher, so I believed the educated people around me. How stupid.

        Around 16 years ago, we had some major trauma in our lives that I believe triggered my gluten intolerance to become celiac disease. I am not going through any testing at this time. I’m done with that and have learned, and as a metaphysics minister and Reiki master, I think I’m long overdue to start trusting my own instincts. At this time 16 years ago, I felt like something was rotten inside me and, because I had a severe pain in my right side, went to the HEAD of Cleveland Clinic’s Women’s Health. Fear forces the issue.

        Tests found thyroid antibodies and she diagnosed Hashimoto’s thyroid disease but was unable to figure out why I hurt or felt rotten inside, so she prescribed Neurotonin. I took it two days and immediately got off it for very obvious reasons. She got angry with me and reprimanded me. I switched doctors and never went back.

        My doctor now is an older gent who practices Osteopathy and Holistic medicine, specializing in Fibromyalgia, and I love him to death, but he has also not been able to tell me why my body is attacking itself. You did.

        I have an appointment with him tomorrow to consult since I want to be off of the Armour Thyroid. Since I’ve been on the gluten-free diet, I had definite overdose symptoms from the meds. and didn’t take it yesterday. I took half a dose today and my doctor and I are going to talk tomorrow.

        I really apologize for writing this book, but you have hit a very raw nerve. I’m going to ask my doc this tomorrow, but I would also like to know what you think.

        Cleveland Clinic’s diagnosis was based on antibodies attacking my thryoid, I think. Is it possible the antibodies were from the gluten intolerance and that I may not really have Hashimoto’s? Please don’t be afraid to answer. I will not take myself off my meds without a plan that my doctor and I devise. I’m going to ask him if I can go a month or two without the thyroid meds. while following a strict gluten-free diet, and then get a blood test at that time. What are your thoughts on that?

        I do plan on following my doctor’s advice. He’s a good man, but you have finally hit the nail on the head for me. I’ve never felt like I had thyroid disease. Incidentally, I fixed my knee and hip after the x-ray that diagnosed my arthritis by swimming again, as I mentioned. I’m very glad to hear I’m not condemned to get arthritis.

        I hope I’m not bothering you. Thanks so much. Your website has done more good for me than you can imagine.

        Jill B.

        • If the blood tests you had at the CC showed TPO or TG antibodies then yes you have Hashimotos regardless of whether they were from gluten triggering an immune response or not. Though as you know – it’s just a name. Now if you have figured out WHY you have Hashimotos – from gluten or some other cause – and that is removed or resolved, then yes, you may be able to lower or even eliminate your thyroid meds (as you say with your doc). But it depends on how much your thyroid has suffered. If your thyroid is really run down from years of immune attack, then you will always be on some thyroid med – it’s too late – but it’s okay as you will have taken the stress of your immune system and hopefully stopped it from attacking another area of your body resulting in another autoimmune disease. Also, with thyroid meds, you typically want to wean off them – don’t just stop cold – a good doc will be able to advise you correctly. The big idea here is that Hashimotos is NOT a thyroid disease – it’s a thyroid symptom from an immune problem.

          • Jill Bangerter permalink

            Thanks so much for your help, Dr. G. I saw my doctor this morning and he said I do, in fact, have Hashimoto’s but that he was hopeful that my thyroid is not gone yet. He’s reduced my meds., instructed me to continue to follow the gluten free diet and gave me some herbal anti-flammatory pills to take. He’ll be taking my blood each month to see how I fare and reduce my med if possible based on those results.

            I can live with the Hashimoto’s. I’m just happy to have found some answers as to why I have felt so badly for so long and plan to continue on this lifestyle. I really thank-you for sending me on the right path.


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