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Comment by learc83 | Hacker News Reader

NSAIDs greatly increase your chances of ulcers and gastritis even if you take them on a full stomach.

To elaborate, they don't damage your stomach via contact, they inhibit COX which is an enzyme that contributes to gastric mucosal protection and regeneration.

So it doesn't matter whether you eat with them or not, largely, unless what you're eating with them is an antacid or proton pump inhibitor.

Oh wow, thank you, that's pretty interrsting

But wait, there's more! There are at least two COX pathways; COX-1 is involved in protection of stomach lining, COX-2 is responsible, in part, for pain signalling.

Aspirin inhibits both pathways. Other NSAIDs do the same, although they typically have less of an effect on COX-1.

There is something on the unnoficial market which may inhibit only COX-2, a sort of holy grail in the last few decades of medicine: kratom[0].

0.https://www.ncbi.nlm.nih.gov/pubmed/21513785

Anecdotally, Kratom use can also lead to long, opiate like withdrawls (weeks of hyperalgesia, no fun). Other short term opiate like side effects like nausea are common as well. I would definitely recommend against self-experimentation unless you are prepared for lengthy withdrawl symptoms.

Hopefully more research can be done into its constituent chemicals before it is banned in the US. The DEA already tried, and its illegal in several states.

Right, there is some evidence that COX-2 selective inhibitors may be safer for patients with inflammatory bowel disease like Crohn's and Ulcerative Colitis. Currently, those patients are generally advised to not take an NSAIDs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034022/

Ah, but interestingly, inhibiting either cox pathway independently doesn't damage mucosa. you have to inhibit both, simultaneously, and the limiting factor is the one that is the least inhibited. So it's not just "COX-2 good, COX-1 bad", it's actually "Either pathway is fine to inhibit selectively as long as you don't inhibit both"

Damnit im trying to finish a project! Now i have to read that link :P

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