You might want to think twice before popping that next ibuprofen

Pick Your Poison: Episode 3

You’re doing all the right things.

Emily was trying. Hard.

She’d started eating organic. Cut back on processed foods. Swapped her bagels and cream cheese for more protein like eggs and daily protein shakes.
She even bought bone broth from Whole Foods and started doing apple cider vinegar shots every morning—the latest wellness trend everyone swore by.

After what she uncovered about glyphosate—how it strips the gut lining, drives inflammation, and sets the stage for leaky gut—she thought the worst was behind her.

Her body should’ve been healing by now.
Especially after all the changes she made in her diet.

She was diagnosed with endometriosis in her early twenties, after years of being told her pain was “just bad periods.” Her OB gave her the usual playbook: birth control to “regulate” things. Ibuprofen for the pain. Work out regularly. Eat healthy-ish.

So she did all of it.
Hard workouts. High-protein snacks. Lemon water.
She followed the rules.

But still—every night, her belly bloated like she was five months pregnant.

Then came the cramps.

Not the dull kind. These wrapped around her lower back and pelvis like a vise—tight, stabbing, relentless.

She felt betrayed by her own body.

It was a Tuesday night. She had work in the morning. And her uterus felt like it was being sawed in half.

---

The medicine cabinet.

So she did what she always did.
She opened the medicine cabinet.

“Aleve or ibuprofen tonight?”

She popped two Kirkland-brand ibuprofen and curled up with her heating pad. Ibuprofen always felt safer—less side effects somehow.

That’s what we do, right?
Push through. Smile. Show up. Power through the pain.

But this time… the pain didn’t move.
It stayed. It pulsed.

It clawed through her uterus like barbed wire. Twisted deep in her ovaries like a blade.

The ibuprofen did nothing.

She had to be up in eight hours and was already in tears.
She Googled:
“Can I take naproxen if ibuprofen didn’t work?”

It said wait 8 to 12 hours. But she couldn’t wait 8 minutes.

Back to the cabinet. Two Aleve blue gel caps.

She stared.

What are the side effects of these, really? Maybe I’ve been overdoing it. But what else am I supposed to do? These cramps… this can’t be normal.

By 2 a.m., she was still awake—Googling side effects, waiting for the pills to kick in, wondering if she’d just accidentally overdosed.

And that’s when she found it.
The thing that stopped her cold.

---

But over the counter is safe, right?

Ibuprofen. Aleve. Advil. Motrin. Aspirin.
They sit in nearly every American medicine cabinet.
Emily had been taking them for years—ever since she was diagnosed with endometriosis.

It was standard protocol.
NSAIDs for the pain. Hormonal birth control to “regulate” things.
That was it. That was the whole plan.

So when the cramps started again—and the pills stopped working—she went searching.

At 2 a.m., curled up with a heating pad and a gut full of regret, she found a Reddit thread:
“Are NSAIDs making us more sick than we are?”

"The pain meds we take for our endo might actually be causing our endo… according to research and my own experience."

She blinked.

“NSAIDs lower prostaglandins—but they also cause leaky gut, which leads to microbial translocation, chronic inflammation… and yep, some studies now link that to endometriosis.”

It hit her like a slap in the face.

“I’ve been on ketoprofen for 14 years and I feel like I can’t take it anymore. It’s causing way too much stomach pain.”

Her story.
Word for word.

And then a thought she couldn’t shake crawled up from the back of her mind:

“What if I’ve been making it worse this whole time?”
“What if the thing I thought was saving me… was actually keeping me sick?”

She wasn’t alone. The comments poured in—GERD, IBS, autoimmune flare-ups, PPIs just to survive the side effects.

The pieces were starting to click.
And suddenly, she couldn’t unsee it.

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How NSAIDs actually work.

And why Emily’s body wasn’t just in pain—it was under siege.

Emily couldn’t stop reading.

She’d never questioned how ibuprofen worked. It was just something she took—like vitamins, or caffeine. Everyone did it.

But now she was starting to wonder:
How could a painkiller cause gut damage? How could it trigger inflammation?

She found the answer.

NSAIDs (like ibuprofen, naproxen, aspirin) block enzymes called COX-1 and COX-2. These enzymes help your body produce prostaglandins—chemical messengers that regulate pain and inflammation.

But prostaglandins don’t just regulate pain.

They also:

• Protect the stomach lining from acid

• Maintain tight junctions between intestinal cells (keeping the gut sealed)

• Drive peristalsis (gut muscle contractions that help you poop)

• Modulate immune responses and inflammatory resolution

• Maintain blood flow to the intestinal lining

• Regulate hormonal signaling and feedback

• Trigger uterine contractions during menstruation

• Support blood vessel dilation in reproductive tissues

So when NSAIDs block prostaglandins, they don’t just reduce pain—they disrupt the entire framework that keeps your gut, immune system, and reproductive health intact.

Emily’s stomach problems.
Her cramps.
Her bloating.
Her fatigue.

They weren’t random symptoms.
They were signs of systemic disruption.

---

The damage you won’t feel until it’s too late.

What came next made her sick to her stomach—literally.

NSAIDs weren’t just interfering with signals.
They were damaging the gut lining itself.

According to recent research:

• They thin the mucus layer that protects the stomach and intestines

• They damage mitochondria in gut-lining cells, impairing repair

• They weaken tight junctions, causing "leaky gut"

• They disrupt the gut microbiome, leading to dysbiosis

• They reduce blood flow to the intestines, slowing healing

• They increase permeability, allowing food particles, toxins, and bacteria to cross into the bloodstream

• They trigger microbial translocation—bacteria leaking out of the gut and spreading elsewhere

These weren’t fringe theories.
They were known consequences of long-term NSAID use. Documented in the literature. Confirmed in patient after patient.

