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Acetaminophen Linked to Increased Risk of Kidney Dysfunction When Combined with Alcohol

Story at-a-glance -

  • Acetaminophen can have adverse effects on your liver and kidneys, and acetaminophen-containing prescription drugs must now carry a warning about the potential for serious and potentially lethal skin disorders
  • Acetaminophen is the number one cause of acute liver failure in the US. Taking just a little more than the recommended dose over the course of several days or weeks (“staggered overdosing”) is far more risky than taking one large overdose
  • Recent research suggests that acetaminophen also significantly increases your risk of kidney dysfunction if taken with alcohol—even if the amount of alcohol is small
  • Previous research suggests acetaminophen might render vaccinations less effective when administered together
  • Foundational lifestyle basics for a pain-free life, as well as specific treatment modalities for acute and chronic pain, as well as all-natural alternatives to analgesic drugs are reviewed

By Dr. Mercola

Given the fact that acetaminophen (sold under the brand name Tylenol, among others) is one of the most widely used drugs in the world, you might be surprised to learn that taking just a bit too much, on a regular basis, or taking it in combination with alcohol, can have rather significant health risks.

The drug can have adverse effects on your liver and kidneys, and acetaminophen-containing prescription drugs must now carry a warning about the potential for serious and potentially lethal skin disorders.

Acetaminophen can be toxic to your liver, even at recommended doses, when taken daily for just a couple of weeks.1

Research2 has also shown that taking just a little more than the recommended dose over the course of several days or weeks (referred to as "staggered overdosing") is far more risky than taking one large overdose.

Unfortunately, familiarity with this drug and the false sense of security it can bring puts many in harm's way. When suffering with a cold, headache or other pain, many end up doubling or even tripling the maximum recommended dose by taking multiple OTC medications, all of which may contain acetaminophen at varying amounts.

Certain prescription painkillers, such as Vicodin and Percocet, also contain acetaminophen and should therefore not be mixed with other acetaminophen-containing medications.

Failing to heed this warning can easily lead to an overdose, which can cause serious liver damage or liver failure. Acetaminophen is actually the number one cause of acute liver failure in the US.

Tylenol + Alcohol = 123 Percent Increased Risk of Kidney Damage

Recent research3 suggests that acetaminophen also significantly increases your risk of kidney dysfunction if taken with alcohol—even if the amount of alcohol is small. The findings were presented at the 141st annual American Public Health Association meeting in Boston, Massachusetts. 4

The risk is worrisome enough that the researchers advise doctors who recommend acetaminophen for pain management to educate their patients about the risks of mixing it with alcohol. Besides alcoholics,5 young adults are particularly at risk as they're more likely to consume both.

The video above specifically addresses the potential hazards of using Tylenol to treat a hangover.

When you consider that both excessive alcohol consumption and regular use of acetaminophen can promote kidney toxicity and/or damage,6, 7 it's not a major stretch to imagine that combining them might heighten such risks.

Data from more than 10,000 participants was analyzed for the featured study. In all, 2.6 percent of participants reported using acetaminophen together with small to moderate amounts of alcohol, and 1.2 percent of those who did so had impaired kidney function.

While that might not sound like much of a worry, the researchers found that the combination of alcohol with acetaminophen raised the risk of kidney damage by 123 percent, compared to either of them taken individually. According to the authors:

"Although individually it may not be harmful to ingest therapeutic dose of acetaminophen and a light/moderate amount of alcohol, combining the two may be potentially hazardous."

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Acetaminophen May Reduce Immune Function

When a medication is sold without a prescription and used with such frequency as acetaminophen, it's easy to forget that every drug carries the potential for causing adverse effects—especially if used in combination with other drugs. Interestingly, little-known research from 2009 suggests acetaminophen might render vaccinations less effective when administered together.

Since vaccine-induced immunity is already inferior to naturally acquired immunity, it certainly doesn't make sense to take something that might reduce whatever meager effectiveness a vaccine might offer.

According to this Czechoslovakian study,8 infants who received acetaminophen right after getting a vaccination experienced lowered immune response, developing significantly fewer antibodies against the disease they were vaccinated against.

The vaccines used in the study were for pneumococcal disease, Haemophilus influenzae type b (Hib), diphtheria, tetanus, whooping cough, hepatitis B, polio and rotavirus. (No flu vaccines were included. However, it's likely the effect might still be the same.) The authors concluded that:

"Although febrile reactions significantly decreased, prophylactic administration of antipyretic drugs at the time of vaccination should not be routinely recommended since antibody responses to several vaccine antigens were reduced."

