 Previously, I explored the use of spinach for athletic performance and recovery, attributed to its anti-inflammatory effects. But most athletes aren't using spinach to beat back inflammation. They use drugs, typically non-steroidal anti-inflammatory drugs like ibuprofen, used by up to 95% of collegiate athletes, and even three-quarters of kids playing high school football, including prophylactic use in an attempt to prevent pain and inflammation before it occurs. However, scientific evidence for this approach is currently lacking, and athletes should be aware of the potential risks, which include gastrointestinal pain and bleeding, kidney damage, liver damage. This is the study that freaked everyone out. I studied thousands of marathon runners, and five times the incidence of organ damage among those taking over-the-counter painkillers before the race. Nine were hospitalized, three kidney failure after taking ibuprofen, four with gastrointestinal bleeding after aspirin, and two heart attacks, whereas none of the control group, not taking painkillers, ended up in the hospital. And it looks like the drugs didn't even help. An analysis of the pain reported before and after the race showed no real advantage to taking the drugs. So it appeared to just be all downsides. What about using ginger instead? In that marathon study, the most common adverse effect of taking the drugs was gastrointestinal cramping. Ginger, in contrast to aspirin or ibuprofen-type drugs, may actually improve gastrointestinal function. For example, endurance athletes can suffer from nausea, and hey, ginger is prized for its anti-nausea properties. Yeah, but does it work for muscle pain? There's been at least eight randomized double-blind placebo-controlled trials of ginger for pain, everything from osteoarthritis to irritable bowel to painful periods. I've made videos about all those, as well as its use for migraine headaches. Overall, ginger extracts, like the powdered ginger spice you'd get at any grocery store, were found to be clinically effective pain-reducing agents with a better safety profile than the drugs. In some of the studies, the ginger worked better than in others, which is thought to be due in part to the different doses that were used. There's a strong dose-effect relationship. The best results, in terms of reduction of pain, were 1.5 to 2 grams a day, which is a full teaspoon of ground ginger. The drugs work by suppressing an enzyme in the body called cyclooxygenase 2, which triggers inflammation. The problem is that the drugs also suppress cyclooxygenase 1, which does good things like protect the lining of your stomach and intestines. So since the inhibition of COX-1 is associated with gastrointestinal irritation, if only we could selectively inhibit the inflammatory one. That would offer the best of both worlds, and that's what ginger seems to do. Here's the effect of two ginger compounds against cyclooxygenase 1, the good one, no effect, but can dramatically cut down on the pro-inflammatory one. OK, but does it work for muscle pain? Not acutely. You can't just take it like a drug. If you give folks a teaspoon of ginger before a bout of cycling, no difference in leg muscle pain over the 30 minutes. However, ginger may attenuate the day-to-day progression of muscle pain. Taking ginger five days in a row appears to accelerate the recovery of maximal strength following a high-load weightlifting protocol, put all the studies together, and a single dose of ginger doesn't appear to help, but a teaspoon or two for a couple of days or weeks in a pumpkin smoothie or something, and you may be able to reduce muscle pain and soreness and accelerate recovery of muscular strength. Is fresh ginger preferable to powdered? Maybe not. There's all sorts of compounds in ginger with creative names, like gingeralls and ginger dials and ginger diones, but the most potent and inflammatory component may be a compound called shojil. And interestingly, dried ginger contains more than fresh, justifying the medicinal uses of powdered ginger for illnesses due to oxidative stress and inflammation. Why not then just give the extracted shojil component in a pill by itself? Each of the active ginger components individually reduce inflammation, some more than others, but the whole ginger is greater than the sum of its parts. You can't boost shojil concentration of whole ginger by drying it, as they're the major ginger all dehydration products. They're created when ginger is dried. Heating ginger may increase shojil concentration even more, so could heated ginger work better against pain than raw? You don't know until you put it to the test. A study of 11 days of a teaspoon of raw ginger versus ginger that was boiled for three hours on muscle pain. A significant reduction in muscle soreness a day after pumping iron in the cooked ginger group and the same benefit from the raw ginger. Either way, daily consumption of raw and heated dried ginger can result in moderate to large reductions in muscle pain, following exercise-induced muscle injury.