And they mapped directly onto Emily’s symptoms.

“What if the bacteria in my gut are escaping?”

“Where else are they going?”

She didn’t have all the answers yet—but something clicked.
The bloating, digestive issues, and endometriosis aren’t isolated. They are connected.

And the silent, spiraling feedback loop she didn’t know she was trapped in… began to unravel.

Your gut and pelvis are connected.

Emily stared at the ceiling.

All this time, she’d thought her symptoms were separate.

Gut issues on one side. Reproductive pain on the other.

Now she wasn’t so sure.

She kept thinking about that phrase she’d seen in one of the papers:
Microbial translocation.

Bacteria from the gut crossing into the bloodstream.
Slipping through the cracks of a damaged intestinal wall.
Traveling to places they were never meant to go.

Where do they go?
Anywhere they can.

The pelvic cavity sits just inches away from the intestines. The uterus, ovaries, fallopian tubes, and bladder are surrounded by fascia, lymph, and connective tissue—all vulnerable to the spillover of systemic inflammation.

In women with endometriosis, gut permeability has been shown to be significantly higher.
Bacterial DNA has been found in endometrial lesions.
Leaky gut correlates with pelvic pain flares and immune activation in the reproductive tract.

Emily’s flares weren’t random.
They were part of a larger system failure—one that started in her gut and spread outward.

“My gut was already inflamed from glyphosate.”
“Then I stacked years of NSAIDs on top.”
“Now my immune system is stuck in overdrive, trying to clean up a mess it can’t contain.”

Maybe her endo wasn’t just hormone-driven.
Maybe it was microbe-driven too.

And if that was true, then everything she believed about her body… was about to change.

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A new thread to pull.

The next morning, Emily stood in her kitchen, waiting for her frozen waffles to pop up from the toaster.

Trader Joe’s. Organic. Whole wheat.
She just needed something to stop what felt like hunger pains. Or what is it the copious amount of pain killers from last night?

But her stomach still felt uneasy after eating her waffles and Orgain protein shake.
Her throat burned faintly—again.
Reflux. Bloating. The usual. She was sick of feeling sick.

She grabbed her phone and searched:
“How to heal leaky gut.”

Listicles. YouTube videos. Reddit threads.
Everyone had a different opinion—but one phrase kept popping up:

Cut out gluten.

She rolled her eyes. Instinctively.

Gluten? Seriously? That trend again?

She’d always assumed gluten-free was just for celiac patients or wellness influencers selling almond flour muffins convincing you it was the next big weight loss strategy.

But the more she read, the more it started to click.

“Gluten increases intestinal permeability—even in people without celiac.”
“In a compromised gut, gluten can amplify inflammation and immune activation.”
“It’s not always the root cause—but it can pour gasoline on the fire.”

She looked down at her plate.

Her stomach turned.

It wasn’t that she was suddenly afraid of gluten.
It was that—for the first time—she wasn’t sure she trusted it.

And that was enough to keep reading.

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Up Next on Pick Your Poison

Episode 4: The Gluten Illusion
Because sometimes, the foods we trust the most are the ones silently feeding our inflammation.

Scientific sources Emily encountered in her late-night rabbit hole:

1. Wang X, Tang Q, Hou H, et al. (2021). Gut Microbiota in NSAID Enteropathy: New Insights from Inside.
   Frontiers in Cellular and Infection Microbiology, 11.
   https://pubmed.ncbi.nlm.nih.gov/34295835/
   → Covers NSAID-induced mucus thinning, microbiome disruption, and intestinal damage.

2. Watanabe T, Fujiwara Y, Chan FKL. (2019). Current Knowledge on NSAID-Induced Small-Bowel Damage.
   Current Gastroenterology Reports.
   https://pubmed.ncbi.nlm.nih.gov/31865463/
   → Discusses mitochondrial injury in gut epithelial cells and energy metabolism disruptions caused by NSAIDs.

3. Bjarnason I, et al. (2018). Mechanisms of Damage to the Gastrointestinal Tract from NSAIDs.
   Gastroenterology, 154(3), 500–514.
   https://pubmed.ncbi.nlm.nih.gov/29221664/
   → Comprehensive review of NSAID damage across the stomach and intestines.

4. Cleveland Clinic. Prostaglandins: What They Are and What They Do.
   https://my.clevelandclinic.org/health/articles/24411-prostaglandins
   → Clear breakdown of prostaglandin function, including their role in reproductive health and gut lining protection.

5. Tang F, et al. (2024). Unraveling the Microbial Puzzle: Exploring the Intricate Role of Gut Microbiota in Endometriosis Pathogenesis.
   Frontiers in Cellular and Infection Microbiology, 14:38435309.
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10904627
   → Explores how gut dysbiosis, inflammation, and endotoxin production contribute to endometriotic lesion growth and estrogen disruption.

6. Tang Y, et al. (2024). Unraveling the Relationship Between Gut Microbiota and Site-Specific Endometriosis: A Mendelian Randomization Analysis.
   BMC Medicine, 22:11254793.
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11254793
   → Establishes causal associations between specific gut microbes and various subtypes of endometriosis and infertility risk.

7. Twardowska A, et al. (2022). Preventing Bacterial Translocation in Patients with Leaky Gut Syndrome: Nutrition and Pharmacological Treatment Options.
   Nutrients, 14(6):1261.
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8949204
   → Reviews the pathophysiology of bacterial translocation from the gut to “sterile” tissues.