The researchers suggested that the acetaminophen's anti-inflammatory activity might interfere with your body's immune system antibody response, which could explain why the vaccines were rendered less effective. It's worth noting that a lowered immune response also means you're more susceptible to develop other infections.

And, as we now know, in the case of the flu for example, it is secondary infections such as bacterial staph infections that turn out to be deadly -- not the flu virus in and of itself. From that perspective, it may be worth reconsidering your use of acetaminophen when you feel like you're "coming down with something." You just might be better off skipping the pain reliever, and taking steps to boost your immune system instead, such as boosting your vitamin D levels.

Beware of Fatal Skin Reactions

The potential hazards of this medicine cabinet staple don't end at liver and kidney damage. After reviewing data from the FDA Adverse Event Reporting System (FAERS), the FDA found 107 cases of serious skin reactions linked to acetaminophen products from 1969 to 2012. Sixty-seven of them required hospitalization; 12 died. The data, coupled with several cases documented in medical literature, has prompted the FDA to require a warning about potential skin reactions be added to prescription acetaminophen products.9 The skin reactions linked to acetaminophen include:

  • Stevens-Johnson Syndrome (SJS): This reaction begins with flu-like symptoms that progress into a painful purple or red rash that blisters and causes the top layer of your skin to slough off. This can lead to serious infections, blindness, damage to internal organs, permanent skin damage and even death.
  • Toxic Epidermal Necrolysis (TENS): TENS also typically begins with flu-like symptoms (cough, headache, aches, fever) and progresses into a blistering rash. Layers of the skin may peel away in sheets, and hair and nails may fall out. TENS is often fatal, typically as a result of infection.
  • Acute Generalized Exanthematous Pustulosis (AGEP): This skin eruption causes numerous pustules to appear on the skin, often accompanied by fever. This condition typically resolves within two weeks once the acetaminophen is stopped.

While the main cause of SJS, TENS and AGEP is the consumption of certain acetaminophen-containing medications, no one knows exactly why it occurs, or what makes certain people more at risk. What is particularly alarming is that it can occur at any time, even if you've taken the medication in the past without issue. According to the FDA:10

"A serious skin reaction can occur at any time, even if you've taken acetaminophen previously without a problem. There is currently no way of predicting who might be at higher risk. If you've ever had a skin reaction when taking acetaminophen, don't take the drug again…" [Emphasis mine]

Boosting Your Glutathione Levels May Help Counteract Acetaminophen Hazards

While I generally do not recommend using acetaminophen-containing drugs for minor aches and pains, given their health risks, they are sometimes necessary to temporarily suppress severe pain, such as post-surgical pain. For those instances, I recommend taking it along with N-acetyl cysteine (NAC), which is the rate-limiting nutrient for the formation of the intracellular antioxidant glutathione. It is believed that the liver damage acetaminophen causes is largely due to the fact that it can deplete glutathione, an antioxidant compound secreted by your liver in response to toxic exposure. Glutathione also helps protect your cells from free radical damage.

If you keep your glutathione levels up, the damage from the acetaminophen may be largely preventable. (This is why anyone who overdoses on Tylenol receives large doses of NAC in the emergency room.) So whether you are taking Tylenol in prescription or over-the-counter form, I strongly suggest taking NAC along with it. Bear in mind that while this may help prevent liver damage from occurring, I'm not aware of any evidence supporting its use for the prevention of kidney toxicity and/or potential skin reactions.

Foundational Strategies to Address Chronic Pain

Chronic pain is perhaps one of the most common ailments there is. And while different diseases and conditions may benefit from specific pain-relieving strategies, I believe the following guidelines are foundational basics for the treatment of most if not all painful conditions.

  • Get sufficient high-quality, animal-based omega-3 fats. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. One of the best sources of omega-3s is krill oil supplement. The omega-3 fats EPA and DHA contained in krill oil have been found in many animal and clinical studies to have anti-inflammatory properties. Unlike fish oil, krill oil does not pose any toxicity and rancidity to your body, which may only damage your health. It is also far lower on the food chain, making it far less likely to accumulate environmental chemicals and toxins.
  • Eliminate or radically reduce your intake of grains and sugars, especially fructose. Excessive intake of grains and sugars will elevate your insulin and leptin levels primarily through causing your body to be resistant to them, resulting in increased inflammation in your body.
  • Optimize your vitamin D levels through regular and appropriate sun exposure. Combined with vitamin K2, vitamin D can help prevent the softening of your bones that can often lead to lower back pain. Sun exposure also has pain-killing or analgesic properties beyond vitamin D production. Research has shown sun exposure can be quite beneficial for fibromyalgia pain for example.
  • Avoid aspartame and MSG, both of which are notorious for causing headaches and triggering migraines.
  • Grounding. Walking barefoot; grounding your body to the Earth, is a simple way to reduce chronic inflammation and pain. When you're grounded, there's a transfer of free electrons, which are among the most potent antioxidants currently known, from the Earth into your body. The effect is sufficient to maintain your body at the same negatively charged electrical potential as the Earth.
  • This results in a number of health benefits, including calming your sympathetic nervous system which produces beneficial changes in heart rate and blood pressure, improved sleep, decreased levels of inflammation, reduced pain, and an improved general state of well-being. It also thins your blood and reduces your blood viscosity, resulting in improved blood flow throughout your body.

    Research has demonstrated it takes about 80 minutes for the free electrons from the earth to reach your bloodstream and transform your blood. A newer theory also proposes that grounding may facilitate the formation of structured water in your body, which may be critical for optimal health. To learn more about this, please see my interview with water expert Dr. Gerald Pollack.

Effective Pain-Relieving Modalities: Laser Therapy, EFT, and More

I recently interviewed Dr. Phil Harrington about the benefits of infrared laser therapy for pain. Laser therapy treatment helps reduce pain and inflammation and enhances tissue healing—both in hard and soft tissues, including muscles, ligaments, and even bones. It increases oxygenation of tissues and allows injured or damaged cells to absorb photons of light, which speeds healing. While there are a number of companies that manufacture lasers for tissue healing, K-Laser is currently the leading manufacturer of these types of infrared laser tools. Examples of the types of painful injuries that this kind of laser therapy can be helpful for include:

  • Acute injuries, such as strains, sprains, and shoulder injuries
  • Repetitive-use injuries such as carpal tunnel syndrome
  • Traumatic injuries, such as post-motor vehicle accident with cervical strain/sprain
  • Chronic issues such as frozen shoulder and arthritis

To me, at this point in time, it would almost be medical negligence bordering on medical malpractice not to try laser treatment before prescribing drugs or surgery for conditions such as these. Other therapeutic mind-body modalities such as Emotional Freedom Technique (EFT), yoga, acupuncture, meditation, hot and cold packs, and Foundation Training can also result in astonishing pain relief without any drugs. It's worth noting that EFT is effective against both acute and chronic pain.

Pain-Relieving Alternatives to Acetaminophen (and Other Analgesic Drugs)

The following options can also provide excellent pain relief without any of the health hazards associated with acetaminophen and other pain killers.

  • Astaxanthin: One of the most effective oil-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than many NSAIDs. Higher doses are typically required and one may need 8 mg or more per day to achieve this benefit.
  • Ginger: This herb is a potent anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
  • Curcumin: Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study11 of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility. In fact, curcumin has been shown to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.12
  • Boswellia: Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.
  • Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used this for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards. I used a topical preparation for this.
  • Evening Primrose, Black Currant and Borage Oils: These contain the fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain.
  • Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmits pain signals to your brain.

You Can Avoid the Painkiller Trap

Whether you're trying to address acute or chronic pain, know that there are many safe and effective alternatives to more hazardous prescription and over-the-counter painkillers. K-Laser therapy can be an excellent choice for many painful conditions, including acute injuries.

For long-term relief, you'll want to start taking a high-quality, animal-based omega-3 fat like krill oil, as omega-3 fats are precursors to mediators of inflammation called prostaglandins. Addressing your diet by eliminating or radically reducing most grains and sugars (including fructose) is also important, as avoiding grains and sugars will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production. That is why eliminating sugar and grains is so important to controlling your pain.

I also recommend optimizing your production of vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain. Along with these strategies, be sure you are also addressing any emotional elements. EFT is particularly useful for this—whether your pain is chronic or acute. In both instances, your level of stress, your anxiety and your perceptions of pain all play a role in how you experience pain, and addressing these elements can go a long way toward providing effective pain relief.